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Author Spotlight: Assessing the Reliability of Doppler Ultrasound in Measuring Leg Blood Flow
Published on: December 15, 2023
'Current trends in lower limb Doppler scanning in Ireland'
1University of Cumbria, Lancaster, United Kingdom; University College Dublin, Ireland.
Insights
Irish ultrasound departments show inconsistent practices for diagnosing deep vein thrombosis (DVT). A lack of standardized protocols and awareness of guidelines impacts patient care, particularly for below knee DVT (BKDVT).
Area of Science:
- Medical Imaging
- Vascular Ultrasound
- Deep Vein Thrombosis Diagnosis
Background:
- Clinical diagnosis and treatment of above knee deep vein thrombosis (AKDVT) are established.
- The necessity of diagnosing and treating below knee deep vein thrombosis (BKDVT) remains debated, leading to varied clinical practices.
- This variation necessitates an investigation into current diagnostic standards in Irish ultrasound departments.
Purpose of the Study:
- To determine if a standardized practice exists for deep vein thrombosis (DVT) diagnosis in Irish ultrasound departments.
- To identify the current practices and information sources used by sonographers for DVT diagnosis.
- To highlight inconsistencies in DVT diagnostic protocols and their underlying guidelines.
Main Methods:
- A questionnaire was developed using SurveyMonkey to gather data on sonographer experience, examination types, and protocols.
- The survey was distributed online to sonographers across Irish ultrasound departments.
- Questions addressed adherence to protocols, reasons for deviation, and awareness of DVT management.
Main Results:
- Ninety responses were collected, revealing a near-even split in scanning practices: 49% routinely perform whole leg ultrasound, while 46% perform proximal ultrasound only.
- Only 41% of protocols were based on clinical guidelines, with 22% of participants unaware of these guidelines.
- A significant number of respondents (49%) were uncertain about patient treatment following a negative DVT ultrasound with high clinical suspicion.
Conclusions:
- A significant inconsistency in sonographer practices and scanning approaches for DVT diagnosis was established nationwide.
- Inconsistencies extend to the guidelines informing departmental protocols and the terminology used in radiology reporting.
- There is a need for national consensus on DVT diagnostic protocols, particularly for BKDVT, to ensure equitable patient care and standardized sonographer training.
Introduction:
The clinical need to diagnose and treat above knee deep vein thrombosis (AKDVT) has long been established in literature and in practice. On the other hand, the need to diagnose and treat below knee deep vein thrombosis (BKDVT) continues to be debated in literature. This has resulted in variation in clinical guidelines and protocols nationwide. This research aims to establish if there is a standard practice in Irish ultrasound departments and if so, what that practice is and where sonographers are getting information to inform this.
Methods:
A questionnaire was designed using SurveyMonkey and distributed using online platforms. The questionnaire aimed to establish the experience of the sonographer, the types of exams performed, protocols/guidelines used as well as scenarios where the sonographer might deviate from protocol.
Results:
The study yielded 90 responses. The research found 49% of sites perform whole leg ultrasound routinely and 46% perform proximal ultrasound only. 41% of respondents said their protocols were based on clinical guidelines however, 22% of participants didn't know what these guidelines were. 49% of respondents were unaware of what treatment a patient would receive in cases where there is a high clinical suspicion of DVT, but the ultrasound is negative for DVT.
Conclusion:
The research has established a lack of consistency amongst sonographers and scanning practices with a fairly even split (49% of respondents perform whole leg ultrasound and 46% perform proximal only). Not only has the research identified a lack of standardised scanning approach nationwide, but inconsistencies are also seen in the guidelines that inform our department's protocols as well as inconspicuous terms used in radiology reporting and jargon in literature in relation to DVT.
Implications For Practice:
1. An inconsistency in practice has been established. Discussions are now needed to decide what guidelines should be implemented into Irish Ultrasound DVT protocols. 2. A national protocol for BKDVT would result in all patients in Ireland having access to the same standard of care. 3. Call for consensus on appropriate training for sonographers undertaking LLDs.
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