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Radiographer-acquired and radiologist-reviewed ultrasound examination: agreement with radiologist’s bedside evaluation
Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
Department of Radiology, Copenhagen University Hospital at Herlev, Denmark.
Östergötlands Läns Landsting, Centre for Diagnostics, Department of Radiology in Linköping.
Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Radiology in Linköping.ORCID iD: 0000-0002-7750-1917
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. Vol. 52, no 1, 70-74 p.
Keyword [en]
Ultrasound, radiographer, radiologist, comparison, diagnostic
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-67047DOI: 10.1258/ar.2010.090260ISI: 000290498800013OAI: oai:DiVA.org:liu-67047DiVA: diva2:406326
Available from: 2011-03-25 Created: 2011-03-25 Last updated: 2017-12-11Bibliographically approved
In thesis
1. New workflow method for ultrasound examinations
Open this publication in new window or tab >>New workflow method for ultrasound examinations
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:nbn:se:liu:diva-67050 (URN)978-91-7393-229-5 (ISBN)
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
2. Standardized ultrasonography with cine-loop documentation: diagnostic variability in liver and kidney examinations
Open this publication in new window or tab >>Standardized ultrasonography with cine-loop documentation: diagnostic variability in liver and kidney examinations
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Ultrasound examination of the abdomen is often a first choice at radiology departments due to the lack of ionizing radiation. For diagnostic accuracy and economic benefits there has been a need for new routines in this area that incorporate the benefits of an radiographer or sonographer performing a multitude of ultrasound examinations following strictly standardized examination protocols and documentation forms made by cine-loops that will give the radiologist access to all relevant information needed for an accurate postexamination diagnosis.

Aim: The overall objective of this thesis was to evaluate the diagnostic variability in examinations of the kidneys and liver that use a standardized ultrasound method along with video documentation of the entire examination and off-line review by radiologists. More specifically, we wanted to compare the agreement between readers and between operators.

Design and method: This thesis is based on four quantitative studies using standardized protocols for kidney, liver and gallbladder examinations. In paper I, including 64 patients, and paper IV, including 98 patients, the patients were prospectively enrolled and the  examinations were retrospectively reviewed. The patients in papers I and IV were examined by one radiographer (sonographer) and one radiologist during the same session. In paper I, findings using the standardized ultrasound method were compared with traditional bedside assessments by a radiologist. In paper IV, the patients were examined using only the standardized method. In paper II, including 98 patients, and in paper III, including 115 patients, the patients were examined by one sonographer using the standardized method and the examinations were reviewed by two or three radiologists.

Results: In paper I, no significant systematic differences were found between the findings using the standardized method and the traditional bedside assessment.

Paper II showed good intra- and inter-observer agreement between three experienced radiologists when reviewing examinations conducted using the standardized method.

In paper III we verified good inter-observer agreement between two radiologists reviewing ultrasound examinations using the standardized technique in patients who had undergone surgery for colorectal cancer. Intravenous contrast was used and the injection of contrast medium increased the visibility of liver lesions.

In paper IV, we observed that using a standardized cine-loop technique, there was a slightly better inter-operator agreement than inter-reader agreement.

Conclusion: The satisfactory agreement shown in all four studies suggests that the new workflow method using standardized ultrasound examinations and stored cine-loops, performed by a radiographer or sonographer and analyzed off-line by a radiologist, is a promising technique. The results are less affected when a radiologist examiner is replaced by a radiographer or sonographer than when the reviewer is replaced by a different radiologist.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1483
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-124676 (URN)10.3384/diss.diva-124676 (DOI)978-91-7685-946-9 (ISBN)
Public defence
2016-01-29, Berzeliussalen, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2016-02-10 Created: 2016-02-09 Last updated: 2016-02-10Bibliographically approved

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Stenman, CarinaSmedby, Örjan

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