title: Quality assurance of lower limb venous duplex scans performed by vascular surgeons.
abstract: OBJECTIVE
  Duplex scanning is the gold standard for investigating venous reflux; increasingly surgeons perform these scans themselves. There has been no data published analysing the accuracy of Duplex scans performed by vascular surgeons. We aimed to evaluate an objective method of comparing the results of lower limb Duplex scans performed by one consultant vascular surgeon with those performed by a vascular technologist.
  
  
  METHODS
  We assessed 100 legs with symptomatic varicose veins. Each patient underwent two lower limb venous Duplex scans; one performed by a consultant vascular surgeon and one by a vascular technologist. Scan results were randomised and sent to two consultant vascular surgeons blinded to the identity and experience of the sonographer. They were asked to recommend treatment. A k score was calculated in each case to assess the level of agreement between the scans performed by the consultant and the technologist.
  
  
  RESULTS
  Eighty-one patients were studied (53 females). The kappa score for assessor 1 was 0.60 (95%CI:0.44-0.75) and for assessor 2 was 0.62 (95%CI:0.48-0.75). k scores >0.60 represent a substantial strength of agreement.
  
  
  CONCLUSIONS
  Duplex scans performed by this surgeon were comparable to those performed by a vascular technologist. It is possible to quality-assure duplex performed by vascular surgeons without directly observing the scanning process or reviewing digitally recorded images. We propose standardisation of training, assessment and quality assurance for vascular surgeons wishing to perform ultrasound scans.
authors.affiliation: Department of Vascular Surgery, Royal Bolton Hospital, Bolton, UK - madu@doctors.org.uk.
authors.forename: A
authors.initials: A
authors.lastname: Kordowicz
authors.forename: G
authors.initials: G
authors.lastname: Ferguson
authors.forename: R
authors.initials: R
authors.lastname: Salaman
authors.forename: M
authors.initials: M
authors.lastname: Onwudike
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities / Q000592:standards; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D011785:Quality Assurance, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D013038:Specialization; D018616:Ultrasonography, Doppler, Duplex / Q000592:standards*; D014656:Vascular Surgical Procedures; D014680:Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult