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Fang AH, Franco I, Pizzuti JM, Boroda JU, Friedman SC, Fine RG, Horowitz M, Schlussel RN, Landau-Dyer L, Zelkovic PF, Freyle J, Sommer JE, Gitlin JS. Size matters: Total testicular volume predicts sperm count in Tanner V varicocele patients. J Pediatr Urol 2024; 20:960-966. [PMID: 38876892 DOI: 10.1016/j.jpurol.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/25/2024] [Accepted: 05/18/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION It is known the prevalence of varicoceles in adolescent men is 14-29% but there is debate surrounding implications on fertility. As obtaining a semen analysis (SA) may be challenging, there is need for objective tests as measures of fecundity. Our aim was to investigate the relationship between testicular volume differential (TVD), varicocele grade, and total testicular volume (TTV) on seminal parameters including total motile sperm count (TMSC). MATERIALS AND METHODS We conducted a retrospective single-center chart review over 14 years of 486 Tanner V adolescent males. Three hundred and four met inclusion of palpable, non-operated left-sided varicocele who underwent at least one SA and ultrasound. Abnormal TMSC was defined by World Health Organization 2010 criteria for minimal reference ranges. Multivariate logistic regression, receiver operating characteristic analysis with Youden J-statistic and descriptive statistics were performed. RESULTS Three hundred and four Tanner V adolescents with median age of 18.0 years (18.0-19.0), median TTV of 34.5 cc (28.9, 40.2) and median TMSC of 62.5 million/ejaculate (25.4, 123.4) were evaluated. TTV cutoff of 29.5 cc was found to predict TMSC of <9 million/ejaculate with negative predictive value of 96.2% and odds ratio of 6.08 ([2.13-17.42], p < 0.001). TVD greater than 20% did not reach statistical significance with an odds ratio of 1.66 ([0.41-6.62], p = 0.50). DISCUSSION In clinical practice, each patient will need to have an individualized plan. Based on our data, for older adolescents (17 or 18 years) with varicocele and an abnormal TTV, clinicians may have a lower threshold for advising SA, and if unable to obtain, surgical intervention and/or closer surveillance should be stressed. Patients should be informed of their six-fold increase in abnormal SA. Patients with normal TTV should be advised they are at lower risk of having abnormal SA. Younger patients with varicocele and an initial TVD>20%, should be followed closely but intervention delayed until 17 or 18 to better assess TTV. The importance of trending patient data should be emphasized as a single measurement has low predictive value for developing adolescents. Limitations of our study include a retrospective design and the lack of uniform correlation between adolescent SA and paternity. CONCLUSIONS Total testicular volume less than 29.5 cc increased odds of abnormal semen analysis by over six times and had a negative predictive value of 96.2%. Ultrasound results may be useful for risk stratification and counselling on appropriateness of surgical intervention.
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Affiliation(s)
- Alexander H Fang
- SUNY Downstate Health Sciences University, College of Medicine, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
| | - Israel Franco
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
| | - Joseph M Pizzuti
- Renaissance School of Medicine at Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA.
| | - Joseph U Boroda
- SUNY Downstate Health Sciences University, College of Medicine, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
| | - Steven C Friedman
- Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
| | - Ronnie G Fine
- NYU Langone Hospital - Long Island, 259 1st Street, Mineola, NY 11501, USA.
| | - Mark Horowitz
- NYU Langone Hospital - Long Island, 259 1st Street, Mineola, NY 11501, USA.
| | - Richard N Schlussel
- Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Lori Landau-Dyer
- Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA.
| | - Paul F Zelkovic
- Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA.
| | - Jaime Freyle
- Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, USA.
| | - Jessica E Sommer
- NYU Langone Hospital - Long Island, 259 1st Street, Mineola, NY 11501, USA.
| | - Jordan S Gitlin
- NYU Langone Hospital - Long Island, 259 1st Street, Mineola, NY 11501, USA.
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Schäfer FM, Bürgener D, Stehr M, Rompel O. Intra- and Interobserver Variability in Ultrasound Measurement of Testicular Volumes in Pubertal Boys. CHILDREN (BASEL, SWITZERLAND) 2024; 11:741. [PMID: 38929320 PMCID: PMC11202271 DOI: 10.3390/children11060741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
Accurate measurement of testicular volume (TV) in boys is an important tool in clinical practice, e.g., in varicocele treatment. This study aims to assess the degree of intra- and interobserver variability of testicular volume measurements. In a prospective study, boys between 11 and 17 years of age without testicular pathology were enrolled. Testicular ultrasound was performed by three investigators (A: pediatric radiologist; B: pediatric surgery/urology resident; C: pediatric urologist). Intraobserver variability was calculated in investigators B and C and interobserver variability between all three investigators. A total of 30 boys were enrolled. Mean intraobserver variability in both observers was +0.3% with a range of -39.6 to 51.5%. The proportion of measurements with a difference >20% was 18.6%. The mean interobserver variability was -1.0% (range: -74.1% to 62.8%). The overall proportion of measurements with a difference >20% was 35%. A lower testicular size of < 4 mL showed a significantly higher rate of >20% difference in both the intraobserver group (31.1% vs. 14.4%; p = 0.035) and the interobserver group (63.2% vs. 26.2%; p = 0.000031). Furthermore, the rate of >20% difference was significantly lower in obese compared to non-obese patients in both the intraobserver (2.8% vs. 22.4%; p = 0.0084) and the interobserver group (24% vs. 40.8%, p = 0.0427). Both intraobserver and interobserver variability in ultrasound-based TV measurements in pubertal boys contain a relevant degree of uncertainty that renders them unsuitable for individualized follow-up care. At the cohort level, however, mean differences in ultrasound-based TV measurements are low enough to make ultrasound comparisons reasonable.
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Affiliation(s)
- Frank-Mattias Schäfer
- Cnopfsche Kinderklinik, Department of Pediatric Surgery and Pediatric Urology, 90419 Nürnberg, Germany; (D.B.); (M.S.)
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Daniel Bürgener
- Cnopfsche Kinderklinik, Department of Pediatric Surgery and Pediatric Urology, 90419 Nürnberg, Germany; (D.B.); (M.S.)
| | - Maximilian Stehr
- Cnopfsche Kinderklinik, Department of Pediatric Surgery and Pediatric Urology, 90419 Nürnberg, Germany; (D.B.); (M.S.)
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany;
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Pedersen MRV, Otto PO, Fredslund M, Smedegaard C, Jensen J, McEntee MF, Loft MK. Ultrasound assessment of testicular volume - An interobserver variability study. J Med Imaging Radiat Sci 2023; 54:692-698. [PMID: 37838500 DOI: 10.1016/j.jmir.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Ultrasonography measurement of the testicles and subsequent calculation of the testicular volume is recommended as a part of a standard scrotal ultrasound examination. The interobserver variability of testicular volume measurement has implications for surgical recommendations. Therefore, this study aimed to investigate the interobserver variability in the measurement of testicular volume. METHODS Interobserver variability was established by comparing testicular measurements performed by two observers on the same patient during the same clinical appointment. The observers were blinded to each other's measurements. Testicular volume was calculated using the Lambert formula: length x width x height x 0.71. A total of three observers, A, B and C, participated in the study. The observers had between 4 to 20 years' experience with scrotal ultrasound examinations. RESULTS In total, 24 patients' were included (48 testicles). The patient´s mean age was 43 years (range 19-75 years). The overall mean right testicular volume was 19.8 ml (range 7.3-31.6 ml), and the left was 20.1 ml (range 7.1-36.1 ml). The interclass correlation coefficient (ICC) between observer A and B was excellent (ICC= 0.98, CI:0.92-0.99), between observer A and C, was excellent (ICC=0.91, CI: 0.77-0.97) and between B and C good (ICC=0.82, CI:0.51-0.93). CONCLUSION Variability in estimating testicular volume is low, with interobserver agreement ranging from good to excellent. Ultrasound provides a highly reproducible tool to determine testicular volume.
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Affiliation(s)
- Malene Roland Vils Pedersen
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University Hospital of Southern Denmark, Department of Radiology, Kolding hospital, Sygehusvej 24, Kolding, Denmark; University of Southern Denmark, Institute of Regional Health, Campusvej 55, Odense, Denmark.
| | - Peter Obel Otto
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Mads Fredslund
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Claus Smedegaard
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Janni Jensen
- Odense University Hospital, Department of Radiology, J. B Winsløwsvej 4, Odense, Denmark; Research and Innovation Unit of Radiology, University Hospital of Southern Denmark
| | - Mark F McEntee
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University of Southern Denmark, Institute of Regional Health, Campusvej 55, Odense, Denmark; University College Cork, School of Medicine, Discipline of Medical Imaging and Radiation Therapy, Ireland
| | - Martina Kastrup Loft
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University Hospital of Southern Denmark, Department of Radiology, Kolding hospital, Sygehusvej 24, Kolding, Denmark
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Rajaram N, Thelen BJ, Hamilton JD, Zheng Y, Morgan T, Funes-Lora MA, Yessayan L, Shih AJ, Henke P, Osborne N, Bishop B, Krishnamurthy VN, Weitzel WF. Semiautomated Software to Improve Stability and Reduce Operator-Induced Variation in Vascular Ultrasound Speckle Tracking. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2755-2766. [PMID: 35170801 DOI: 10.1002/jum.15960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Ultrasound is useful in predicting arteriovenous fistula (AVF) maturation, which is essential for hemodialysis in end-stage renal disease patients. We developed ultrasound software that measures circumferential vessel wall strain (distensibility) using conventional ultrasound Digital Imaging and Communications in Medicine (DICOM) data. We evaluated user-induced variability in measurement of arterial wall distensibility and upon finding considerable variation we developed and tested 2 methods for semiautomated measurement. METHODS Ultrasound scanning of arteries of 10 subjects scheduled for AVF surgery were performed. The top and bottom of the vessel wall were tracked using the Kanade-Lucas-Tomasi (KLT) feature-tracking algorithm over the stack of images in the DICOM cine loops. The wall distensibility was calculated from the change of vessel diameter over time. Two semiautomated methods were used for comparison. RESULTS The location of points selected by users for the cine loops varied significantly, with a maximum spread of up to 120 pixels (7.8 mm) for the top and up to 140 pixels (9.1 mm) for the bottom of the vessel wall. This variation in users' point selection contributed to the variation in distensibility measurements (ranging from 5.63 to 41.04%). Both semiautomated methods substantially reduced variation and were highly correlated with the median distensibility values obtained by the 10 users. CONCLUSIONS Minimizing user-induced variation by standardizing point selection will increase reproducibility and reliability of distensibility measurements. Our recent semiautomated software may help expand use in clinical studies to better understand the role of vascular wall compliance in predicting the maturation of fistulas.
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Affiliation(s)
- Nirmala Rajaram
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian J Thelen
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Statistics, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, Michigan, USA
| | - James D Hamilton
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Yihao Zheng
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Timothy Morgan
- John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
| | | | - Lenar Yessayan
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Henke
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Osborne
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Brandie Bishop
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Venkataramu N Krishnamurthy
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Radiology, Case Western Reserve, Cleveland, Ohio, USA
| | - William F Weitzel
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Dumont L, Levacher N, Schapman D, Rives-Feraille A, Moutard L, Delessard M, Saulnier J, Rondanino C, Rives N. IHC_Tool: An open-source Fiji procedure for quantitative evaluation of cross sections of testicular explants. Reprod Biol 2021; 21:100507. [PMID: 33906096 DOI: 10.1016/j.repbio.2021.100507] [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: 11/03/2020] [Revised: 03/19/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Immunohistochemical analysis is a routine procedure for clinical and research studies in male fertility. However, most of the interpretations remain subjective and time-consuming, with inherent intra- and inter-observer variability. Given the prognostic and research implications of testicular assessment, a more objective and less time-consuming method is required. In the current study, we used in vitro matured pre-pubertal murine testes as a model. The main objective was to develop an affordable automated digital immunohistochemistry image analysis tool for an unbiased and quantitative assessment of testicular tissue sections. Testicular explants were fixed, cut, and stained for specific germ cell markers. The classical manual counting procedure was evaluated. Background and noise were reduced on brightfield images. Photomicrographs were stitched (Background_Elimination_Stitching) to create high-quality images. Two procedures were evaluated (IHC_Tool and Stained_Nuclear_Area); then a procedure (Necrotic_Area_Elimination) allowing withdrawal of the necrotic area observed after culture was assessed. Finally, the number of stained nuclei in the unaltered tissue area was extracted. The automated IHC_Tool procedure with images saved as TIFF at a ×200 magnification allowed the most rigorous cell quantification. IHC_Tool developed for testicular sample analysis can be used for various types of tissues. We foresee that this method will minimize inter-observer variations across laboratories and will be helpful for clinical trials and translational initiatives.
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Affiliation(s)
- Ludovic Dumont
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Department of Reproductive Biology - CECOS, F 76000, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.
| | | | - Damien Schapman
- Normandie Univ, UNIROUEN, INSERM, PRIMACEN, F 76000, Rouen, France
| | - Aurélie Rives-Feraille
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Department of Reproductive Biology - CECOS, F 76000, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Laura Moutard
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Department of Reproductive Biology - CECOS, F 76000, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Marion Delessard
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Department of Reproductive Biology - CECOS, F 76000, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Justine Saulnier
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Department of Reproductive Biology - CECOS, F 76000, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Christine Rondanino
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Department of Reproductive Biology - CECOS, F 76000, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Nathalie Rives
- Normandie Univ, UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, Department of Reproductive Biology - CECOS, F 76000, Rouen, France; Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
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You JH, Zhuang YF, Lu MZ, Chen L, Chen ZK, Chen XK. Three‑Dimensional Ultrasonography in Preoperative and Postoperative Volume Assessment of the Undescended Testicle. Med Sci Monit 2020; 26:e924325. [PMID: 33046685 PMCID: PMC7568441 DOI: 10.12659/msm.924325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasound (US) is the preferred imaging method for cryptorchidism, but most guidelines indicate that its value is questionable. The aim of this study was to evaluate the clinical value of ultrasonic mobility and testicular atrophy index (TAI) based on three‑dimensional US (3DUS) in preoperative and postoperative assessment of the undescended testis. MATERIAL AND METHODS Data from 158 children with unilateral extraperitoneal cryptorchidism were collected and their diagnoses were surgically confirmed. They were divided into different age groups and into 2 ultrasonic mobility groups: the mobile group (MG) and the restricted group (RG). Differences in sonographic characteristics between different groups were compared. Three-dimensional ultrasound performed with virtual organ computer-aided analysis (VOCAL) was used to determined preoperative and postoperative TAI and the reliability of TAI was analyzed. RESULTS Measurement of testicular volume with the VOCAL method was significantly more reliable than that done with the two-dimensional Lambert method. In all age groups, preoperative testicular volumes were smaller than that in the contralateral scrotal testis and postoperatively, they increased steadily. Both preoperative and postoperative TAI were higher in the RG than in the MG. In the MG, postoperative TAI decreased significantly in all age groups. In the RG, in contrast, effective volume growth was only achieved in patients who had undergone surgery before they reached age 1 year. CONCLUSIONS TAI values determined with 3DUS using the VOCAL technique objectively reflect recovery of testicular volume following surgery for undescended testicle. Ultrasonic mobility evaluation is beneficial for clinical management of the condition.
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Affiliation(s)
- Jian-Hong You
- Department of Ultrasound, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, P.R. China
| | - Yi-Fan Zhuang
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, P.R. China
| | - Ming-Zhu Lu
- Department of General Surgery, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, P.R. China
| | - Ling Chen
- Department of Neonatology, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, P.R. China
| | - Ze-Kun Chen
- Department of Ultrasound, Children’s Hospital of Fudan University Xiamen Branch, Xiamen Children’s Hospital, Xiamen, Fujian, P.R. China
| | - Xiao-Kang Chen
- Department of Ultrasound, Children’s Hospital of Fudan University Xiamen Branch, Xiamen Children’s Hospital, Xiamen, Fujian, P.R. China
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Leadership to improve consistency in echocardiography data. J Echocardiogr 2020; 18:265-266. [PMID: 32500355 DOI: 10.1007/s12574-020-00478-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
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