Submitted by:. Yamamoto and Dr O. Updated by CRAC Friday 8 May Last Reviewed:. Table 1 shows the presence of a pathological condition on the ultrasound in relation to various aspects of the request, in both the pre- and post-intervention phase. In requests with a tentative diagnosis, better quality and more appropriate requests were associated with a higher percentage of pathological results. Relationship between the result of the ultrasound and the characteristics of the request.
Finally, Table 2 shows the relationship between the quality of the ultrasound request and its appropriateness. As can be seen, better quality was significantly associated in both phases with a more appropriate request p 0. Relationship between the quality of the ultrasound request and its appropriateness. Abdominal ultrasound, being a safe, inexpensive, easy-to-perform test that provides a wealth of information, is a valuable clinical tool, particularly at the PC level.
It is the first examination that should be requested in a patient with a strong suspicion of a pathological abdominal condition. However, the widespread availability of this test greatly increases the number of examinations requested, some of them unjustified, prompting several diagnostic imaging societies to create referral guidelines to address this problem.
With this aim, we decided to create a set of indications and recommendations for abdominal ultrasound for PC professionals using the nominal group technique, 18 in which a panel of experts in diagnostic radiology, gastroenterology and family medicine agreed on the different criteria to be included. The guidelines presented in the present paper contain the recommendations for the use of abdominal ultrasound proposed and agreed by this expert panel. They are intended to help professionals rationalise the use of ultrasound techniques, although physicians are obviously free to request whatever complementary tests they consider appropriate.
A poor quality ultrasound request could lead the radiologist to make mistakes in assessing the findings. For this reason, requests should be correctly and legibly filled in, clearly explaining the reason why the examination is requested and providing sufficient clinical information to allow the diagnostic radiologist to understand the tentative diagnosis or the problems to be resolved by the ultrasound.
We also observed that improving the quality and appropriateness of requests resulted in a higher percentage of pathological conditions detected, thus enhancing the effectiveness of the process. In order to prevent the inappropriate use of diagnostic imaging techniques, diagnostic radiology societies in both the United Kingdom and Spain 6,14,19,20 have drawn up guidelines for referring patients to diagnostic imaging services in order to unify referral criteria, as complementary tests are useful when the results—whether positive or negative—help to modify the clinician's diagnostic and therapeutic approach.
In this respect, in the Catalan Institute of Health asked a group of experts to draw up a set of recommendations and criteria for indicating computed tomography CT and magnetic resonance imaging MRI ; the implementation of these guidelines had a positive effect on improving indications and reduced the number of referrals.
In our study, the main reasons for consultation or requesting abdominal ultrasound were abdominal pain or discomfort, abnormal liver function tests and, to a lesser degree, monitoring of chronic liver diseases. Studies have shown that the higher the quality of the request, the greater the chance of detecting a pathological condition.
This is important, because in many patients with abdominal discomfort, very little information was provided, and in these cases the percentage of normal results was higher.
These findings are similar to those of a recent study. In this respect, an interesting cohort study was conducted in Holland in —, which included a total of 76 PC physicians and patients.
The study objectives were to quantify the influence of positive and negative abdominal ultrasound findings on changes in therapy and patient management. Finally, an interesting development has been the recent publication of studies echoing the recommendations made by various radiology and family medicine societies that family physicians receive training in the diagnostic use of abdominal ultrasound, and even that this be included in specialist training programmes. It is clear that this will involve specifying objectives, both in terms of clinical practice and training requirements.
Our study has some limitations that should be mentioned. Firstly, one of the problems encountered was to define the concept of quality in the context of the abdominal ultrasound request. As we were unable to find any information regarding this in the literature, we based our definition on the 4 categories described in the methodology, after having carried out a pilot study on requests.
Obviously, other criteria could be defined, but we believe that those used in this study would enable us to classify the quality of the requests in a valid and simple manner. Secondly, we were unable to differentiate between new and repeat ultrasound scans; therefore, a pathological finding may not have been newly identified, but might have been diagnosed previously.
Although we did not have this information, a pathological finding on ultrasound does not necessarily indicate a good quality request. Thirdly, the study was based on abdominal ultrasounds related with abdominal disease; however, since they were sometimes requested for monitoring renal calculi and polyps, or for studying renal function, we included the results derived from these conditions.
Lastly, although ultrasound requests were collected at different times of the year, we do not believe that this affected our results in any way, as the vast majority of symptoms and much of the pathology associated with abdominal ultrasounds are not influenced by seasonal factors.
However, delay in performance and results could be increased in the month of August peak holiday time in Spain and therefore with little activity. In view of our results, we can conclude that recommendations and indications for abdominal ultrasound improve the quality of requests, as they provide more clinical information, a tentative diagnosis and, based on the results of our study, can also improve appropriateness. The authors declare that they have no conflict of interests.
The authors would like to thank Dr Conxita Bru for her review and critical appraisal of the manuscript.. First question. What reasons do you consider appropriate for requesting an abdominal ultrasound?. Second question. What reasons do you consider unjustified for requesting an abdominal ultrasound?. Third question. In which cases do you consider that follow-up abdominal ultrasound should be performed and how often?.
Fourth question. What is the minimal information that you consider should be provided on an abdominal ultrasound request?. Recommendations and indications for abdominal ultrasound for primary care professionals..
Gastroenterol Hepatol. ISSN: Previous article Next article. Issue 8. Pages October More article options. Acceptability and quality of abdominal ultrasound studies requested by medical professionals. Download PDF. Corresponding author. This item has received. Article information. Show more Show less. Table 1. Relationship between the result of the ultrasound and the characteristics of the request..
Table 2. Relationship between the quality of the ultrasound request and its appropriateness.. Table A1. Table A2. Table A3. Table A4. Post-intervention phase: three months after dissemination analyze the same number of requests assessing the same variables included in the pre-intervention phase. Results Pre-intervention phase: 1, requests, The better the quality of the request, the better the acceptability of the studies and the greater the number of pathological conditions identified.
Conclusions Guidelines for ultrasound improve the quality of requests, diagnostic orientation and acceptability of the studies. Abdominal ultrasound. Palabras clave:. Full Text. Introduction Abdominal ultrasound is a very valuable test in primary care PC , as it enhances the clinician's diagnostic capability, allows serious disorders to be detected quickly, has no associated adverse effects or contraindications, is inexpensive, and provides useful information.
Good: Sufficient clinical information on the reason for the consultation with no details of the same or the diagnostic approach. Design of consensus guidelines on the use of abdominal echography clearly defining the criteria of adequate use of this diagnostic procedure.
The consensus will be made by different experts, general practitioners, radiologists and gastroenterologists. The methodology to be used will be the consensus technique denominated "the nominal group technique" [ 24 ].
Diffusion of the recommendations and the criteria of indication of abdominal echography through meetings and sessions in the different centres with all the professionals therein and the edition of leaflets with the guidelines to give out to each physician of the different centres. Evaluate the impact of the use of the guidelines on the adequacy of abdominal echographies, greater rationalisation of echography as a diagnostic test and the quality of the requests.
To do this new abdominal echograhies from the same physicians will also be analysed and the same variables as those in phase I will be studied. Descriptive univariate analysis will be performed of the quantitative variables percentiles, means and standard deviation and the qualitative variables frequency and percentages. Descriptive bivariate statistical analysis will also be carried out of the main variables adequacy and quality of the echographies and some of the secondary variables.
To do this, the chi-square and Fisher exact tests will be used for comparison among the main qualitative variables and the secondary qualitative varibles and the Student's-t test and the non parametric Mann-Whitney tests will be used for the secondary quantitative variables. To compare the quality of the requests for echography and the adequacy of the abdominal echographies before and after the implementation of the guideline of recommendations and criteria of use of abdominal echograhies the chi-square test will be used since non paired data will be involved.
The Stata version 11 statistical programme will be used to analyse the data. One of the limitations of this study may be the lack of a definition of adequacy of abdominal echographies. This will be defined once the initial field work has been finalised by analysing all the data and obtaining a consensus related to the criteria of adequacy of abdominal echographies among the different experts with the aim of providing plans of action.
Another limitation is that the information of some of the associated variables will be collected based on the registries of computerised clinical histories with the risk this implies of finding inexistent data. We will attempt to palliate this by proactively complementing the non reported data with the physician in charge of the cases.
The introduction of a control group has been considered but we believe that the presence of such a group could present a serie of limitations.
The presence of this type of group would require the selection of either a specific number of physicians or different centres which would induce these to modify the remission criteria because of their having been selected. Some of the physicians or centres selected could also refuse to continue once the project has been initiated.
In the short term no changes which could modify the medical criteria of action of the different professionals are expected in our health care system. We are therefore before an important problem since abdominal echography is a very advantageous examination because of its innocuousness, low cost and diagnostic reliability. These advantages have led to increasing requests for abdominal echographies in primary care with the consequent rise in pressure on the radiodiagnostic departments.
The importance of this project lies in determining whether the professionals in our reference area remit abdominal echographies well.
On the other hand, it is also important to determine whether these requests are adequate or not. With the aim of establishing the latter, a work group will be created among general practitioners, gastroenterologists and radiologists. The results of this consensus and according to the results obtained we aim to create a guideline of recommendations to define the reasons and adequacy of abdominal echography and thereby avoid the undertaking of unnecessary tests, reduce costs and avoid overcrowding of the departments of radiodiagnosis.
Edited by: Doyma. Google Scholar. Article PubMed Google Scholar. Technique and focal and diffuse disease. Radiol Clin North Am. BMC Gastroenterol. Radiol Clin N Am. Am J Roentgenol. Article Google Scholar. Liel Y, Fraenkel N: Use and misuse of thyroid ultrasound in the initial workup of patients with suspected thyroid problems referred by primary care physicians to an endocrine clinic. J Gen Intern Med. Br Med J. Connor SE, Banerjee AK: General practitioner requests for upper abdominal ultrasound: their effect on clinical outcome.
You should always check that the image data refers to the correct patient and that the X-ray is the current examination. This is the most sensitive plain radiographic study to detect the presence of free gas in the abdomen. Occasionally patients are too ill to be positioned erect.
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