Image and report quality in non-obstetric ultrasound examinations undertaken by sonographers: Results of an audit of 3731 cases.

INTRODUCTION: This paper reports the results of a rolling audit of sonographer-performed non-obstetric ultrasound examinations undertaken between 2010 and 2020 in a large University Teaching Hospital Ultrasound Department in the United Kingdom. We believe that this represents the largest published audit of sonographer non-obstetric ultrasound examination quality. METHODS: Random samples of sonographer ultrasound examinations were regularly and systematically audited by consultant-level ultrasound practitioners through review of soft copy images and reports. Examination and report quality were assessed against an internal audit standard in 3731 patients over an 11-year period and also against externally set audit standards in 3186 patients over a nine-year period. RESULTS: Both image and report quality exceeded externally set audit standards in all nine years of audit. In the internal audit, the quality standard just failed to be met for the first five years of audit but was achieved in all the subsequent six years. CONCLUSION: This audit provides further information on the quality and safety of sonographer-led ultrasound service delivery within a service that has quality safeguards, readily available support and an active education programme. It is used not only to provide assurance to patients, clinicians, managers and commissioners of this service but also to direct individual professional development and drive an iterative process of quality improvement.

Comparison of Digital Tomosynthesis and Chest Radiography for the Detection of Noncalcified Pulmonary and Hilar Lesions.

OBJECTIVES: The aim of this study was to compare the sensitivity and specificity of chest digital tomosynthesis (DTS) with chest radiography (CXR) for the detection of noncalcified pulmonary nodules and hilar lesions using computed tomography (CT) as the reference standard. MATERIALS AND METHODS: A total of 78 patients with suspected noncalcified pulmonary lesions on CXR were included in the study. Two radiologists, blinded to the history and CT, analyzed the CXR and the DTS images (separately), whereas a third radiologist analyzed the CXR and DTS images together. Noncalcified intrapulmonary nodules and hilar lesions were recorded for analysis. The interobserver agreement for CXR and DTS was assessed, and the time taken to report the images was recorded. RESULTS: A total of 202 lesions were recorded in 78 patients. There were 111 true lesions confirmed on CT in 53 patients; in 25 patients subsequent CT excluded a lesion. The overall sensitivity was 32% for CXR and 49% for DTS. This improved to 54% when the posteroanterior CXR and DTS were reviewed together (CXR-DTS). The overall specificities for CXR, DTS, and CXR-DTS were 49%, 96%, and 98%, respectively. There were 56 suspected hilar lesions with subgroup sensitivities of 76% for CXR, 65% for DTS, and 76% for CXR-DTS. The specificity for hilar lesions was 59%, 92%, and 97% for CXR, DTS, and CXR-DTS, respectively. CONCLUSIONS: DTS significantly improves the detectability of noncalcified nodules when compared with and when used in combination with CXR. The specificity and interobserver agreement of DTS in the diagnosis of suspected noncalcified pulmonary nodules and hilar lesions are significantly better than those of CXR and approaches those of CT.

The value of digital tomosynthesis of the chest as a problem-solving tool for suspected pulmonary nodules and hilar lesions detected on chest radiography.

OBJECTIVES: To assess the capability of digital tomosynthesis (DTS) of the chest compared to a postero-anterior (PA) and lateral chest radiograph (CXR) in the diagnosis of suspected but unconfirmed pulmonary nodules and hilar lesions detected on a CXR. Computed tomography (CT) was used as the reference standard. MATERIALS AND METHOD: 78 patients with suspected non-calcified pulmonary nodules or hilar lesions on their CXR were included in the study. Two radiologists, blinded to the history and CT, prospectively analysed the CXR (PA and lateral) and the DTS images using a picture archiving and communication workstation and were asked to designate one of two outcomes: true intrapulmonary lesion or false intrapulmonary lesion. A CT of the chest performed within 4 weeks of the CXR was used as the reference standard. Inter-observer agreement and time to report the modalities were calculated for CXR and DTS. RESULTS: There were 34 true lesions confirmed on CT, 12 were hilar lesions and 22 were peripheral nodules. Of the 44 false lesions, 37 lesions were artefactual or due to composite shadow and 7 lesions were real but extrapulmonary simulating non-calcified intrapulmonary lesions. The PA and lateral CXR correctly classified 39/78 (50%) of the lesions, this improved to 75/78 (96%) with DTS. The sensitivity and specificity was 0.65 and 0.39 for CXR and 0.91 and 1 for DTS. Based on the DTS images, readers correctly classified all the false lesions but missed 3/34 true lesions. Two of the missed lesions were hilar in location and one was a peripheral nodule. All three missed lesions were incorrectly classified on DTS as composite shadow. CONCLUSIONS: DTS improves diagnostic confidence when compared to a repeat PA and lateral CXR in the diagnosis of both suspected hilar lesions and pulmonary nodules detected on CXR. DTS is able to exclude most peripheral pulmonary nodules but caution and further studies are needed to assess its ability to exclude hilar lesions.

Detection of free intraperitoneal fluid in healthy young men.

OBJECTIVES: Free intraperitoneal fluid is a secondary sign of abdominal disorders. The detection of small volumes of fluid has been documented as a normal finding in women of childbearing age and also in pediatric sonography. However, the finding of free fluid in asymptomatic men has not been similarly documented by sonography. We postulate that with high-frequency linear probes, small volumes of fluid may be detected in asymptomatic men without underlying abdominal disorders. METHODS: Ten healthy male volunteers underwent targeted abdominal sonographic examinations after an overnight fast and in an immediate postprandial state. The findings were documented, and representative images were saved for analysis. RESULTS: We found small slivers or geometric collections of fluid between bowel loops in 4 of the 10 volunteers. No obvious correlation between the detection of fluid and the nutritional or hydration status of the patient was identified. CONCLUSIONS: The findings suggest that small volumes of pelvic free fluid in healthy men can be normal and do not necessarily indicate underlying disorders. The role of free fluid identification as an indicator of major intra-abdominal disorders must be viewed with caution and with careful clinical correlation.

Role of simulation-based education in ultrasound practice training.

The aim of this systematic review was to determine whether ultrasound (US)/US procedural simulation leads to improvement in US competence, particularly in the clinical setting. The electronic databases MEDLINE, EMBASE, CINAHL, ERIC, and OVID were searched for relevant published articles between 1950 and April 2011. Fourteen articles of an initial 371 articles met the inclusion criteria. The eligible studies differed in terms of the study population, sample size, study design, US simulator used, and measured outcomes. Most of the studies demonstrated acquisition of knowledge and skills with suggestions of correlation with simulation training and improved performance in the same simulated environment. There is little compelling evidence based on published studies at present to support the widespread adoption of simulation-based medical education to improve clinical US competence.

Sonographic appearance of a migrated Angelchik anti-reflux prosthesis in the pelvis.

Surgical implantation of Angelchik prosthesis around the distal esophagus was a popular treatment for gastroesophageal reflux in the 1980s. However, because of frequent complications, this surgical technique was abandoned. We report a case of a migrated Angelchik prosthesis in a 56-year-old woman in whom the prosthesis was found in the pelvic cavity 20 years after the initial surgery. The plain radiographic and ultrasound findings are described.

The sonographic appearance of acute focal pyelonephritis 8 years experience.

AIM: Acute focal pyelonephritis (AFP) is a variant of pyelonephritis in which single or multiple discrete areas show changes of inflammation. The reported sonographic appearances of AFP are varied but are typically described as being echopoor. The purpose of this study was to review the sonographic appearances of AFP and attempt to explain the range of findings by correlation with clinical details. MATERIALS AND METHODS: We reviewed retrospectively the sonographic findings and medical records of 17 cases of AFP. The study group consisted of 13 women and four men (mean age 20 years). Lesions were designated as echogenic, echopoor or of mixed echogenicity as compared to the adjacent renal cortex, and to the liver or spleen. RESULTS: The abnormal areas were echogenic in 12 patients, echopoor in three and of mixed echogenicity in two. An attempt was made to explain the variation in appearances by correlation with clinical details including the patient's age, the duration of symptoms, the length of antibiotic treatment and the presence of haematuria. CONCLUSION: Areas of acute focal pyelonephritis may be echogenic, echopoor or of mixed echogenicity. Our data would suggest that areas of increased echogenicity are more common. There is no discernible correlation with clinical findings.