Standardized cine-loop documentation in renal ultrasound facilitates skill-mix between radiographer and radiologist

Abstract

Background

The radiographers' role in ultrasound (US) has been debated due to the operator-dependent aspect of diagnostic US. With standardized cine-loop ultrasound (SCUS) a reliable diagnosis can be achieved by reading SCUS independently from performing the procedure.

Purpose

To study the correlation between sonographic findings when SCUS is performed and read by a radiologist and when SCUS is performed by a radiographer and read by a radiologist, and to assess the radiologists' confidence when reading SCUS examinations performed by a radiographer.

Material and Methods

Thirty-four patients (64 kidneys) who underwent SCUS of the kidneys were included in this study. All patients underwent two consecutive SCUS examinations, one performed by an experienced radiologist reading his own examination (online), and one performed by a SCUS-trained radiographer, read by an experienced radiologist who was not involved in the examination of the patient (offline). Study reports were made using a structured report form designed for this study. Confidence was measured on a visual analog scale ranging from 0 (no confidence) to 100 (extremely confident). The final diagnosis (the reference standard) was defined as the consensus between two US-experienced radiologists. All personnel were blinded to each other's results.

Results

We found discordance between image findings for online and offline in eight out of 64 kidneys. There was no systematic difference between online and offline reading. There was a good correlation between online and offline, kappa 0.75 (95% CI 0.60–0.90, P < 0.001). Kappa correlation for online and offline compared to reference standard was 0.94 (95% CI 0.86–1.00, P < 0.001) and 0.81 (95% CI 0.66–0.96, P < 0.001), respectively. Radiologists reported a confidence level of 88 (range, 74–94) and 85 (range, 67–92) in the online and offline group, respectively (P = 0.005).

Conclusion

There is a high degree of correlation between reported findings in radiologist and radiographer performed SCUS examinations.

Keywords

Health policy and practice ultrasound adults computer applications – teleradiology comparative studies

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References

Almén

Friberg

Widmark

. Radiologiske undersøkelser i Norge per 2008 Trender i undersøkelsesfrekvens og stråledoser til befolkningen. Strålevern Rapport (In Norwegian) 2010; Vol. 12, Østerås: Statens strålevern2010.

Brealey

Scally

Hahn

. Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis. Clin Radiol 2005; 60: 232–241–232–241.

Chan

. Routine abdominal and pelvic ultrasound examinations: an audit comparing radiographers and radiologists. Ann Acad Med Singapore 2003; 32: 126–128–126–128.

Leslie

Lockyer

Virjee

. Who should be performing routine abdominal ultrasound? A prospective double-blind study comparing the accuracy of radiologist and radiographer. Clin Radiol 2000; 55: 606–609–606–609.

Howlett

. Who should be performing routine abdominal ultrasound? Clin Radiol 2001; 56: 166–167–166–167.

Stenman

Thorelius

Knutsson

. Radiographer-acquired and radiologist-reviewed ultrasound examination--agreement with radiologist's bedside evaluation. Acta Radiol 2011; 52: 70–74–70–74.

Hardy

Hutton

Snaith

. Is a radiographer led immediate reporting service for emergency department referrals a cost effective initiative? Radiography 2013; 19: 23–27–23–27.

Dormagen

Gaarder

Drolsum

. Standardized cine-loop documentation in abdominal ultrasound facilitates offline image interpretation. Acta Radiol 2013. doi: 10.1177/0284185113517228.