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Multicenter Study
. 2018 Sep 25;16(1):20.
doi: 10.1186/s12947-018-0138-7.

Quality control of B-lines analysis in stress Echo 2020

Maria Chiara Scali  1   2 , Quirino Ciampi  3   4 , Eugenio Picano  5 , Eduardo Bossone  6 , Francesco Ferrara  6 , Rodolfo Citro  7 , Paolo Colonna  8 , Marco Fabio Costantino  9 , Lauro Cortigiani  10 , Antonello D' Andrea  11 , Sergio Severino  11 , Claudio Dodi  12 , Nicola Gaibazzi  13 , Maurizio Galderisi  14 , Andrea Barbieri  15 , Ines Monte  16 , Fabio Mori  17 , Barbara Reisenhofer  18 , Federica Re  19 , Fausto Rigo  20 , Paolo Trambaiolo  21 , Miguel Amor  22 , Jorge Lowenstein  23 , Pablo Martin Merlo  23 , Clarissa Borguezan Daros  24 , José Luis de Castro E Silva Pretto  25 , Marcelo Haertel Miglioranza  26 , Marco A R Torres  27 , Clarissa Carmona de Azevedo Bellagamba  27 , Daniel Quesada Chaves  28 , Iana Simova  29 , Albert Varga  30 , Jelena Čelutkienė  31 , Jaroslaw D Kasprzak  32 , Karina Wierzbowska-Drabik  32 , Piotr Lipiec  32 , Paulina Weiner-Mik  32 , Eva Szymczyk  32 , Katarzyna Wdowiak-Okrojek  32 , Ana Djordjevic-Dikic  33 , Milica Dekleva  34 , Ivan Stankovic  35 , Aleksandar N Neskovic  35 , Angela Zagatina  36 , Giovanni Di Salvo  37 , Julio E Perez  38 , Ana Cristina Camarozano  39 , Anca Irina Corciu  40 , Alla Boshchenko  41 , Fabio Lattanzi  2 , Carlos Cotrim  42 , Paula Fazendas  43 , Maciej Haberka  44 , Bozena Sobkowic  45 , Wojciech Kosmala  46 , Tomasz Witkowski  46 , Piotr Gosciniak  47 , Alessandro Salustri  48 , Hugo Rodriguez-Zanella  49 , Luis Ignacio Martin Leal  2 , Alexandra Nikolic  50 , Suzana Gligorova  51 , Madalina-Loredana Urluescu  52 , Maria Fiorino  53 , Giuseppina Novo  54 , Tamara Preradovic-Kovacevic  55 , Miodrag Ostojic  50   55 , Branko Beleslin  33 , Bruno Villari  56 , Michele De Nes  5 , Marco Paterni  5 , Clara Carpeggiani  5 ; Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)
Collaborators, Affiliations
Multicenter Study

Quality control of B-lines analysis in stress Echo 2020

Maria Chiara Scali et al. Cardiovasc Ultrasound. .

Abstract

Background: The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion.

Purpose: To provide web-based upstream quality control and harmonization of B-lines reading criteria.

Methods: 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics.

Results: All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01).

Conclusions: Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.

Keywords: Certification; Lung comets; Quality control; Stress echocardiography; Wall motion.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was reviewed and approved by the institutional ethics committee as a part of the SE 2020 study (1487-CE Lazio-1, July 20, 2016).

Consent for publication

All the authors have read and approved the manuscript and accorded the consent for pubblication.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The road to accreditation for the aspiring recruiting centers. After the first essential step of RWMA, the reader completes the second step (B-lines) and starts enrolling with dual imaging (RWMA and B-lines)
Fig. 2
Fig. 2
The Stress-LUS general protocol. LUS for B-lines are assessed at baseline and at the end of stress, after the acquisition for RWMA. The adopted protocol is the 4-site simplified scan
Fig. 3
Fig. 3
The screenshot of the test-match step during B-lines quality control. There are 5 still frames (or videos) with B-lines and the trainee has to choose among 5 possible answers, ranging from 0 (left lower panel) to 9 (upper middle panel)
Fig. 4
Fig. 4
The test results of a reader passed with full marks (20/20)
See this image and copyright information in PMC

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