Basic paediatric echocardiography

• For this, the first level of expertise, the trainee should understand the basic physical principles of ultrasonic imaging and the practical usage of ultrasonic equipment.
• The trainee should have demonstrated the ability to perform and interpret echocardiograms in patients with simple forms of congenital cardiac diseases, and acquired diseases of the heart as seen in children.

This level of expertise requires the supervised performance of at least 250 echocardiograms in children with acquired and congenital diseases of the heart.

Advanced paediatric echocardiography

Accreditation at this second level of expertise will require the following:

• The performance of at least 750 additional supervised echocardiographic studies in children with acquired and congenital cardiac malformations under supervision.
• Demonstration by the trainee of the ability to perform transoesophageal and fetal echocardiography under supervision.

This second level of expertise will need to be satisfied in order for the trainee to obtain the European Accreditation in Paediatric Echocardiography.

Specialized paediatric echocardiography

Accreditation at this third, and most advanced, level of training will require the following:

• The performance and interpretation of at least 2,000 paediatric, transoesophageal, and fetal echocardiographic studies.
• Knowledge and practical experience of other advanced techniques.
• Demonstration of the ability to supervise paediatric echocardiography studies.

Accreditation at the tertiary level will be needed by those seeking to direct echocardiographic laboratories in European centres for treatment of children with acquired and congenital cardiac disease.

Basic paediatric echocardiography

This training requires:

• A good understanding of the physics of cardiac ultrasound.
• A thorough understanding of ultrasonic instrumentation, and insight into its use and safety.
• A basic understanding of cardiac anatomy and physiology associated with acquired and congenital diseases of the heart.
• A thorough knowledge of sequential morphological analysis of congenital cardiac disease.
• Performance and interpretation of complete transthoracic echocardiographic studies in patients with simple forms of congenital cardiac disease, such as septal defects, arterial valvar stenoses, and coarctation of the aorta.

The trainee should have performed and interpreted at least 250 echocardiographic studies in children, of whom at least 100 should be infants. No more than one-fifth of these may be normal studies.

Advanced paediatric echocardiography

All paediatric cardiologists performing paediatric echocardiography in children should have demonstrated expertise at the second level. This level requires:

• Performance and interpretation of transthoracic echocardiographic studies in patients with more complex forms of acquired and congenital cardiac diseases, both before and after any therapeutic interventions.
• Assessment of systolic, diastolic, and regional myocardial function, including M-mode, contrast, Doppler, and other advanced techniques.
• Experience in transoesophageal echocardiography.
• Experience in fetal echocardiography.
• Experience in monitoring interventional procedures.

The trainee should perform and interpret at least 750 additional transthoracic echocardiograms independently, and at least 75 transoesophageal and 50 fetal studies under supervision. The transoesophageal studies include the introduction and manipulation of the ultrasonic probe under direct supervision. The trainee must have performed at least 25 studies monitoring interventional procedures, albeit that these can include intracardiac echocardiography.

On completion of training to the second level, the trainee will be eligible to apply for Accreditation in Paediatric Echocardiography as organized by Association for European Paediatric Cardiology, in co-operation with the European Society of Cardiology. This accreditation process includes submission of a logbook, along with theoretical and practical assessments.

Specialized paediatric echocardiography

This tertiary level of training should be achieved by all those paediatric cardiologists who have responsibility for training paediatric sonographers and physicians, and directing paediatric echocardiographic laboratories or programmes of training.

In addition to attaining accreditation at the second level, the trainee should:

• develop a high-level expertise in the performance and interpretation of transthoracic, transoesophageal, and fetal echocardiography;
• maintain up-to-date knowledge and experience of advanced techniques;
• actively participate in training junior paediatric cardiologists and sonographers;
• actively participate in research.

To achieve this level, the trainee should have performed and interpreted at least a further 1,000 transthoracic studies, 100 transoesophageal examinations, and 100 fetal investigations, all including a variety of clinical situations of different complexities, and including normal studies.