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Do radiologists agree when reviewing ultrasound examinations performed by a sonographer and a radiologist?
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Ultrasound examinations are usually performed by a radiologist or, in suitable cases, by a sonographer or radiographer. Standardized scanning protocols and cine-loop documentation may permit the transfer of tasks from a radiologist to a sonographer or radiographer.

Purpose: To study the diagnostic variability in standardized ultrasound examinations of the kidney by comparing inter-reader agreement between two radiologists who reviewed examinations acquired by a sonographer and a radiologist, as well as inter-operator agreement between the sonographer and the radiologist.

Material and methods: After approval by the local research ethics committee, 98 adult patients, aged from 18 to 92, referred for diagnostic renal sonographic examination and were prospectively enrolled. Both kidneys were imaged using standardized scanning protocols, and the entire examination was documented with cine-loops. Two radiologists reviewed the examinations for different types of pathology, including tumors, cysts, decreased cortical thickness, increased echogenicity and hydronephrosis. Inter-reader and inter-operator agreement was evaluated with kappa coefficient and intra-class correlation.

Results: The most common finding was cysts, which were found in 32 to 40 cases. Tumors were found in three to 10 cases. With one exception, the kappa values for inter-operator agreement (0.65–1.00) were higher than those for inter-reader agreement (0.31–1.00). With two exceptions, no systematic differences between operators or between observers were found.

Conclusion: Using a standardized cine-loop technique, we found slightly better interoperator agreement than inter-reader agreement. This suggests that it may be easier to exchange an operator than to exchange a reader.

Keyword [en]
Cine-loop imaging, renal sonography, agreement
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-124674OAI: oai:DiVA.org:liu-124674DiVA: diva2:901975
Available from: 2016-02-09 Created: 2016-02-09 Last updated: 2016-02-10Bibliographically approved
In thesis
1. 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 (Print) (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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Division of Radiological SciencesFaculty of Medicine and Health SciencesCenter for Medical Image Science and Visualization (CMIV)Department of Radiology in Linköping
Radiology, Nuclear Medicine and Medical Imaging

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