Standardized cine-loop documentation in abdominal ultrasound facilitates offline image interpretation

One of the main disadvantages of conventional ultrasound is its operator dependency, which might impede the reproducibility of the sonographic findings. A new approach with cine-loops and standardized scan protocols can overcome this drawback.

To compare abdominal ultrasound findings of immediate bedside reading by performing radiologist with offline reading by a non-performing radiologist, using standardized cine-loop sequences.

Over a 6-month period, three radiologists performed 140 dynamic ultrasound organ-based examinations in 43 consecutive outpatients. Examination protocols were standardized and included predefined probe position and sequences of short cine-loops of the liver, gallbladder, pancreas, kidneys, and urine bladder, covering the organs completely in two planes. After bedside examinations, the studies were reviewed and read out immediately by the performing radiologist. Image quality was registered from 1 (no diagnostic value) to 5 (excellent cine-loop quality). Offline reading was performed blinded by a radiologist who had not performed the examination. Bedside and offline reading were compared with each other and with consensus results.

In 140 examinations, consensus reading revealed 21 cases with renal disorders, 17 cases with liver and bile pathology, and four cases with bladder pathology. Overall inter-observer agreement was 0.73 (95% CI 0.61-0.91), with lowest agreement for findings of the urine bladder (0.36) and highest agreement in liver examinations (0.90). Disagreements between the two readings were seen in nine kidneys, three bladder examinations, one pancreas and bile system examinations each, and in one liver, giving a total number of mismatches of 11%. Nearly all cases of mismatch were of minor clinical significance. The median image quality was 3 (range, 2-5) with most examinations deemed a quality of 3. Compared to consensus reading, overall accuracy was 96% for bedside reading and 94% for offline reading.

Standardized cine-loop documentation enables accurate offline reading in abdominal ultrasound and shows high agreement with immediate bedside reading.