title: Effects of position and operator on high-frequency ultrasound scan quality.
abstract: OBJECTIVE
  High-frequency ultrasound may evaluate those at risk for pressure ulcers. Images may be obtained by clinicians with limited training. The prone position is recommended for obtaining sacral scans but may not be feasible in the critically ill. This study investigated image quality using multiple operators and a variety of patient positions.
  
  
  METHODS
  Sacral scans were performed in three randomised positions in 50 volunteers by three different investigators using a 20 MHz ultrasound system. General linear models and ANOVA random effects models were used to examine the effects of operator and position on image quality rating, and measures of dermal thickness and dermal density.
  
  
  RESULTS
  The best scan for each position and operator was used for analysis (n=447 images). Image rating varied by operator (p=0.0004), although mean ratings were 3.5 or above for all operators. Dermal thickness was less for the prone position than in 90° or 60° side-lying positions (p=0.0137, p=0.0003). Dermal density was lower for the prone position than for the 90° or 60° positions (p<0.0001 for both).
  
  
  CONCLUSIONS
  These data show that overall scan quality was acceptable in all positions with all operators. However, differences were found between side-lying positions and the prone for dermal thickness and dermal density measures.
authors: School of Nursing, University of Texas, Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX 77030, United States.
authors: Ruth S
authors: RS
authors: Burk
authors: CVS Minute Clinic, Richmond, VA, United States.
authors: Angela
authors: A
authors: Parker
authors: School of Nursing, Virginia Commonwealth University, 1100 East Leigh Street, Richmond, VA 23298-0567, United States.
authors: Lisa
authors: L
authors: Sievers
authors: Georgia Kidney Associates, 55 Whitcher Street, Marietta, GA 30060, United States.
authors: Melissa B
authors: MB
authors: Rooney
authors: School of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA 23284-3068, United States.
authors: Anathea
authors: A
authors: Pepperl
authors: Department of Mathematics and Statistics, Air Force Institute of Technology, 2950 Hobson Way, Wright-Patterson Air Force Base, OH 45433, United States.
authors: Christine M
authors: CM
authors: Schubert
authors: School of Nursing, Virginia Commonwealth University, 1100 East Leigh Street, Richmond, VA 23298-0567, United States. Electronic address: mjgrap@vcu.edu.
authors: Mary Jo
authors: MJ
authors: Grap
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D011187:Posture; D003668:Pressure Ulcer / Q000000981:diagnostic imaging* / Q000451:nursing; D016684:Prone Position; D012445:Sacrococcygeal Region; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: Evaluation; High frequency ultrasound; Position; Pressure ulcers; Skin integrity; Technology
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