Comparison of Ultrasound Image Quality Between Users on a Novel Automated Device for Extremity Injury

Plain radiography traditionally serves as the first-line imaging modality for extremity injuries. However, x-rays have limitations in subtle fracture detection and soft tissue visualization. Ultrasound represents an alternative modality with potential diagnostic benefit but requires substantial operator expertise.

We sought to evaluate the image quality and patient comfort associated with a novel volumetric ultrasound system (Accuro XV) that intends to automate imaging acquisition. Scans obtained by clinical research assistants (CRAs) were compared to those obtained by board-certified emergency physicians.

This was a prospective, multi-site study of patients aged 5 and older presenting with acute ankle or wrist trauma. 205 subjects were enrolled, each undergoing x-ray and Accuro XV imaging. Pain levels were assessed using a Numerical Rating Scale. Fifty CRA and 50 physician-acquired studies were randomly selected for blinded image quality analysis.

There was no significant difference in image quality between CRA and physician groups (mean scores 3.6 vs. 3.7; p = 0.24), with over 90% of studies rated as diagnostically adequate. Interrater reliability amongst reviewers was moderate (intraclass correlation coefficient 0.53-0.56). Pain scores were similar with both showing minimal discomfort (median pain increase during imaging of 0; interquartile range 0-1).

This study demonstrates the feasibility of high-quality extremity ultrasound imaging using the Accuro XV device, including by nonphysician operators with minimal training. The technology shows potential for broader adoption in acute care with nonphysician operators. Further studies are warranted to evaluate diagnostic accuracy and clinical impact.