Aims: To evaluate the carotid ultrasound intra-and interobserver agreements in a common clinical scenario when making manual measurements of the intima-media thickness (IMT) and peak systolic (PSV) and end diastolic (EDV) velocities in the common (CCA) and the internal carotid (ICA) arteries. Material and methods: Three different experienced operators performed two time-point carotid ultrasounds in 21 patients with cardiovascular risk factors. Each operator measured freehand the CCA IMT three consecutive times in each examination. The CCA and ICA hemodynamic parameters were acquired just once. . Intraobserver agreements were fair-moderate for PSVs and good-excellent for EDVs. Interobserver agreements were good-excellent for both PSVs and EDVs. Overall, 95% confidence intervals were narrower for the left IMTmean and CCA velocities. Conclusions: Intra and interobserver agreements in carotid ultrasound are variable. In order to improve carotid IMT agreements, IMTmean is preferable over IMTmax.

Background Possible COVID-19 pneumonia patients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision’s reliability. Methods We assessed 849 consecutive ppCOVID-19 patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative—group 1- and positive—group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1: pneumonia negative, home-confinement follow-up; group 2: pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi2 tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission. Results The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients: 0:41 ± 1:05 h; 3:36 ± 2:58 h; 3:50 ± 3:16 h; group 1 vs. all group 2 and group 3 patients: 0:41 ± 1:05 h; 5.25 ± 3.08; 5:36 ± 4:36 h; group 2 vs. group 3 admitted patients: 5:27 ± 3:08 h vs. 7:42 ± 5:02 h; all p < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients. Conclusions Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.

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