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New workflow method for ultrasound examinations
Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
2011 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Growing demand for ultrasound examinations and higher quality requirements motivate searching for routines combining the diagnostic accuracy of radiologist-performed examinations with the economical advantages of sonographerperformed examinations. One possible approach is to use strictly standardized examination protocols and documentation made by cine-loops that will give the radiologist access to all relevant information after the examination. Ultrasound examinations are usually regarded as observer dependent, but using documentation with cine-loops acquired in a standardized way attempts to reduce this problem.

Aims: The aim of study I was to compare a recently introduced routine, combining acquisition by a radiographer, documentation as standardized cine-loops, and review by a radiologist (“standardized method”), with the formerly used routine where the diagnosis is made bed-side by the radiologist (“traditional method”). The aim of study II was to evaluate the intra-observer and inter-observer agreement of the standardized method in ultrasound liver examinations.

Material and Methods: In study I there was 64 policlinic patients examining the kidneys ( n = 27) or the gallbladder ( n =37) by both the standardized and the traditional method. The radiologists’ findings of hydronephrosis, tumors, cysts, echogenicity changes, and cortical thickness (in the kidneys), and wall thickness, concrements, and polyps (in the gallbladder) were compared between the methods with respect to agreement as well as systematic differences. In study II 98 out-patients were examined by a radiographer using the standardized method. Three radiologists with 10 – 20 years of experience of ultrasound reviewed the cine-loops retrospectively and independently filled out a predetermined protocol. After 4 weeks, the review was repeated, blinded to the initial reading.

Results: Study I showed for the gallbladder examination a median agreement of 97% (86 – 100%; kappa =0.64 – 1.00) and for the kidney examination an agreement of 90% (78 – 100%; kappa = 0.69 – 1.00). There were no significant systematic differences between the two methods. In study II, the intra-observer agreement was highest for concrements in the gallbladder (kappa = 0.91 to 0.96) and lowest when assessing the need for further examination (kappa = 0.38 to 0.64). For increased liver echogenicity, kappa varied between 0.51 and 0.85, and for skip areas between 0.73 and 0.90. The interobserver agreement was also highest for concrements in the gallbladder (kappa = 0.84 to 1.00) and lowest for need for further examination (kappa = -0.12 to 0.46). For most other findings, substantial intra-observer agreement (kappa ≥ 0.61) was found.

Conclusion: The satisfactory agreement in study I indicates that the new workflow with ultrasound examinations performed by a radiographer and analyzed off-line by a radiologist is promising. Study II shows a fairly good inter-observer agreement for ultrasound examinations acquired with a standardized technique by an experienced radiographer and reviewed by experienced radiologists. In general, intra-observer agreement was higher than inter-observer agreement.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2011. , 30 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 115
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-67050ISBN: 978-91-7393-229-5OAI: oai:DiVA.org:liu-67050DiVA: diva2:406337
Presentation
2011-04-08, Wrannesalen, CMIV, plan 11, Campus US, Linköpings universitet, Linköping, 10:00 (Swedish)
Supervisors
Available from: 2011-03-25 Created: 2011-03-25 Last updated: 2016-02-09Bibliographically approved
List of papers
1. Radiographer-acquired and radiologist-reviewed ultrasound examination: agreement with radiologist’s bedside evaluation
Open this publication in new window or tab >>Radiographer-acquired and radiologist-reviewed ultrasound examination: agreement with radiologist’s bedside evaluation
2011 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 52, no 1, 70-74 p.Article in journal (Refereed) Published
Abstract [en]

Background: Growing demand for ultrasound examinations and higher quality requirements motivate searching for routines combining the diagnostic accuracy of radiologist-performed examinations with the economical advantages of sonographer-performed examinations. One possible approach is to use strictly standardized acquisition and documentation schemes that give the radiologist access to all relevant information after the examination.

Purpose: To compare a recently introduced routine, combining acquisition by a radiographer, documentation as standardized cine-loops, and review by a radiologist (‘standardized method’), with the formerly used routine where the diagnosis is made bedside by the radiologist (‘traditional  method’).

Material and Methods: In 64 policlinic patients, the kidneys (n ¼ 27) or the gallbladder (n ¼ 37) were examined with both the standardized and the traditional method. The radiologists’ findings of hydronephrosis, tumors, cysts, echogenicity changes, and cortical thickness (in the kidneys), and wall thickness, concrements, and polyps (in the gallbladder) were compared between the methods with respect to agreement (proportion of agreement and kappa coefficient) as well as systematic differences (McNemar’s test).

Results: The findings at the gallbladder examination showed a median agreement of 97% (86–100%; kappa ¼ 0.64–1.00), and those at the kidney examination, an agreement of 90% (78–100%; kappa ¼ 0.69–1.00). There were no significant systematic differences between the methods.

Conclusion: The satisfactory agreement in this preliminary study indicates that the new workflow with ultrasound examinations performed by a radiographer and analyzed off-line by a radiologist is promising, and motivates further studies.

Place, publisher, year, edition, pages
Informa Healthcare, 2011
Keyword
Ultrasound, radiographer, radiologist, comparison, diagnostic
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67047 (URN)10.1258/ar.2010.090260 (DOI)000290498800013 ()
Available from: 2011-03-25 Created: 2011-03-25 Last updated: 2016-02-10Bibliographically approved
2. Do Radiologists Agree on Findings in Radiographer-Acquired Sonographic Examinations?
Open this publication in new window or tab >>Do Radiologists Agree on Findings in Radiographer-Acquired Sonographic Examinations?
Show others...
2013 (English)In: Journal of ultrasound in medicine, ISSN 0278-4297, E-ISSN 1550-9613, Vol. 32, no 3, 513-518 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

Sonographic examinations are usually regarded as observer dependent, but a recently introduced method using documentation with cine loops acquired in a standardized way attempts to address this problem. The aim of this study was to evaluate the intraobserver and interobserver agreement of sonographic liver examinations using strictly standardized examination protocols with cine loop documentation.

METHODS:

Ninety-eight outpatients were examined by a radiographer using the standardized method. Three radiologists, each with 10 to 20 years of experience in sonography, reviewed the cine loops retrospectively. After 4 weeks, the review was repeated; the 3 radiologists were blinded to the initial reading. The κ coefficient was used to analyze intraobserver and interobserver agreement, and agreement in percent was also calculated.

RESULTS:

The intraobserver agreement was highest for concrements in the gallbladder (κ= 0.91-0.96) and lowest when assessing the need for further examination (κ = 0.38-0.64). For increased liver echogenicity, κ varied between 0.73 and 0.92 and for skip areas between 0.73 and 0.90. The interobserver agreement was also highest for concrements in the gallbladder (κ = 0.84-1.00) and lowest for the need for further examination (κ = -0.12-0.46). For most other findings, substantial intraobserver agreement was found.

CONCLUSIONS:

For sonographic examinations performed according to a standardized examination protocol by a radiographer and viewed by an experienced radiologist, good interobserver agreement was found, except for judgments of the need for further examinations.

Place, publisher, year, edition, pages
American Institute of Ultrasound in Medicine, 2013
Keyword
agreement, liver examination, observer, radiologist, sonography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90759 (URN)000315835900016 ()23443192 (PubMedID)
Note

On the day of the defence date of the Ph.D. Thesis the status of this artilce was Manuscript and the title was Do radiologists agree on findings in radiographer-acquired ultrasound liver examinations?

Available from: 2013-04-05 Created: 2013-04-05 Last updated: 2016-02-10

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