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Thứ Sáu, 22 tháng 12, 2017

JACR: Rads want more help with point-of-care ultrasound


By Kate Madden Yee, AuntMinnie.com staff writer
December 21, 2017 -- Radiologists would like more support from the American College of Radiology (ACR) for point-of-care ultrasound, according to an analysis of data from the ACR's 2017 workforce survey published December 19 in the Journal of the American College of Radiology.

Why is point-of-care ultrasound such a concern? Because it's complicated, according to co-authors Dr. Jay Harolds of Michigan State University in Grand Rapids and Dr. Edward Bluth of the Ochsner Clinic Foundation in New Orleans.
"[Point-of-care ultrasound] is complex -- potentially involving educational and reimbursement issues, standard setting, leadership development, marketing, and lobbying -- and does not have an easy solution," they wrote. "The ACR's study of this problem and development of a recommended comprehensive strategy ... would be of value."
This year, the ACR's workforce survey asked about areas in which Practice of Radiology Environment Database (PRED) group leaders would like more help. The survey was conducted between January and March. Out of 1,800 group leaders, 477 responded, for a response rate of 26%.
In response to the question about what areas survey participants would like additional help with from ACR leadership, 52% identified point-of-care ultrasound as a "somewhat high" to "high" priority, Harolds and Bluth wrote. Turf issues were the second most important issue to survey respondents, and the development of a patient satisfaction survey was the third.
Areas where radiologists want support from the ACR
IssueSomewhat high to high priority
Point-of-care ultrasound52%
Turf issues36%
Development of a patient satisfaction survey28%
Development of a referring physician satisfaction survey22%
Documenting non-relative value unit (RVU) added-value activities14%
The researchers also found that the majority of participants (67%) were satisfied with their involvement in managing allied health professionals. However, almost a third (28%) were dissatisfied or very dissatisfied with their level of involvement in the management of radiology IT activities.
"A potential cause of this dissatisfaction is highlighted by the survey result showing that only 29% of radiology IT resources report directly to radiology leaders compared to 49% that report to institutional IT departments," they wrote.
When asked about their influence within their own institution, 26% of survey respondents said they believe it has decreased, Harolds and Bluth noted.

"The fact that more than one-quarter of responding radiology department leaders feel their influence is diminishing is concerning and should be carefully monitored to determine if this is a developing trend," they wrote. "Perhaps the use of ACR resources such as the Radiology Leadership Institute should be further emphasized and made more easily available."

Chủ Nhật, 3 tháng 12, 2017

Meta-analysis: ARFI Elastography versus Transient Elastography for the Evaluation of Liver Fibrosis.

 2013 Sep;33(8):1138-47. doi: 10.1111/liv.12240. Epub 2013 Jul 16.

Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis.

Bota S1, Herkner H, Sporea I, Salzl P, Sirli R, Neghina AM, Peck-Radosavljevic M.

Abstract

AIMS:

This meta-analysis aims to compare the diagnostic performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis using liver biopsy (LB) as 'gold-standard'.

METHODS:

PubMed, Medline, Lilacs, Scopus, Ovid, EMBASE, Cochrane and Medscape databases were searched for all studies published until 31 May 2012 that evaluated the liver stiffness by means of ARFI, TE and LB. Information abstracted from each study according to a fixed protocol included study design and methodological characteristics, patient characteristics, interventions, outcomes and missing outcome data.

RESULTS:

Thirteen studies (11 full-length articles and 2 abstracts) including 1163 patients with chronic hepatopathies were included in the analysis. Inability to obtain reliable measurements was more than thrice as high for TE as that of ARFI (6.6% vs. 2.1%, P< 0.001). For detection of significant fibrosis, (F ≥ 2) the summary sensitivity (Se) was 0.74 (95% CI: 0.66-0.80) and specificity (Sp) was 0.83 (95% CI: 0.75-0.89) for ARFI, while for TE the Se was 0.78 (95% CI: 0.72-0.83) and Sp was 0.84 (95% CI: 0.75-0.90). For the diagnosis of cirrhosis, the summary Se was 0.87 (95% CI: 0.79-0.92) and Sp was 0.87 (95% CI: 0.81-0.91) for ARFI elastography, and, respectively, 0.89 (95% CI: 0.80-0.94) and 0.87 (95% CI: 0.82-0.91) for TE. The diagnostic odds ratio of ARFI and TE did not differ significantly in the detection of significant fibrosis [mean difference in rDOR = 0.27 (95% CI: 0.69-0.14)] and cirrhosis [mean difference in rDOR = 0.12 (95% CI: 0.29-0.52)].

CONCLUSION:

Acoustic radiation force impulse elastography seems to be a good method for assessing liver fibrosis, and shows higher rate of reliable measurements and similar predictive value to TE for significant fibrosis and cirrhosis.

KEYWORDS:

ARFI; acoustic radiation force impulse elastography; fibroscan®; liver fibrosis; liver stiffness; transient elastography

Which are the cut-off values of 2D-Shear Wave Elastography (2D-SWE) liver stiffness measurements predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method?
Ioan SporeaDescription: 'Correspondence information about the author Ioan SporeaDescription: http://www.ejradiology.com/templates/jsp/_style2/_marlin/images/icon_email.pngEmail the author Ioan Sporea
Simona Bota1,Description: http://www.ejradiology.com/templates/jsp/_style2/_marlin/images/icon_email.pngEmail the author Simona Bota
Oana Gradinaru-Taşcău2,Description: http://www.ejradiology.com/templates/jsp/_style2/_marlin/images/icon_email.pngEmail the author Oana Gradinaru-Taşcău
Roxana Şirli2,Description: http://www.ejradiology.com/templates/jsp/_style2/_marlin/images/icon_email.pngEmail the author Roxana Şirli
Alina Popescu2,Description: http://www.ejradiology.com/templates/jsp/_style2/_marlin/images/icon_email.pngEmail the author Alina Popescu
Ana Jurchiş2,Description: http://www.ejradiology.com/templates/jsp/_style2/_marlin/images/icon_email.pngEmail the author Ana Jurchiş
Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
1Address: 2, Str. Intrarea Martir Angela Sava, 300742 Timisoara, Romania. Tel.: +40 256488003; fax: +40 256488003.
2Address: 10, Bd. Iosif Bulbuca, 300736 Timisoara, Romania. Tel.: +40 256488003; fax: +40 256488003.

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European Journal of Radiology, March 2014Volume 83, Issue 3, Pages e118–e122

Abstract
Introduction
To identify liver stiffness (LS) cut-off values assessed by means of 2D-Shear Wave Elastography (2D-SWE) for predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method.
Methods
Our prospective study included 383 consecutive subjects, with or without hepatopathies, in which LS was evaluated by means of TE and 2D-SWE. To discriminate between various stages of fibrosis by TE we used the following LS cut-offs (kPa): F1-6, F2-7.2, F3-9.6 and F4-14.5.
Results
The rate of reliable LS measurements was similar for TE and 2D-SWE: 73.9% vs. 79.9%, p=0.06. Older age and higher BMI were associated for both TE and 2D-SWE with the impossibility to obtain reliable LS measurements. Reliable LS measurements by both elastographic methods were obtained in 65.2% of patients. A significant correlation was found between TE and 2D-SWE measurements (r=0.68). The best LS cut-off values assessed by 2D-SWE for predicting different stages of liver fibrosis were: F1: >7.1kPa (AUROC=0.825); F2: >7.8kPa (AUROC=0.859); F3: >8kPa (AUROC=0.897) and for F=4: >11.5kPa (AUROC=0.914).
Conclusions
2D-SWE is a reliable method for the non-invasive evaluation of liver fibrosis, considering TE as the reference method. The accuracy of 2D-SWE measurements increased with the severity of liver fibrosis.
Keywords: