Table 1 10-point maximum skill test scoring system

PLAX

2

Excellent:

All 7 chambers and anatomical structures (LA, LV, LVOT, RV, AV, MV, and IVS) visualized or similar to the excellent quality reference^a.

1

Acceptable:

One chamber (LA, LV, or RV) severely foreshortened or 1 anatomical structure (LVOT, AV, MV, or IVS) not visualized well.

0

Poor:

Any 2 chambers or structures (LA, LV, LVOT, RV, AV, MV, and IVS) severely foreshortened/not visualized well, the left and right sides of the image are flipped, raters do not recognize the view as a parasternal long-axis view, or no image obtained.

PSAX

2

Excellent:

All 4 chambers and anatomical structures (round LV, RV, papillary muscles, and IVS) visualized or similar to the excellent quality reference^a.

1

Acceptable:

One chamber or anatomical structure (round LV, RV, papillary muscles, or IVS) not visualized well, oval LV, significant lateral wall drop out of LV compared with the excellent quality reference^a, or mitral level of parasternal short-axis view.

0

Poor:

Any 2 chambers or anatomical structures (round LV, RV, papillary muscles, and IVS) not visualized well, apical level or aortic valve level of parasternal short-axis view, the left and right sides of the image are flipped, raters do not recognize the view as a parasternal short-axis view, or no image obtained.

A4C

2

Excellent:

All 8 chambers and anatomical structures (LA, LV, RA, RV, MV, TV, IAS, and IVS) visualized or similar to the excellent quality reference^a.

1

Acceptable:

One chamber (LA, LV, RA, or RV) severely foreshortened, 1 anatomical structure (MV, TV, IAS, or IVS) not visualized well, aortic outflow added (5-chamber view), or significant lateral wall drop out of LV compared with the excellent quality reference^a.

0

Poor:

Any 2 chambers or anatomical structures (LA, LV, RA, RV, MV, TV, IAS, and IVS) not visualized well, the left and right sides of the image are flipped, raters do not recognize the view as an apical 4-chamber view, or no image obtained.

S4C

2

Excellent:

All 7 chambers and anatomical structures (LA, LV, RA, RV, IAS, IVS, and liver) visualized or similar to the excellent quality reference^a.

The left and right side flipped image does not affect the subcostal 4-chamber view scoring.

1

Acceptable:

One chamber or anatomical structure (LA, LV, RA, RV, IAS, IVS, or liver) severely foreshortened/not visualized well or aortic outflow added (5-chamber view).

0

Poor:

Any 2 chambers or anatomical structures (LA, LV, RA, RV, IAS, IVS, and liver) not visualized well, raters do not recognize the view as a subcostal 4-chamber view, or no image obtained.

SIVC

2

Excellent:

IVC visualized in a longitudinal fashion, connection of IVC to RA visualized clearly, and IVC diameter > = 1.0 cm at 2 cm from the RA-IVC junction, or similar to the excellent quality reference^a. The left and right sides flipped image does not affect the subcostal IVC view scoring.

1

Acceptable:

IVC diameter > = 1.0 cm at 2 cm from the RA-IVC junction, but no clear connection of IVC to RA, or IVC not visualized in a longitudinal fashion.

0

Poor:

IVC diameter < 1.0 cm at 2 cm from the RA-IVC junction, descending aorta imaged instead of IVC, raters do not recognize the view as a subcostal IVC view, or no image obtained.