Utilization of real-time 3D transesophageal echocardiography in an urban academic medical center

Purpose: Real-time three-dimensional transesophageal echocardiography (3D TEE) is useful in a variety of clinical scenarios. However, the pattern of its clinical utilization in an urban academic center is unknown. The objective of this study is to evaluate the practical use of 3D TEE and to explore factors that may affect its applications. Methods: We conducted a retrospective study by reviewing 2,734 consecutive TEEs performed at Montefiore Medical Center in Bronx, NY, between January 2009 and August 2011. Types of 3D modes (biplane, live, 3D zoom, full volume, and 3D quantifications) and indications were reviewed. Linear regression was performed to examine the association between echocardiographers' characteristics and 3D TEE utilization. Results: 3D modalities were utilized in 1,655 studies (61%) during the study period. The use of 3D technology increased from 44% at 4 months to 79% at 32 months. Biplane, 3D zoom, and full volume acquisition showed a steady increase, but quantification remained very low throughout the study period. Level 3 training was significantly associated with 66.6% (95% CI 13.0%, 120.1%, P = 0.029) higher rate of 3D TEE utilization compared to level 2, after adjusting for age, sex, years of practice, and total TEE volume. Level 3 echocardiographers utilized more zoom 3D and full volume, whereas level 2 echocardiographers used biplane more frequently. Conclusions: There has been a growing use of 3D TEE over time, but not all 3D modes were equally employed. The association between advanced training and increased 3D utilization is likely due to interest and self-motivation.