Background: Inter-societal Accreditation Commission (IAC) mandates using specific/appropriate image acquisition for transesophageal echocardiography (TEE). We hypothesized that an automated TEE imaging protocol improves study efficiency and workflow compared with a manual protocol. Methods: Three TEE disease-based protocols were included. Image acquisition was done twice for each TEE, once each using a manual and automated method in random order. TEE exam duration and number of sonographer keystrokes for each method were recorded. Keystrokes were grouped into specific categories. Multivariate analysis of variance was performed for each variable. The same automated TEE software was used for all automated protocol TEE exams. Results: The study included 22 patients, 14 males, ages 31-83 years, average BMI of 28.8 kg/m2 (S.D.+/-6.3). Automated protocols compared with manual protocols significantly reduced TEE exam duration (novice, 10:59±2 vs 12:23±2 min; expert, 8:35±1 vs 9:54±2 min, p<0.05). The protocol performed second was shorter regardless of protocol method; however, the percentage decrease in duration was significantly greater when the automated protocol was performed second (27% vs 6%, p <0.05). The automated protocol required fewer sonographer keystrokes than the manual protocol (novice, 206±34 automated vs 287±48 manual; expert, 185±30 automated vs 254±43 manual, p<0.05). The total number of images acquired was similar between automated and manual protocols, without a significant difference in image quality. Conclusion: Automated protocols improve TEE efficiency by reducing the study duration and sonographer keystrokes regardless of TEE operator experience and without a difference in the total number of TEE images acquired or TEE image quality.