title: Transesophageal echocardiography interpretation: a comparative analysis between cardiac anesthesiologists and primary echocardiographers.
abstract: Diagnostic interpretation of intraoperative transesophageal echocardiography (TEE) examinations may vary, particularly when the echocardiographer is also the anesthesiologist. We therefore evaluated the concordance of TEE interpretation as part of a process of continuous quality improvement (CQI). Ten cardiac anesthesiologists participating in a CQI program conducted 154 comprehensive TEE examinations, each consisting of 16 major fields describing cardiac anatomy and function. These examinations were subsequently interpreted off-line by two primary echocardiographers (a radiologist and a cardiologist). Agreement was assessed using the kappa coefficient and percent agreement. Overall kappa and percent agreement were 0.58 and 83% for anesthesiologists versus radiologist, 0.57 and 80% for anesthesiologists versus cardiologist, and 0.60 and 82% for radiologist versus cardiologist. Anesthesiologists with longer than 5 yr of TEE experience had higher levels of agreement with the radiologist when assessing the aorta, right atrium, pulmonary vein flow, transmitral flow, and fractional area change. Cardiac anesthesiologists supported by a CQI program interpret TEE examinations at a level comparable with physicians whose primary practice is echocardiography. Thus, the anesthesiologist and the intraoperative echocardiographer need not be mutually exclusive.
  
  
  CONCLUSIONS
  Interpretation of intraoperative transesophageal echocardiograms can be reliably performed by cardiac anesthesiologists.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. mathe014@mc.duke.edu
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mathew
authors.forename: Manuel L
authors.initials: ML
authors.lastname: Fontes
authors.forename: Susan
authors.initials: S
authors.lastname: Garwood
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Davis
authors.forename: William D
authors.initials: WD
authors.lastname: White
authors.forename: Gerard
authors.initials: G
authors.lastname: McCloskey
authors.forename: Jane C K
authors.initials: JC
authors.lastname: Fitch
authors.forename: Sherif
authors.initials: S
authors.lastname: Afifi
authors.forename: David L
authors.initials: DL
authors.lastname: Lee
authors.forename: Phillip
authors.initials: P
authors.lastname: Kraker
authors.forename: Terence D
authors.initials: TD
authors.lastname: Rafferty
authors.forename: Paul G
authors.initials: PG
authors.lastname: Barash
authors.forename: Linda
authors.initials: L
authors.lastname: Gillam
authors.forename: Edward
authors.initials: E
authors.lastname: Prokop
mesh_terms: D000328:Adult; D000776:Anesthesiology; D006348:Cardiac Surgical Procedures; D002309:Cardiology; D002983:Clinical Competence; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011871:Radiology