Echos of Insight: Ali Reflects on the Echo Review Process

Alison (Ali) Tompsett, RDCS, is a Senior Echocardiography Technologist based in Washington, DC, with extensive experience in advanced cardiac imaging and patient care. She is skilled in performing and interpreting complex echocardiographic studies to support accurate cardiovascular diagnoses and clinical decision-making. Please read below for a featured interview where Alison Spaziani, another member of the Echo Core, sits down with Ali to discuss her insights and experiences navigating the review process — offering a behind-the-scenes look at the expertise, precision, and collaboration that drive high-quality echocardiographic review.

1. Team Dynamic

How would you describe the working dynamic of the Echo team, and what makes it effective (or challenging)?

The Echo team thrives on a foundation of mutual respect and a shared commitment to patient care. What’s remarkable is how each member manages to balance their demanding clinical schedules with the responsibility of reviewing these studies in a timely manner. For some, the challenges of working in remote areas with limited internet access shows their deep dedication and commitment to the research and patients. Yet, despite these hurdles and the pull of their many other professional responsibilities, the team consistently prioritizes their readings and meeting schedule. It’s a clear reflection of their dedication: no matter the obstacle, patients always come first.

2. Adjudication Process / Review

Can you walk us through how the adjudication or review process is structured and how decisions are typically reached?

The ARC adjudication team is composed of four international cardiologists representing 3 continents, along with two dedicated support staff.  Ali Tompsett, a US-based echo technician, pre-reviews all studies to ensure the images are of diagnostic quality.  The review panel not only serves as adjudicators, but also as mentors to the sites to improve their echo image acquisition, so they can continue learning and improving their skills.    The physicians do an initial review of the studies, detailing clinical and research-specific data.  The adjudication team is not only reviewing the studies for the presence of Rheumatic Heart Disease but also ensuring that any studies showing potential other heart disease is communicated to the different sites to ensure all participants are receiving appropriate clinical follow-up if necessary.  The review panel meets monthly via Zoom to discuss any studies the reviewers disagreed on the diagnostic category.   During a typical Zoom session, each case with a diagnostic disagreement is presented, where the echocardiographic images are analyzed collectively, with detailed discussion focusing on valvular morphology and the presence or severity of regurgitation. Each cardiologist has the opportunity to independently express their final diagnostic impression following the group discussion. The mutual respect between the group and this collaborative process, each person’s perspective and voice is heard. Consensus is reached after discussion, ensuring consistency.

3. Collaboration & Communication

What strategies or tools does the team use to ensure smooth collaboration and clear communication across members?

The team does a great job with staying in constant contact even though we are in different countries and time zones.   Whenever a question arises, we are able to email each other and there is a response within the day.  The physicians are also continually working to improve the quality of their interpretations by developing and refining criteria for the different Rheumatic Heart Disease categories.

4. Continuous Improvement

• Looking ahead, what improvements or changes could strengthen team dynamics, the adjudication process, or overall communication?

The team is always open-minded to different ideas about making the adjudication process more efficient.   As the team moves into the follow-up portion of the reads, the readers have been in constant contact with each other with ideas about making the process more effective, by suggesting different review approaches, database organization, and having open dialogue via email and during our virtual review sessions.