title: Targeted ultrasound of the liver: Impact on scanning time of a new approach in chronic liver disease.
abstract: BACKGROUND
  Targeted ultrasound of the liver (TUSL) has been proposed as a new approach in chronic liver disease to meet the increasing demands on ultrasound services in this patient population. This study analyses the impact of TUSL on examination time.
  
  
  METHODS
  Retrospective cohort analysis of time taken to perform liver ultrasound on consecutive chronic liver disease patients pre- (n = 230) and post- (n = 147) introduction of TUSL. Within each cohort, patients were subdivided into three categories based on the clinical indication: Group 1. hepatocellular carcinoma (HCC) surveillance; Group 2. detection of cirrhosis, fibrosis or fatty liver; Group 3. detection of portal hypertension. The primary outcome was difference in examination time in the pre- and post-intervention groups.
  
  
  RESULTS
  Introduction of TUSL led to 49% reduction in examination time (median (Q1-Q3) 23.7 (16.7-36.2) min in pre-TUSL period vs 12.1 (6.4-19.5) min in post, P < 0.001) and it was consistent across all three clinical indication groups (gr1: median 23.1 minutes vs 8.1 minutes (P < 0.001), gr2: 23.0 minutes vs 14.3 minutes (P < 0.001), gr3: 32.2 minutes vs 15.3 minutes (P = 0.006)). After the adjustment for clinical indication and sonographer's experience, impact of TUSL on time reduction remained significant with a 66.6% time reduction (95% CI 53.6 to 79.5).
  
  
  CONCLUSIONS
  Targeted ultrasound of the liver improves efficiency of chronic liver disease ultrasound with halving of examination times and consequently has the potential to greatly improve resource utilization.
authors.affiliation: Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Harris
authors.affiliation: Melbourne Epicentre, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gorelik
authors.affiliation: Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.|Department of Radiology, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Gibson
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods*
keywords: chronic liver disease; cirrhosis; hepatocellular carcinoma; liver; ultrasound