Purpose
This document updates existing British Society of Echocardiography (BSE) guidance to align with national professional standards, including the General Medical Council (GMC) Intimate Examinations and Chaperones Guidance and the Society of Radiographers (SoR) Intimate Examinations and Chaperones Policy.
These documents emphasise the importance of patient dignity, informed consent, and the routine offer of a chaperone for examinations that may be perceived as intimate.
Principles
The General Medical Council (2024) definition of an intimate examination is agreed as a guiding principle: “Examinations of the breast, genitalia and rectum but could also include any examination where it is necessary to touch, examine intimate parts of the patient’s body digitally, or even be close to the patient.”
Transthoracic echocardiography (TTE) is a non-invasive but intimate procedure that requires exposure of the chest and, in some cases, contact with breast tissue.
In line with GMC guidance, patients undergoing a transthoracic echocardiogram should be offered a chaperone, irrespective of the echocardiographer’s or the patient’s gender.
Role of the chaperone
- The SoR defines a chaperone as an “impartial observer whose role is to safeguard patient dignity, provide reassurance, and protect both the patient and the practitioner”
- The chaperone should be of the same sex as the patient, wherever practicable
- The chaperone should be a member of the clinical team (Healthcare Assistant or Echo Support Worker) who is familiar with TTE and can reliably assess whether the practitioner’s actions are professionally appropriate and justified
- NHS England states that chaperones should be appropriately trained and able to recognise and, if needed, raise concerns
- A relative, friend, or carer of the patient is not a trained, impartial observer and therefore would not be a suitable chaperone
- The presence of a chaperone does not override a patient’s wish to be supported by a relative, friend or carer
- If a patient declines a chaperone, this decision should be respected and the refusal clearly documented
- If the patient or echocardiographer feels uncomfortable proceeding without a chaperone, the examination should be delayed or rescheduled. This should be handled sensitively and explained to the patient
- If at any stage the echocardiographer feels uncomfortable during the TTE, they should pause and request a chaperone before proceeding
- Where a chaperone is not immediately available, consideration should be given to delaying or rescheduling the examination if clinically appropriate and provided this does not compromise patient care
Offering a chaperone
- Prior to undergoing a TTE examination, patients must be given a clear explanation of the procedure, including the need for chest exposure, the nature of physical contact, and any potential discomfort
- Patients should be informed before the examination that a chaperone is available
- The echocardiographer must confirm that the patient understands the nature and purpose of the examination
- The echocardiographer must also confirm that the patient consents to the examination proceeding under their care
While a thorough explanation may reduce the likelihood that a chaperone is required, it does not remove the obligation to offer one.
When a chaperone is recommended or required
A chaperone is recommended for all patients undergoing TTE, regardless of the patient's or echocardiographer’s gender. Managers of community echo services should take steps to ensure suitable chaperone provision is always available. The BSE suggests that a chaperone is highly recommended in the following scenarios:
- Cross-gender examinations of young adults over the age of 16 years old
- When the patient expresses discomfort or anxiety even if this is part way through the procedure
- If there is any communication barrier (e.g. language, cognitive impairment)
- When cultural, religious or personal factors make the examination more sensitive
- The echocardiographer feels that a chaperone would provide additional reassurance or protection for the patient or themselves
The offer of a chaperone should be clearly documented in the patient’s clinical records and/or the echocardiogram report, including whether the offer was accepted or declined, and the name and designation of the chaperone.
The patient should be informed of their right to decline a chaperone.
Students and trainees
- When a trainee echocardiographer is involved in the examination, patients must be informed of the trainee’s role, and verbal consent for the trainee's involvement should be obtained prior to participation
- Patients retain the right to decline trainee involvement and must not be disadvantaged for doing so
- Trainees must work within their scope of practice and under appropriate supervision in accordance with departmental standards and ‘Professional Standards of Behaviour and Practice for the Healthcare Science workforce’ (AHCS, 2025)
This approach is intended to:
- Uphold patient dignity, comfort, privacy, and informed consent
- Provide transparency and reassurance to the patient prior to and during the examination
- Safeguard staff and patients against potential misunderstandings or allegations, in line with NHS workforce safety standards (NHS Employers, 2022)
Staff responsibilities
All staff involved in the delivery of TTE should ensure the following:
- Identification of all staff present in the examination, including their name and role, if applicable
- Clear and comprehensive explanation of the procedure, including anticipated areas of physical contact and expected sensations (e.g., proximity of the echocardiographer, application of cold gel, placement of the probe on the chest)
- Explicit verbal consent should be obtained prior to the examination and reaffirmed as required during the procedure
- Patient consent regarding any trainee involvement
- The offer of a chaperone and documentation of whether this offer is accepted or declined
- If the offer is accepted, documentation of the chaperone's name and role.
- Provision of a gown to all patients, irrespective of patient or staff gender
- Maintain privacy and dignity throughout the examination, minimising exposure of the chest and breasts wherever possible
Patient information
Echocardiography departments must provide detailed information explaining what to expect during a TTE appointment.
This should include:
- The patient will be asked to remove all clothing above the waist, and a hospital gown will be provided
- Lights will be dimmed to allow the best view of the screen
- A probe and ultrasound gel will be used to obtain images of the heart from the chest and the area under the breast
- The echocardiographer will be in close proximity to and/or leaning over the patient
- The gown covering the chest will be moved during the test to obtain all necessary views of the heart
The information should state that patients may invite a relative or friend to accompany them; however, such individuals are not considered formal chaperones.
The information should advise that the test may be performed by either a male or a female echocardiographer. If the patient would like to request a chaperone or a specific gender for the test, the department's contact details for arranging this in advance should be provided.
Visible notices offering to provide chaperones should be displayed in the echocardiography department.
Documentation requirements
A record must be made in the patient’s clinical documentation of whether a chaperone was offered and whether the offer was accepted or declined. Where a chaperone is present, the name and professional designation of the chaperone must be documented, as well as if there are any relevant concerns or deviations from standard practice.
The BSE recommend that the following statement is included in the echo report:
Verbal consent obtained, chaperone declined/accepted. Chaperone/s present: name and role
BSE Council and Trustees, July 2026, with thanks to Johannes Pintacasi, Esta Felix, Jude Skipper and Wendy Gamlin
References
- General Medical Council. Intimate examinations and chaperones [Internet]. Gmc-uk.org. 2024 [cited 2026 July 22]. Available from: https://www.gmc-uk.org/professional-standards/the-professional-standards/intimate-examinations-and-chaperones
- The Society of Radiographers. Intimate Examinations and Chaperone Policy [Internet]. SoR. [cited 2026 July 22]. Available from: https://www.sor.org/learning-advice/professional-body-guidance-and-publications/documents-and-publications/policy-guidance-document-library/intimate-examinations-and-chaperone-policy
- Academy for Healthcare Science. Good Scientific Practice Professional Standards of Behaviour and Practice for Healthcare Scientists GSP 2025. In [cited 2026 July 22]. Available from: https://documents.ahcs.ac.uk/docs/334/-023-Good-Scientific-Practice-v1.7-January-2025.pdf
- NHS Employers. Workplace health and safety standards | NHS Employers [Internet]. www.nhsemployers.org. 2023 [cited 2026 July 22]. Available from: https://www.nhsemployers.org/publications/workplace-health-and-safety-standards
- NHS England. Improving chaperoning practice in the NHS: key principles and guidance [Internet]. England.nhs.uk. 2025 [cited 2026 July 22]. Available from: https://www.england.nhs.uk/long-read/improving-chaperoning-practice-in-the-nhs-key-principles-and-guidance/