Questionnaire survey on the state of routine echocardiographic examination in Japan

Questionnaires sent to 35 representative institutes in Japan were returned by 33 (94%). In 61% of the responding institutes, more than half of the routine echocardiographic examinations were performed by sonographers; in 27% of these institutes, they were performed mainly by physicians. Forty-nine percent of the respondents spent 20 to 30 minutes examining one patient; the second-most-frequent (21%) response was 30 to 45 minutes. In 71% of the institutes, echocardiographic reports included sonographers' comments. Every case was recorded on videotape in 27 (82%) institutes. Left ventricular dimensions and wall thickness were determined by M-mode in 15% of the institutes; 70% indicated that they primarily used M-mode but sometimes used two-dimensional echocardiography. Left ventricular ejection fraction was measured only or mainly by M-mode in 82% of the examinations and by two- dimensional echocardiography in 18%. The pulsed Doppler method was used to evaluate left ventricular inflow in all cases in 79% of the institutes, and the continuous wave Doppler method was used to determine the pressure gradient of tricuspid regurgitation in all cases at 73% of the institutes. In contrast, quantitative Doppler was always used to routinely evaluate regurgitation or shunt flow in only 2 (6%) institutes. The Doppler method was always used to measure cardiac output or stroke volume in only 2 (6%) of the institutes. The larger the number of routine echocardiographic examinations conducted at a responding institute, the greater the likelihood that they were conducted by sonographers.