title: Efficacy and Accessibility of a Novel Liver Fibrosis Evaluation Program: Limited Abdominal Ultrasound with Concurrent Transient Elastography.
abstract: OBJECTIVE
  To review sustainability and fair access related to setting up a centralized transient elastography (TE) program in the radiology department and to perform a quality assessment of a novel liver fibrosis evaluation program that combines TE with limited abdominal ultrasound (US).
  
  
  METHODS
  As part of a quality assessment, a retrospective chart review was performed on 758 patients who underwent TE immediately after limited abdominal US of the liver over a 12-month period. The elastography results and sonographic findings were documented, including the number and type of lesions identified. In terms of fair access evaluation, the indication for TE and referring service was reviewed for each case.
  
  
  RESULTS
  Most referrals were initiated by infectious disease (52.2% [396 of 758]) or gastroenterology (46.3% [351 of 758]) for patients with viral hepatitis (29.8% [226 of 758] for HBV and 52.2% [396 of 758] for HCV) and nonalcoholic steatohepatitis (11.9% [90 of 758]). Only 3.2% (24 of 758) of indications were outside the usual indications for which standardized values of TE were available. Most studies demonstrated minimal fibrosis (66.6% [510 of 766] ≤F1) or more advanced fibrosis (21.1% [162 of 766] ≥F3). Liver nodularity was observed in 63 cases, correlating to F2 fibrosis and above in 81.0% (51 of 63). US screening detected five new cases of hepatocellular carcinoma (HCC).
  
  
  CONCLUSIONS
  This unique program allows fair access and ensures that referrals are requested for appropriate indications. Concurrent US confers many advantages including proper TE probe placement to optimize measurement success, characterization of sonographic features that correlate with advanced fibrosis, and provides an opportunity to screen for HCC, in a population which may not otherwise have access to standardized screening.
authors: Department of Radiology, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada. Electronic address: cory.ozimok@uottawa.ca.
authors: Cory J
authors: CJ
authors: Ozimok
authors: Department of Radiology, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada; Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors: Ania Z
authors: AZ
authors: Kielar
authors: Department of Radiology, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada; Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors: Wael M
authors: WM
authors: Shabana
mesh_terms: D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D009864:Ontario; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Transient elastography; cirrhosis; liver fibrosis