Objective Volumetric flow measurement with Doppler ultrasound is useful in assessing blood flow as part of an evaluation of arteriovenous fistula maturity in patients undergoing hemodialysis. In this study, we assessed both accuracy and variability in volumetric flow measurements obtained using modern and commercially available ultrasound systems and an in vitro experimental setup. Methods Volumetric flow measurements using duplex ultrasound were obtained by 3 users operating 5 different systems for randomized flow in the range of 100 to 1000 mL/min. Users performed 3 consecutive measurements at a given flow rate. Data were analyzed using statistical techniques to assess measurement accuracy and variability. Results Over the span of flow rates studied, the root mean square error (RMSE) for the 5 ultrasound systems ranged from 38.8 to 79.7, 36.8 to 52.0, 73.0 to 85.3, 26.7 to 44.6, and 43.9 to 93.5 mL/min. Corresponding average RMSE values were 60.3, 42.7, 81.1, 37.2, and 64.4 mL/min, respectively. A linear regression analysis of mean interobserver measurements revealed an excellent correlation for all ultrasound systems (r2 > 99.1%). Assessment of intraobserver measurements revealed no statistically significant differences for any ultrasound system evaluated (P > .94). Comparison of interobserver measurements indicates no statistically significant differences between any of the 5 systems (P > .14). Conclusions Modern ultrasound systems are reasonably accurate in blood flow measurement in an experimental setup mimicking clinically relevant blood flow ranges in a hemodialysis fistula. Users need adequate training and experience to perform multiple measurements and use appropriate techniques to minimize errors in flow measurement.
How to Make Your Practice Flourishltrasound is the most widely used imaging modality in the world. Benefits include relative low cost, lack of ionizing radiation, no potential nephrotoxicity from contrast agents, and portability. With extensive recent technical improvements, the quality and breadth of ultrasound examinations have increased substantially. Ultrasound is no longer just a screening modality but a tool that can make a definitive, final diagnosis. Demand for ultrasound has risen substantially because of all of these factors.Despite the universal embrace of ultrasound, competition from modalities such as computed tomography (CT) and magnetic resonance imaging is high. The required CT examination time has drastically diminished; now it often takes longer to transfer a patient on and off the CT table than it does to perform the scan. Equivalent time-saving changes have not occurred in ultrasound to date.Current challenges facing the ultrasound department include maintaining high quality while increasing the number of examinations, all without adding sonographers or ultrasound scanners. The ever-increasing demands on physicians to do more work in less time mirror the pressure on the ultrasound department. Physician extenders can be useful in a well-controlled setting. Sonographer and resident training, accreditation, report turnaround time, and quality control are all vital ingredients in achieving excellence and success.The ultrasound section at the University of Alabama at Birmingham is flourishing despite these obstacles, with a continued annual growth rate of 7.7% per year over the past 17 years and 17.6 % growth over the past 2 years. In part, our success has resulted from the dedication of our faculty members, with a total of 112 years of postresidency experience. We have also benefited from extensive involvement in professional societies, such as
Learning how to perform endovaginal pelvic ultrasound is often challenging for novices in a busy clinical practice. In this article, we describe a program in which we hired female patient models to help residents acquire basic endovaginal scanning skills.
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