**10. Quality control**

Leading echocardiography laboratories must ensure that high standards are accomplished both for clinical practice and for scientific research. Recommendations for core laboratories, including quality control guidelines, have been published by the American Society of Echocardiography [108, 127] and European Association of Echocardiography (Cardiovascular Imaging) [128]. Periodic auditing of stored images and reports should be undertaken and reviewed by an experienced physician. Echocardiographic findings of endocarditis should undergo pathological correlation with surgery or a complimentary imaging modality, such as cardiac CT.

For a center to develop excellence in endocarditis management, a dedicated imaging and clinical database should be established for auditing, quality control, and research purposes. Recent guidelines recommend the establishment of a specialized multidisciplinary team at centers with expertise in managing IE [109]. This approach has been demonstrated to reduce mortality by over 50% [129]. The endocarditis team should be engaged early in the management of suspected IE and urgent echocardiography performed.

The lead echocardiologist should have expertise in the field of cardiac infection and provide ongoing education to medical colleagues and sonographers alike to ensure the highest imaging standards are met. When IE is suspected on echo, expert interpretation of the findings should be communicated urgently to the treating team, especially when significant pathology is identified. The echocardiologist is also able to advise of any requirement for a supplemental procedure, such as TEE or CT, and provide recommendations with regard to appropriate follow-up imaging [17, 27, 109, 130].
