Lung Ultrasound Protocol and Quality Control of Image Interpretation Using an Adjudication Panel in the Household Air
Suzanne M Simkovich1, Shakir Hossen2, Eric D McCollum3
1Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Healthcare Delivery, MedStar Health Research Institute, Hyattsville, MD, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, DC, USA.
Insights
Lung ultrasound (LUS) provides a reliable method for diagnosing pneumonia in infants, crucial for research and disease surveillance. Standardized protocols ensure high confidence in LUS pneumonia diagnosis.
Area of Science:
- Pediatric infectious diseases
- Medical imaging
- Ultrasound diagnostics
Background:
- Chest radiography is standard for pneumonia diagnosis, but lung ultrasound (LUS) offers an alternative.
- Standardized LUS methods are needed for research and disease surveillance of pneumonia.
Purpose of the Study:
- To develop and evaluate standardized lung ultrasound (LUS) methods for diagnosing severe pneumonia in infants.
- To assess the feasibility and reliability of LUS for pneumonia diagnosis in a multi-center trial.
Main Methods:
- Developed standardized LUS definitions, protocols for recruitment, training, image acquisition, and interpretation.
- Utilized a blinded panel approach with randomized LUS cine-loops and expert review for diagnosis.
- Collected 357 LUS scans across Guatemala, Peru, and Rwanda.
Main Results:
- Pneumonia diagnosis required expert input in 39% of cases.
- Lung ultrasound diagnosed pneumonia in 40% of scans, with 60% negative and <1% uninterpretable.
- Inter-reader agreement ranged from 62% to 67%, with kappa values between 0.24 and 0.33.
Conclusions:
- Standardized imaging protocols, sonographer training, and an adjudication panel enhance diagnostic confidence for pneumonia using LUS.
- LUS is a viable tool for pneumonia diagnosis in infants, supporting its use in research and surveillance.
Objective:
Lung ultrasound (LUS) is an alternative to chest radiography to confirm a diagnosis of pneumonia. For research and disease surveillance, methods to use LUS to diagnose pneumonia are needed.
Methods:
In the Household Air Pollution Intervention Network (HAPIN) trial, LUS was used to confirm a clinical diagnosis of severe pneumonia in infants. We developed a standardized definition of pneumonia, protocols for recruitment and training of sonographers, along with LUS image acquisition and interpretation. We use a blinded panel approach to interpretation with LUS cine-loops randomized to non-scanning sonographers with expert review.
Discussion:
We obtained 357 lung ultrasound scans: 159, 8 and 190 scans were collected in Guatemala, Peru and Rwanda, respectively. The diagnosis of primary endpoint pneumonia (PEP) required an expert tie breaker in 181 scans (39%). PEP was diagnosed in 141 scans (40%), not diagnosed in 213 (60%), with 3 scans (<1%) deemed uninterpretable. Agreement among the two blinded sonographers and the expert reader in Guatemala, Peru and Rwanda was 65%, 62% and 67%, with a prevalence-and-bias-corrected kappa of 0.30, 0.24 and 0.33, respectively.
Conclusion:
Use of standardized imaging protocols, training and an adjudication panel resulted in high confidence for the diagnosis of pneumonia using LUS.
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