A structured and extensive training program on vascular ultrasound, results in an excellent agreement between ultrasound and temporal artery biopsy in the diagnosis of giant cell arteritis

S. Chrysidis, U. Fredberg, U. M. Dohn, T. Lorenzen, L. Terslev, K. Larsen, A. P. Diamantopoulos

Research output: Contribution to journalConference abstract in journalResearchpeer-review

Abstract

Background/Purpose: There is an increased use of vascular ultrasound (US) for diagnosing giant cell arteritis (GCA). Consequently, extensive and structured training of ultrasonographers performing vascular ultrasound is required in order to ensure standardization of examination technique and machine settings to obtain reliable results. The primary aim of this study was to evaluate the results of a standardized training program for ultrasonographers in the diagnosis of temporal artery (TA) vasculitis in GCA. Methods: Rheumatologists with long-standing experience in musculoskeletal US were extensively trained in the use of vascular US by a specific program. Initially participation in the International Workshop on US in Large Vessel Vasculitis and Polymyalgia Rheumatica in Kristiansand, Norway (5 hours theoretical and 10 hours supervised hands-on education) followed by a two day workshop in Denmark (6 hours of supervised hands-on trainings and 1 hour of image evaluation)with additional training and standardization of scanning technique and optimization of settings . Immediately after this training program a US study on patients suspected for GCA was initiated. Patients were examined with high-end US equipment with high resolution transducers, optimized vascular settings and standardized examination technique. After the US examination of TA, a temporal artery biopsy (TAB) was performed. Pictures and film clips of all three TA branches in two planes were recorded and evaluated by the performing sonographer and by a blinded expert. Detailed feedback on the US technique was given to the performing sonographer by the external expert. US was considered positive in the presence of the halo sign (hypoechoic arterial wall swelling) and/or the presence of a positive compression-sign (arterial wall remaining visible upon compression with US transducer). Results: During 12 months, 37 patients from three Danish Rheumatologic Departments (Esbjerg, Glostrup, Silkeborg) suspected to have GCA were recruited. In 20 patients with a positive TAB for GCA, US was positive in all patients according to both the performing sonographer and the blinded external expert. In 15 patients with negative TAB, neither the performing sonographer, nor the external reader found signs of vasculitis. In one patient with a negative TAB, US showed vasculitis (both readers) and in one the local sonographer's finding of US vasculitis was rejected by the blinded expert. In total, 222 branches of TA were scanned and vasculitis changes were observed in 82 branches (expert) and in 80 branches (performing sonographer). The inter-observer agreement between the performing sonographer and the blinded expert was excellent in all three centres/departments (Cohens kappacoefficient: Esbjerg k=0.88, Glostrup k=0.90 and Silkeborg k=0.82). Conclusion: Following an intense structured training program on vascular ultrasound using high quality equipment, we were able to obtain an excellent agreement between US of TA and subsequent TAB in patients suspected for GCA. Furthermore, an excellent interobserver agreement between the performing sonographers and the blinded expert reader were seen. This training set-up could be useful in the implementation of US for diagnosing GCA.
Original languageEnglish
Article number1960
JournalArthritis & Rheumatology
Volume67
Issue numberS10
Pages (from-to)2334-2335
ISSN2326-5191
DOIs
Publication statusPublished - 2015
EventACR/ARHP: American College of Rheumatology - San Francisco, United States
Duration: 7. Nov 201511. Nov 2015

Conference

ConferenceACR/ARHP
CountryUnited States
CitySan Francisco
Period07/11/201511/11/2015

Cite this

@article{82b8707bda394ee69ef2b6c5596cede1,
title = "A structured and extensive training program on vascular ultrasound, results in an excellent agreement between ultrasound and temporal artery biopsy in the diagnosis of giant cell arteritis",
abstract = "Background/Purpose: There is an increased use of vascular ultrasound (US) for diagnosing giant cell arteritis (GCA). Consequently, extensive and structured training of ultrasonographers performing vascular ultrasound is required in order to ensure standardization of examination technique and machine settings to obtain reliable results. The primary aim of this study was to evaluate the results of a standardized training program for ultrasonographers in the diagnosis of temporal artery (TA) vasculitis in GCA. Methods: Rheumatologists with long-standing experience in musculoskeletal US were extensively trained in the use of vascular US by a specific program. Initially participation in the International Workshop on US in Large Vessel Vasculitis and Polymyalgia Rheumatica in Kristiansand, Norway (5 hours theoretical and 10 hours supervised hands-on education) followed by a two day workshop in Denmark (6 hours of supervised hands-on trainings and 1 hour of image evaluation)with additional training and standardization of scanning technique and optimization of settings . Immediately after this training program a US study on patients suspected for GCA was initiated. Patients were examined with high-end US equipment with high resolution transducers, optimized vascular settings and standardized examination technique. After the US examination of TA, a temporal artery biopsy (TAB) was performed. Pictures and film clips of all three TA branches in two planes were recorded and evaluated by the performing sonographer and by a blinded expert. Detailed feedback on the US technique was given to the performing sonographer by the external expert. US was considered positive in the presence of the halo sign (hypoechoic arterial wall swelling) and/or the presence of a positive compression-sign (arterial wall remaining visible upon compression with US transducer). Results: During 12 months, 37 patients from three Danish Rheumatologic Departments (Esbjerg, Glostrup, Silkeborg) suspected to have GCA were recruited. In 20 patients with a positive TAB for GCA, US was positive in all patients according to both the performing sonographer and the blinded external expert. In 15 patients with negative TAB, neither the performing sonographer, nor the external reader found signs of vasculitis. In one patient with a negative TAB, US showed vasculitis (both readers) and in one the local sonographer's finding of US vasculitis was rejected by the blinded expert. In total, 222 branches of TA were scanned and vasculitis changes were observed in 82 branches (expert) and in 80 branches (performing sonographer). The inter-observer agreement between the performing sonographer and the blinded expert was excellent in all three centres/departments (Cohens kappacoefficient: Esbjerg k=0.88, Glostrup k=0.90 and Silkeborg k=0.82). Conclusion: Following an intense structured training program on vascular ultrasound using high quality equipment, we were able to obtain an excellent agreement between US of TA and subsequent TAB in patients suspected for GCA. Furthermore, an excellent interobserver agreement between the performing sonographers and the blinded expert reader were seen. This training set-up could be useful in the implementation of US for diagnosing GCA.",
keywords = "*ultrasound *temporal artery *health practitioner *blood vessel biopsy *diagnosis *giant cell arteritis *American *college *rheumatology *human *training patient vasculitis examination reading transducer compression standardization artery wall workshop clip Denmark education Norway rheumatic polymyalgia swelling feedback system machine",
author = "S. Chrysidis and U. Fredberg and Dohn, {U. M.} and T. Lorenzen and L. Terslev and K. Larsen and Diamantopoulos, {A. P.}",
year = "2015",
doi = "10.1002/art.39448",
language = "English",
volume = "67",
pages = "2334--2335",
journal = "Arthritis & Rheumatology",
issn = "2326-5205",
publisher = "Heinemann",
number = "S10",

}

A structured and extensive training program on vascular ultrasound, results in an excellent agreement between ultrasound and temporal artery biopsy in the diagnosis of giant cell arteritis. / Chrysidis, S.; Fredberg, U.; Dohn, U. M.; Lorenzen, T.; Terslev, L.; Larsen, K.; Diamantopoulos, A. P.

In: Arthritis & Rheumatology, Vol. 67, No. S10, 1960, 2015, p. 2334-2335.

Research output: Contribution to journalConference abstract in journalResearchpeer-review

TY - ABST

T1 - A structured and extensive training program on vascular ultrasound, results in an excellent agreement between ultrasound and temporal artery biopsy in the diagnosis of giant cell arteritis

AU - Chrysidis, S.

AU - Fredberg, U.

AU - Dohn, U. M.

AU - Lorenzen, T.

AU - Terslev, L.

AU - Larsen, K.

AU - Diamantopoulos, A. P.

PY - 2015

Y1 - 2015

N2 - Background/Purpose: There is an increased use of vascular ultrasound (US) for diagnosing giant cell arteritis (GCA). Consequently, extensive and structured training of ultrasonographers performing vascular ultrasound is required in order to ensure standardization of examination technique and machine settings to obtain reliable results. The primary aim of this study was to evaluate the results of a standardized training program for ultrasonographers in the diagnosis of temporal artery (TA) vasculitis in GCA. Methods: Rheumatologists with long-standing experience in musculoskeletal US were extensively trained in the use of vascular US by a specific program. Initially participation in the International Workshop on US in Large Vessel Vasculitis and Polymyalgia Rheumatica in Kristiansand, Norway (5 hours theoretical and 10 hours supervised hands-on education) followed by a two day workshop in Denmark (6 hours of supervised hands-on trainings and 1 hour of image evaluation)with additional training and standardization of scanning technique and optimization of settings . Immediately after this training program a US study on patients suspected for GCA was initiated. Patients were examined with high-end US equipment with high resolution transducers, optimized vascular settings and standardized examination technique. After the US examination of TA, a temporal artery biopsy (TAB) was performed. Pictures and film clips of all three TA branches in two planes were recorded and evaluated by the performing sonographer and by a blinded expert. Detailed feedback on the US technique was given to the performing sonographer by the external expert. US was considered positive in the presence of the halo sign (hypoechoic arterial wall swelling) and/or the presence of a positive compression-sign (arterial wall remaining visible upon compression with US transducer). Results: During 12 months, 37 patients from three Danish Rheumatologic Departments (Esbjerg, Glostrup, Silkeborg) suspected to have GCA were recruited. In 20 patients with a positive TAB for GCA, US was positive in all patients according to both the performing sonographer and the blinded external expert. In 15 patients with negative TAB, neither the performing sonographer, nor the external reader found signs of vasculitis. In one patient with a negative TAB, US showed vasculitis (both readers) and in one the local sonographer's finding of US vasculitis was rejected by the blinded expert. In total, 222 branches of TA were scanned and vasculitis changes were observed in 82 branches (expert) and in 80 branches (performing sonographer). The inter-observer agreement between the performing sonographer and the blinded expert was excellent in all three centres/departments (Cohens kappacoefficient: Esbjerg k=0.88, Glostrup k=0.90 and Silkeborg k=0.82). Conclusion: Following an intense structured training program on vascular ultrasound using high quality equipment, we were able to obtain an excellent agreement between US of TA and subsequent TAB in patients suspected for GCA. Furthermore, an excellent interobserver agreement between the performing sonographers and the blinded expert reader were seen. This training set-up could be useful in the implementation of US for diagnosing GCA.

AB - Background/Purpose: There is an increased use of vascular ultrasound (US) for diagnosing giant cell arteritis (GCA). Consequently, extensive and structured training of ultrasonographers performing vascular ultrasound is required in order to ensure standardization of examination technique and machine settings to obtain reliable results. The primary aim of this study was to evaluate the results of a standardized training program for ultrasonographers in the diagnosis of temporal artery (TA) vasculitis in GCA. Methods: Rheumatologists with long-standing experience in musculoskeletal US were extensively trained in the use of vascular US by a specific program. Initially participation in the International Workshop on US in Large Vessel Vasculitis and Polymyalgia Rheumatica in Kristiansand, Norway (5 hours theoretical and 10 hours supervised hands-on education) followed by a two day workshop in Denmark (6 hours of supervised hands-on trainings and 1 hour of image evaluation)with additional training and standardization of scanning technique and optimization of settings . Immediately after this training program a US study on patients suspected for GCA was initiated. Patients were examined with high-end US equipment with high resolution transducers, optimized vascular settings and standardized examination technique. After the US examination of TA, a temporal artery biopsy (TAB) was performed. Pictures and film clips of all three TA branches in two planes were recorded and evaluated by the performing sonographer and by a blinded expert. Detailed feedback on the US technique was given to the performing sonographer by the external expert. US was considered positive in the presence of the halo sign (hypoechoic arterial wall swelling) and/or the presence of a positive compression-sign (arterial wall remaining visible upon compression with US transducer). Results: During 12 months, 37 patients from three Danish Rheumatologic Departments (Esbjerg, Glostrup, Silkeborg) suspected to have GCA were recruited. In 20 patients with a positive TAB for GCA, US was positive in all patients according to both the performing sonographer and the blinded external expert. In 15 patients with negative TAB, neither the performing sonographer, nor the external reader found signs of vasculitis. In one patient with a negative TAB, US showed vasculitis (both readers) and in one the local sonographer's finding of US vasculitis was rejected by the blinded expert. In total, 222 branches of TA were scanned and vasculitis changes were observed in 82 branches (expert) and in 80 branches (performing sonographer). The inter-observer agreement between the performing sonographer and the blinded expert was excellent in all three centres/departments (Cohens kappacoefficient: Esbjerg k=0.88, Glostrup k=0.90 and Silkeborg k=0.82). Conclusion: Following an intense structured training program on vascular ultrasound using high quality equipment, we were able to obtain an excellent agreement between US of TA and subsequent TAB in patients suspected for GCA. Furthermore, an excellent interobserver agreement between the performing sonographers and the blinded expert reader were seen. This training set-up could be useful in the implementation of US for diagnosing GCA.

KW - ultrasound temporal artery health practitioner blood vessel biopsy diagnosis giant cell arteritis American college rheumatology human training patient vasculitis examination reading transducer compression standardization artery wall workshop clip Denmark

U2 - 10.1002/art.39448

DO - 10.1002/art.39448

M3 - Conference abstract in journal

VL - 67

SP - 2334

EP - 2335

JO - Arthritis & Rheumatology

JF - Arthritis & Rheumatology

SN - 2326-5205

IS - S10

M1 - 1960

ER -