Associations of Ultrasound LI-RADS Visualization Score With Examination, Sonographer, and Radiologist Factors: Retrospective Assessment in Over 10,000 Examinations.
Associations of Ultrasound LI-RADS Visualization Score With Examination, Sonographer, and Radiologist Factors: Retrospective Assessment in Over 10,000 Examinations.
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DOI：
10.2214/ajr.21.26735
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发表时间：
2022-06
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在进行超声(US)筛查肝细胞癌时，许多因素可能会影响肝脏的可视化，潜在地降低敏感性。美国LI-RADS包括可视化评分，作为技术充分性的衡量标准。本文的目的是确定检查、超声和放射科医生因素与肝脏US肝细胞癌筛查的可视化评分之间的关系。这项回顾性研究包括6598名肝癌高危患者(3979名男性，2619名女性；平均年龄58岁)，他们总共接受了91名超声医生进行的10,589次肝脏超声检查，并由50名放射科医生进行了翻译。可视化评分(A，无限制或轻微限制；B，中度限制；C，严重限制)从临床报告中提取。记录患者的就诊地点(急诊科、住院患者、门诊患者)、超声医师和放射科医师在研究期间的肝脏超声检查(50、50-500和500次检查)，以及放射科医师的执业模式(US、腹部、社区、介入)。研究了视觉化分数与视觉化程度的关系。A、B、C组的可视化评分频率分别为71.5%、24.2%、4.2%。在ED患者(49.8%、40.1%和10.2%)、住院患者(58.8%、33.9%和7.3%)和门诊患者(76.7%、20.3%和2.9%)的检查中，得分差异显著(p<；.001)。分数在以下方面也有显著差异(p<；.001)：超声医师数量(<；50次考试：58.4%、33.7%和7.9%；>；500次考试：72.9%、22.5%和4.6%)；读者量(<；50次考试：62.9%、29.9%和7.1%；>；500考试：67.3%、28.0%和4.7%)；和读者实践模式(美国：74.5%、21.3%和4.3%；腹部：67.0%、28.1%和4.8%；社区：75.2%、21.9%和2.9%；干预性：68.5%、24.1%和7.4%)。在多变量分析中，评分C的独立预测因素是患者位置(ED/住院患者：优势比[OR]，2.62；P<；.001)和超声诊断员数量(<；50：OR，1.55；p=.01)。在进行50次或以上检查的超声师中，C分的门诊检查百分比在0.8%到5.4%之间；9/33人超过上限95%的可信区间3.2%。美国LI-RADS可视化评分可以确定影响肝癌筛查检查质量的因素，并根据检查质量较差确定离群点超声师。该方法还突出了放射科医生在其质量评估过程中潜在的系统性偏差。这些发现可应用于指导有针对性的质量改进工作，并建立筛查项目的最佳实践和绩效标准。
When performing ultrasound (US) for hepatocellular carcinoma (HCC) screening, numerous factors may impair hepatic visualization, potentially lowering sensitivity. US LI-RADS includes a visualization score as a technical adequacy measure. The purpose of this article is to identify associations between examination, sonographer, and radiologist factors and the visualization score in liver US HCC screening. This retrospective study included 6598 patients (3979 men, 2619 women; mean age, 58 years) at risk for HCC who underwent a total of 10,589 liver US examinations performed by 91 sonographers and interpreted by 50 radiologists. Visualization scores (A, no or minimal limitations; B, moderate limitations; C, severe limitations) were extracted from clinical reports. Patient location (emergency department [ED], inpatient, outpatient), sonographer and radiologist liver US volumes during the study period (< 50, 50–500, > 500 examinations), and radiologist practice pattern (US, abdominal, community, interventional) were recorded. Associations with visualization scores were explored. Frequencies of visualization scores were 71.5%, 24.2%, and 4.2% for A, B, and C, respectively. Scores varied significantly (p < .001) between examinations performed in ED patients (49.8%, 40.1%, and 10.2%), inpatients (58.8%, 33.9%, and 7.3%), and outpatients (76.7%, 20.3%, and 2.9%). Scores also varied significantly (p < .001) by sonographer volume (< 50 examinations: 58.4%, 33.7%, and 7.9%; > 500 examinations: 72.9%, 22.5%, and 4.6%); reader volume (< 50 examinations: 62.9%, 29.9%, and 7.1%; > 500 examinations: 67.3%, 28.0%, and 4.7%); and reader practice pattern (US: 74.5%, 21.3%, and 4.3%; abdominal: 67.0%, 28.1%, and 4.8%; community: 75.2%, 21.9%, and 2.9%; interventional: 68.5%, 24.1%, and 7.4%). In multivariable analysis, independent predictors of score C were patient location (ED/inpatient: odds ratio [OR], 2.62; p < .001) and sonographer volume (< 50: OR, 1.55; p = .01). Among sonographers performing 50 or more examinations, the percentage of outpatient examinations with score C ranged from 0.8% to 5.4%; 9/33 were above the upper 95% CI of 3.2%. The US LI-RADS visualization score may identify factors affecting quality of HCC screening examinations and identify outlier sonographers in terms of poor examination quality. The approach also highlights potential systematic biases among radiologists in their quality assessment process. These findings may be applied to guide targeted quality improvement efforts and establish best practices and performance standards for screening programs.