title: Standardized cine-loop documentation in renal ultrasound facilitates skill-mix between radiographer and radiologist.
abstract: BACKGROUND
  The radiographers' role in ultrasound (US) has been debated due to the operator-dependent aspect of diagnostic US. With standardized cine-loop ultrasound (SCUS) a reliable diagnosis can be achieved by reading SCUS independently from performing the procedure.
  
  
  OBJECTIVE
  To study the correlation between sonographic findings when SCUS is performed and read by a radiologist and when SCUS is performed by a radiographer and read by a radiologist, and to assess the radiologists' confidence when reading SCUS examinations performed by a radiographer.
  
  
  METHODS
  Thirty-four patients (64 kidneys) who underwent SCUS of the kidneys were included in this study. All patients underwent two consecutive SCUS examinations, one performed by an experienced radiologist reading his own examination (online), and one performed by a SCUS-trained radiographer, read by an experienced radiologist who was not involved in the examination of the patient (offline). Study reports were made using a structured report form designed for this study. Confidence was measured on a visual analog scale ranging from 0 (no confidence) to 100 (extremely confident). The final diagnosis (the reference standard) was defined as the consensus between two US-experienced radiologists. All personnel were blinded to each other's results.
  
  
  RESULTS
  We found discordance between image findings for online and offline in eight out of 64 kidneys. There was no systematic difference between online and offline reading. There was a good correlation between online and offline, kappa 0.75 (95% CI 0.60-0.90, P < 0.001). Kappa correlation for online and offline compared to reference standard was 0.94 (95% CI 0.86-1.00, P < 0.001) and 0.81 (95% CI 0.66-0.96, P < 0.001), respectively. Radiologists reported a confidence level of 88 (range, 74-94) and 85 (range, 67-92) in the online and offline group, respectively (P = 0.005).
  
  
  CONCLUSIONS
  There is a high degree of correlation between reported findings in radiologist and radiographer performed SCUS examinations.
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway uxgaam@ous-hf.no.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaarder
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Therese
authors.initials: T
authors.lastname: Seierstad
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Robin
authors.initials: R
authors.lastname: Søreng
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Drolsum
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Kubra
authors.initials: K
authors.lastname: Begum
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Johann Baptist
authors.initials: JB
authors.lastname: Dormagen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004282:Documentation / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009862:Online Systems; D011859:Radiography / Q000592:standards*; D011871:Radiology / Q000592:standards*; D012015:Reference Standards; D015203:Reproducibility of Results; D014463:Ultrasonography; D055815:Young Adult
keywords: Health policy and practice; adults; comparative studies; computer applications – teleradiology; ultrasound