The clinical ultrasound report: Guideline for sonographers

Australas J Ultrason Med

Shen

Ong

et al. 2020

Self Cite

Introduction Sonographers demonstrate a high standard of diagnostic performance and work with a considerable degree of professional independence. In Australasia, sonographers typically generate a preliminary report which is reviewed by the radiologist who issues a final report. The aim of this study was to determine whether radiologist's review is required in cases reported as normal by the sonographer. Methods This study was a retrospective review of 1000 abdominal US examinations considered normal by sonographers that were subsequently reported by radiologists. Any findings reported by radiologists that were not reported by sonographers were analysed and separated into errors or discrepancies according to commonly accepted definition. Results The 1000 abdominal examinations included 244 complete abdominal, 200 hepatobiliary, 506 urinary tract and 50 other abdominal examinations. Patients’ age ranged from < 1 to 94 years (mean = 35 years, median = 32 years). US examinations were performed by any one of 14 sonographers with 1–21 years (mean = 6 years, median = 7 years) of clinical experience. Two diagnostic errors were made by sonographers and two errors by radiologists. In no single case did the radiologist uncover a case of an acute or serious illness, illness requiring admission or urgent clinical review, nor did the radiologist identify the cause for the presenting symptoms. Eighteen discrepancies were found, but these were of trivial nature and most were rated by specialist clinicians as irrelevant. Conclusion Sonographers are accurate in distinguishing normal abdominal US examinations. The involvement of a radiologist in a second reading of normal abdominal US examinations is unnecessary.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Australas J Ultrason Med

Shen

Ong

et al. 2020

Self Cite

“…Many clinicians, specifically specialists, are well informed about the potential benefit of CEUS in the imaging and management of their patients. Clinicians are also open to be guided by sonographers and radiologists in terms of the most appropriate examination 19 . There is already an industry expectation that sonographers extend the US examination as appropriate to maximise the diagnostic utility of US 19,20 .…”

Section: Discussionmentioning

confidence: 99%

“…Barriers to CEUS identified by respondents Clinicians are also open to be guided by sonographers and radiologists in terms of the most appropriate examination. 19 There is already an industry expectation that sonographers extend the US examination as appropriate to maximise the diagnostic utility of US. 19,20 This may include extending the examination into anatomical regions beyond those specifically requested or incorporating the use of harmonic imaging, spatial compounding, colour Doppler, spectral Doppler, three-dimensional and other US imaging techniques as appropriate.…”

Section: T a B L Ementioning

confidence: 99%

Barriers to contrast‐enhanced ultrasound in New Zealand and proposed solutions

Ong

2020

Sonography

Self Cite

Introduction Contrast‐enhanced ultrasound (CEUS) appears underutilised in New Zealand (NZ). The purpose of this survey was to gain an understanding of the barriers that prevent NZ practitioners from implementing CEUS and to offer practical solutions on how to solve such barriers. Methods A questionnaire was distributed to 88 delegates of two regional meetings on the topic of CEUS convened in Tauranga and Auckland, NZ in November and December 2019. Results Response rate was 82%. Of the 72 respondents, 56 were sonographers and 14 radiologists. The 72 respondents provided 129 responses regarding the barriers that have hindered them or their department in implementing and performing CEUS. The most common barriers were lack of knowledge on part of sonographers or radiologists (n = 23, 42%), lack of support from radiologists (n = 21, 38%), uncertainty about funding or charges (n = 14, 25%), lack of interest on part of radiologists (7, 12%) and lack of leadership (7, 12%). Conclusion This study revealed a broad range of barriers that have prevented practitioners of ultrasound from implementing and performing CEUS. The analysis of these barriers and practical solutions are provided so that readers who are not yet performing CEUS can anticipate and address these common barriers.

“…Instead, sonographers should image the aorta when requested and exercise sound critical judgement and extend the examination to include the aorta where appropriate. Sonographers already carry the mandate to extend the US examination where clinically appropriate, so this would not represent a change to current clinical practice 11–13 …”

Section: Discussionmentioning

confidence: 99%

The value of evaluating the abdominal aorta in patients <50 years of age presenting for abdominal ultrasound

Australas J Ultrason Med

Adams

Brennan

et al. 2020

Self Cite

Introduction Practitioners of US routinely include a survey of the abdominal aorta during abdominal US in accordance with international guidelines. Such practice is of uncertain value in younger patients. Methodology This study was a retrospective review of 2000 abdominal US examinations which included visualisation of the aorta in patients <50 years of age. Patient demographics and referral details were recorded, and US images and reports were reviewed for the presence of aortic and periaortic pathology. Results The most common indications for US were abdominal pain (1337, 44%), deranged liver function tests (453, 15%), nausea and/or vomiting (229, 8%), elevated inflammatory markers (146, 5%), pancreatitis (134, 4%) and pyrexia (127, 4%). Fewer than half (977, 49%) of the reports contained a comment regarding the aorta. Aortic pathology was reported in 2 (0.1%) cases. Both were reported as aortic ectasia and both represented a false‐positive diagnosis. One male patient had a known abdominal aortic aneurysm with endovascular aortic repair. No new aortic aneurysms were found. All cases of atherosclerotic disease were ignored, and none were reported. Periaortic pathology was encountered on 1 patient, but this was known. No case of new periaortic pathology was detected. Conclusion Routine and indiscriminate imaging of the abdominal aorta during abdominal US in patients <50 years of age is not evidence based. No new case of abdominal aortic aneurysm or new para‐aortic pathology was detected, all cases of atherosclerosis were ignored, and two false‐positive diagnoses of aortic ectasia were made.