Echocardiography is the most important noninvasive diagnostic tool for the cardiologist. More than 617.000 two-dimensional echo examinations and 425.000 color coded Doppler analyses were performed in 1992 in the Federal Republic of Germany in private practice. Based on a questionnaire, more than 60% of the departments of cardiology perform echocardiograms in more than 3000 pts per year, and the amount of TEE examinations is in the range 5-15% of the total annual echo performance rate. In more than 80% of all examinations color coded Doppler is used. With regard to the guidelines for performing the different echo modalities the German recommendations are stringent in comparison with the international standard. Due to the fact that an echocardiographic examination is strongly investigator dependent, the primary goal of quality management should be focused on training.