The American College of Cardiology (ACC), in collaboration with the American Heart Association (AHA) and the American Society of Echocardiography (ASE), has released a new document that covers training requirements for performing advanced echocardiographic procedures.
The guidance was published online February 19 in the Journal of the American College of Cardiology, and it will appear in upcoming print issues of Circulation: Cardiovascular Imaging and the Journal of the American Society of Echocardiography.
Cardiovascular echocardiography is used to assess cardiac anatomy and function and to help guide therapies for heart conditions, the ACC said. Three levels of training have long been recognized, but the document clearly defines level III training for the first time. Nine cumulative months of training are usually required to gain the level of experience necessary for level III competency, according to the ACC.
The guidance defines the length of training, the types of disorders to be reviewed, the number of procedures required for competence, and the knowledge base and skills required to be an advanced echocardiographer, the organization said. It also includes requirements for echocardiographic lab accreditation and teaching faculty guidelines.
All cardiologists should have a basic understanding of echocardiographic techniques, said Dr. Susan Wiegers of Temple University, chair of the guidance's writing committee.
"Although it is expected that most, if not all, fellows will achieve level II competency in echocardiography during their three years of general cardiology training, this document describes the more focused, in-depth experience required for level III competency," Wiegers said.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
