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Select Best Cases

The case study submission portion of the accreditation application provides laboratories with an opportunity to demonstrate the quality of work performed. Therefore, laboratories are encouraged to select their "best work" (i.e.: complete, good-quality cases with complete, accurate interpretations). When selecting case studies for submission, laboratory staff are encouraged to closely review Part II, Section 3.1 of The Standards to determine the specific elements of study quality and performance upon which transthoracic cases are evaluated. Part II, Section 3.2 provides details on the required components of a complete study. If a view cannot be optimally obtained on a patient, simply choose an alternate case for submission. Remember that an equally critical component of the representative case study review is the evaluation of the corresponding final report. The final reports are reviewed for compliance with Part II, Section 4 of The Standards.

Required Number of Representative Cases

Reference www.icael.org (How To Apply/Case Studies) to review the number and types of cases required. This number is based upon the total number of staff members (sonographers plus interpreting physicians) from all sites. Laboratories also applying for one or more multiple sites are required to submit the "base" number of cases performed at their primary site PLUS one aortic stenosis case and one regional left ventricular dysfunction case that were performed at each multiple site. Mobile laboratories, or those applying for a mobile component to their primary site, are required to submit only the "base" number of cases as defined by the total number of staff. The [mobile] studies submitted may have been performed at any of the sites; there is no requirement that each of the mobile sites be represented.

Representing Staff Members

If the case number requirement allows for representation of each sonographer and/or each interpreting physician, then this must be accomplished. The only situation in which a staff member may be unrepresented is when there are more staff members than required cases. For example, a laboratory with 10 physicians and three sonographers required to submit eight cases (9 to 15 staff = 8 cases per lab; 4 AS, 4 LVDF). Among the four aortic stenosis and four left ventricular dysfunction cases required, the cases selected for submission must be performed by each of the three sonographers (one or more of the sonographers will be duplicated), but it is required that eight different physicians have interpreted those cases. A staff member cannot be duplicated until all members have been represented. Sometimes it is necessary to discard an original case study choice in favor of a different case, so that all staff members are properly represented. In another example, a laboratory with three sonographers and four doctors must submit six cases (4 to 8 staff = 6 cases per lab). All three sonographers and all four doctors must be represented at least once among the six cases; staff members may then be duplicated in any fashion.

NOTE THAT ALL QUALIFIED STAFF MEMBERS MUST BE LISTED WITHIN THE APPLICATION, AND MUST BE CONSIDERED WHEN CHOOSING REPRESENTATIVE CASES. A laboratory may NEVER omit a staff member from the application because a representative case cannot be located for that individual.

• For adult transthoracic applications, only aortic stenosis cases (native valves with a gradient > 2 m/s) and regional (not global) left ventricular dysfunction cases must be submitted. These cases must have been performed within 12 months of the application filing date.


• Adult transesophageal echocardiograms submitted must demonstrate greater than mild mitral regurgitation (regardless of the indication) OR must have a "cardiac source of embolus" indication (regardless of the findings). At least one of the studies from each laboratory must demonstrate greater than mild mitral regurgitation. These cases must also have been performed within 12 months of the application filing date.


• Stress representative cases must be "abnormal"; submit positive stress cases, or cases with a regional wall motion abnormality at rest, even if no new ischemia develops. Treadmill or pharmacological stress echocardiograms are acceptable. Cases may be selected from the 36-month period prior to the application filing date.

The ICAEL staff carefully reviews the number and types of case studies submitted to ensure proper representation of each laboratory staff member, prior to the application reviewers' receipt of the materials for evaluation. To facilitate this review, please annotate each study with the patient name, study type, sonographer and interpreting physician (or, submit a chart containing this information). Failure to adhere to the instructions for case study submission can result in a delayed accreditation decision.