RT Journal Article
SR Electronic
T1 Lung ultrasound volume sweep imaging for respiratory illness: a new horizon in expanding imaging access
JF BMJ Open Respiratory Research
JO BMJ Open Resp Res
FD British Thoracic Society
SP e000919
DO 10.1136/bmjresp-2021-000919
VO 8
IS 1
A1 Thomas J Marini
A1 Justin M Weis
A1 Timothy M Baran
A1 Jonah Kan
A1 Steven Meng
A1 Alex Yeo
A1 Yu T Zhao
A1 Robert Ambrosini
A1 Sean Cleary
A1 Deborah Rubens
A1 Mitchell Chess
A1 Benjamin Castaneda
A1 Ann Dozier
A1 Timothy O'Connor
A1 Brian Garra
A1 Katherine Kaproth-Joslin
YR 2021
UL http://bmjopenrespres.bmj.com/content/8/1/e000919.abstract
AB Background Respiratory illness is a leading cause of morbidity in adults and the number one cause of mortality in children, yet billions of people lack access to medical imaging to assist in its diagnosis. Although ultrasound is highly sensitive and specific for respiratory illness such as pneumonia, its deployment is limited by a lack of sonographers. As a solution, we tested a standardised lung ultrasound volume sweep imaging (VSI) protocol based solely on external body landmarks performed by individuals without prior ultrasound experience after brief training. Each step in the VSI protocol is saved as a video clip for later interpretation by a specialist.Methods Dyspneic hospitalised patients were scanned by ultrasound naive operators after 2 hours of training using the lung ultrasound VSI protocol. Separate blinded readers interpreted both lung ultrasound VSI examinations and standard of care chest radiographs to ascertain the diagnostic value of lung VSI considering chest X-ray as the reference standard. Comparison to clinical diagnosis as documented in the medical record and CT (when available) were also performed. Readers offered a final interpretation of normal, abnormal, or indeterminate/borderline for each VSI examination, chest X-ray, and CT.Results Operators scanned 102 subjects (0–89 years old) for analysis. Lung VSI showed a sensitivity of 93% and a specificity of 91% for an abnormal chest X-ray and a sensitivity of 100% and a specificity of 93% for a clinical diagnosis of pneumonia. When any cases with an indeterminate rating on chest X-ray or ultrasound were excluded (n=38), VSI lung ultrasound showed 92% agreement with chest X-ray (Cohen’s κ 0.83 (0.68 to 0.97, p<0.0001)). Among cases with CT (n=21), when any ultrasound with an indeterminate rating was excluded (n=3), there was 100% agreement with VSI.Conclusion Lung VSI performed by previously inexperienced ultrasound operators after brief training showed excellent agreement with chest X-ray and high sensitivity and specificity for a clinical diagnosis of pneumonia. Blinded readers were able to identify other respiratory diseases including pulmonary oedema and pleural effusion. Deployment of lung VSI could benefit the health of the global community.Data are available upon reasonable request.