Musculoskeletal Ultrasound: Audit of Sonographer Reporting

Abstract

Musculoskeletal (MSK) ultrasound performed by non-medical practitioners is a developing practice. The aim of this paper is:(1) to audit an experienced sonographer's (SJR) performance after one year's independent reporting against two experienced MSK radiologists (CJG, MC); and (2) to establish an audit standard against which such role development might be contrived. Images and reports from 250 MSK ultrasound examinations performed by a sonographer (SJR) were reviewed independently by two consultant MSK radiologists (CJG and MC). The examinations were graded for discrepancy, e.g. grade 1 -agree with the sonographer report; grade 2 -minor discrepancy unlikely to alter patient care; grade 3 -potentially significant discrepancy; grade 4 -definite, significant discrepancy likely to have adverse consequences for patient care. Two of 250 (0.8%) cases were excluded. Both radiologists agreed completely with the sonographer (grade 1) in 235 of the 248 cases (94.8%). In 13 cases there was discrepancy between the reports of SJR and the radiologists. The discrepancy was grade 2 in six of the 248 cases (2.4%), grade 3 in six of the 248 cases (2.4%) and grade 4 in one of the 248 cases (0.4%). In conclusion, this audit shows a high level of agreement between the sonographer and the consultant MSK radiologist reporting of MSK ultrasound. This level of agreement may set the standard for future quality assurance audit of sonographer MSK reporting.Over the last 20 years there has been a gradual rise in the number of non-medical imaging health professionals performing and independently reporting ultrasound examinations. 1,2 Such a development has taken place in line with recommendations from the professional bodies; The Royal College of Radiologists and The Society of Radiographers and national government initiatives for skill-mix and role extension, primarily in order to meet increasing service demand. 3 -7 Early evidence showed that sonographers were able to produce general medical ultrasound reports to a similar standard as those of radiologists, thus generating a degree of confidence in independent sonographer reporting. 8,9 Further studies showed high diagnostic accuracy and good agreement for independent radiologist and sonographer reporting of abdominal and pelvic ultrasound. 10,11 Non-medical practitioners have been involved in musculoskeletal (MSK) ultrasound for many years but this is still a developing practice. Recent publications in certain areas of MSK ultrasound show involvement of non-medical practitioners, e.g. inter-operator agreement studies in shoulder ultrasound, and radiologist versus podiatrist in rheumatoid MSK ultrasound of the forefoot. 12 -14 To our knowledge, there are no research or audit studies assessing sonographer reporting of MSK ultrasound examinations.In 2007, in order to meet service requirements, responsibility for performance and reporting of MSK ultrasound was delegated to a newly-appointed sonographer (SJR) with eight years MSK ultrasound experience gained at a different institution. This adva...

Feasibility of an Audit System for Canadian Sonographers in Generalist Ultrasound

“…The results of this study cannot be directly compared to the findings of Riley et al., 14 who discovered 95% agreement (DoA 1) between the sonographer technical reports and the radiologist reports in musculoskeletal sonography. In the study by Riley et al, actual sonographic images were available for consultation, and the independently reporting sonographer produced differential diagnoses in an official report, as opposed to a technical impression sheet.…”

Do radiologists need to review abdominal ultrasound examinations reported as ‘normal’ by the sonographer?

“…The high accuracy of sonographers’ diagnostic opinion has been documented in numerous studies across all subspecialties with sonographers often demonstrating comparable standard of diagnostic performance to that of radiologists . This raises important questions about the level of oversight that sonographers require by imaging specialists such as radiologists or other sonologists and the required staffing levels and departmental structures.…”

Who's doing your scan? A European perspective on ultrasound services

“…Mehrere Studien haben das Audit und die "doppelte Befundstellung" von "Sonographer" und Radiologen untersucht, beides Methoden zur Überprüfung der Verlässlichkeit eines initial untersuchenden "Sonographer" im Hinblick auf die Interpretation und den Befundbericht. Die Ergebnisse über mehrere Jahre zeigen, dass "Sonographer" und Radiologen eine ähnlich hohe Treffsicherheit haben [3,4,6,7,9].…”

“…Several studies have conducted audit and "double reporting" by both sonographer and radiologist as a means of initially investigating sonographers' reliability to detect, interpret and report. Results over the years indicate sonographers and radiologists have a similar accuracy [3,4,6,7,9].…”