1
|
Sidhu PS, Ewertsen C, Piskunowicz M, Secil M, Ricci P, Fischer T, Gaitini D, Mitkov V, Lim AKP, Lu Q, Chong WK, Clevert DA. Diversity of current ultrasound practice within and outside radiology departments with a vision for 20 years into the future: a position paper of the ESR ultrasound subcommittee. Insights Imaging 2023; 14:202. [PMID: 38001262 PMCID: PMC10673807 DOI: 10.1186/s13244-023-01548-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/23/2023] [Indexed: 11/26/2023] Open
Abstract
Ultrasound practice is a longstanding tradition for radiology departments, being part of the family of imaging techniques. Ultrasound is widely practiced by non-radiologists but becoming less popular within radiology. The position of ultrasound in radiology is reviewed, and a possible long-term solution to manage radiologist expectations is proposed. An international group of experts in the practice of ultrasound was invited to describe the current organisation of ultrasound within the radiology departments in their own countries and comment on the interaction with non-radiologists and training arrangements. Issues related to regulation, non-medical practitioners, and training principles are detailed. A consensus view was sought from the experts regarding the position of ultrasound within radiology, with the vision of the best scenario for the continuing dominance of radiologists practising ultrasound. Comments were collated from nine different countries. Variable levels of training, practice, and interaction with non-radiologist were reported, with some countries relying on non-physician input to manage the service. All experts recognised there was a diminished desire to practice ultrasound by radiologists. Models varied from practising solely ultrasound and no other imaging techniques to radiology departments being central to the practice of ultrasound by radiologists and non-radiologist, housed within radiology. The consensus view was that the model favoured in select hospitals in Germany would be the most likely setup for ultrasound radiologist to develop and maintain practice. The vision for 20 years hence is for a central ultrasound section within radiology, headed by a trained expert radiologist, with non-radiologist using the facilities.Critical relevance statement The future of ultrasound within the radiology department should encompass all ultrasound users, with radiologists expert in ultrasound, managing the ultrasound section within the radiology department. The current radiology trainees must learn of the importance of ultrasound as a component of the 'holistic' imaging of the patient.Key points: 1. Ultrasound imaging within radiology departments precedes the introduction of CT and MR imaging and was first used over 50 years ago.2. Non-radiology practitioners deploy ultrasound examinations to either 'problem solve' or perform a comprehensive ultrasound examination; radiologists provide comprehensive examinations or use ultrasound to direct interventional procedures.3. Radiology does not 'own' ultrasound, but radiologists are best placed to offer a comprehensive patient-focused imaging assessment.4. A vision of the future of ultrasound within the radiology department is encompassing all ultrasound users under radiologists who are experts in ultrasound, positioned within the radiology department.5. The current radiology trainee must be aware of the importance of ultrasound as a component of the 'holistic' imaging of the patient.
Collapse
Affiliation(s)
- Paul S Sidhu
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE17EH, UK.
- Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Caroline Ewertsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen OE, Denmark
| | | | - Mustafa Secil
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Paolo Ricci
- Unit of Emergency Radiology, Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Thomas Fischer
- Department of Radiology, Interdisciplinary Ultrasound Center, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Diana Gaitini
- Department of Radiology, Unit of Ultrasound, Rambam Medical Center and School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Vladimir Mitkov
- Diagnostic Ultrasound Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Adrian K P Lim
- Department of Imaging, Imperial College Healthcare NHS Trust & Department of digestive diseases, reproduction and metabolism, Imperial College London, London, UK
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, Wuhou District, Chengdu, China
| | - Wui K Chong
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Radiology, Division of Diagnostic Radiology, Houston, Texas, USA
| | | |
Collapse
|
4
|
da Silva PH, Gomes MM, de Matos CAL, de Souza E Silva IS, Gonzalez AM, Torres US, Salazar GMM, D'Ippolito G. HCC Detection on Surveillance US: Comparing Focused Liver Protocol Using US LI-RADS Technical Guidelines to a General Complete Abdominal US Protocol. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2487-2495. [PMID: 33463734 DOI: 10.1002/jum.15637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Focused US examinations of the liver in the routine hepatocellular carcinoma (HCC) screening reduce the time spent on evaluating other structures deemed irrelevant to the clinical setting. It is still unknown, however, if such a strategy may additionally improve the frequency of nodules detection. We aimed to assess the impact of an HCC surveillance program in high-risk patients by means of targeted liver US following LI-RADS technical guidelines in comparison to a complete upper abdominal scan. METHODS In this IRB-approved, single-center, prospective study, patients at high-risk for HCC enrolled from 06/2016 to 09/2019 were randomly assigned to 1 of the 2 institutional protocols: Group A (targeted liver US) or Group B (complete upper abdominal scan). Twenty examiners with similar experience in abdominal US were randomly assigned to perform the examinations exclusively in 1 of the groups (10 in each group). Frequency of hepatic nodules between groups was compared by using Fisher's exact test. RESULTS Four hundred and sixty-five patients were enrolled, with no significant differences in both groups regarding sex, age, etiology of liver disease, MELD scores, and alpha-fetoprotein levels. A significantly higher frequency of nodules detection was found in Group A (230 patients; 23 nodules detected; 10% of the sample) in comparison to Group B (235 patients; 3 nodules; 1.3% of the sample) (p <.001). Five patients in Group A and 1 in Group B were positive for HCC after full diagnostic work-up. CONCLUSION Adopting an HCC screening program based on targeted liver US improved the detection of hepatic nodules among high-risk individuals.
Collapse
Affiliation(s)
- Priscila Henriques da Silva
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Matheus Menezes Gomes
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Carla Adriana Loureiro de Matos
- Department of Gastroenterology, Liver Transplantation Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | | | - Adriano Miziara Gonzalez
- Department of Surgery, Liver Transplantation Unit, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Ulysses S Torres
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Fleury Group, São Paulo, Brazil
| | | | - Giuseppe D'Ippolito
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Fleury Group, São Paulo, Brazil
| |
Collapse
|
5
|
Position statement and best practice recommendations on the imaging use of ultrasound from the European Society of Radiology ultrasound subcommittee. Insights Imaging 2020; 11:115. [PMID: 33165666 PMCID: PMC7652945 DOI: 10.1186/s13244-020-00919-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
This document summarises best practice recommendations for medical imaging use of ultrasound in Europe, representing the agreed consensus of experts from the Ultrasound Subcommittee of the European Society of Radiology (ESR), the European Union of Medical Specialists (UEMS) Section of Radiology, and the European Federation of Societies for Ultrasound in Medicine and Biology. Recommendations are given for education and training, equipment and its maintenance, documentation, hygiene and infection prevention, and medico-legal issues.
Collapse
|
6
|
Ketelaars R, Van Heumen E, Baken LP, Witten M, Scheffer GJ, Engels Y, Hoogerwerf N. Emergency physicians’ attitudes to implementing ultrasound in Dutch emergency departments after a 2-day training: A qualitative study. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918771812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Diagnostic ultrasound is increasingly used by nonradiologists in trauma victims and critically ill patients. In the emergency department, the extended focused assessment with sonography for trauma and Polytrauma Rapid Echo-evaluation Program protocol are often used to assess these patients. Dutch Polytrauma Rapid Echo-evaluation Program-trained Emergency physicians are implementing the use of ultrasound in the emergency department but might encounter barriers to overcome. Objectives: This study aims to explore individual experiences of Dutch emergency physicians. Methods: We performed a qualitative study by conducting semi-structured interviews in Dutch emergency physicians working in a Level 2 emergency department that completed the 2-day Polytrauma Rapid Echo-evaluation Program course at least 1 year before the interviews. Data were analyzed using directed content analysis. Results: Eight emergency physicians employed by eight different hospitals were interviewed. Thirteen categories were identified in the transcribed interviews and these were combined into four general themes: (1) the desire to develop the Emergency Medicine specialty, both nationally and local; (2) incentives to start using ultrasound; (3) exploring practical applications of ultrasound; and (4) barriers faced while implementing emergency physician-performed ultrasound on the emergency department. The interviewees regard the course to be a solid base and are eager to independently perform ultrasound examinations, although challenges are faced. Conclusion: This exploratory study provides essential insight in Dutch emergency physicians implementing ultrasound in their emergency department. It shows that there is a need to develop a quality assurance system and it identified barriers that have to be dealt with.
Collapse
Affiliation(s)
- Rein Ketelaars
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
| | - Esther Van Heumen
- Department of Radiology, Haga Hospital, The Hague, The Netherlands
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Lambert P Baken
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Marja Witten
- Emergency Department, Flevoziekenhuis, Almere, The Netherlands
| | - Gert Jan Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Nico Hoogerwerf
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Helicopter Emergency Medical Service, Lifeliner 3, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Organisation and practice of radiological ultrasound in Europe: a survey by the ESR Working Group on Ultrasound. Insights Imaging 2013; 4:401-7. [PMID: 23715766 PMCID: PMC3731462 DOI: 10.1007/s13244-013-0257-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To gather information from radiological departments in Europe assessing the organisation and practice of radiological ultrasound and the diagnostic practice and training in ultrasound. METHODS A survey containing 38 questions and divided into four groups was developed and made available online. The questionnaire was sent to over 1,000 heads of radiology departments in Europe. RESULTS Of the 1,038 radiologists asked to participate in this survey, 123 responded. Excluding the 125 invitations to the survey that could not be delivered, the response rate was 13 %. CONCLUSION Although there was a low response rate, the results of this survey show that ultrasound still plays a major role in radiology departments in Europe: most departments have the technical capabilities to provide patients with up-to-date ultrasound examinations. Although having a centralised ultrasound laboratory seems to be the way forward, most ultrasound machines are spread between different departments. Ninety-one per cent of answers came from teaching hospitals reporting that training is regarded as an art and is needed in order to learn the basics of scanning techniques, after which working in an organ-oriented manner is the best way to learn how to integrate diagnostic US within the clinical context and with all other imaging techniques. MAIN MESSAGES • Hospitals should introduce centralised ultrasound laboratories to allow for different competencies in US under the same roof, share human and technological resources and reduce the amount of equipment needed within the hospital. • Technique-oriented teaching, time and examinations are necessary to learn how to use US properly within the framework of organ-oriented training. • A time period of about 6 months dedicated solely to learning US scanning techniques is deemed sufficient in most cases.
Collapse
|