. 2023 May;49(5):1194-1201.

doi: 10.1016/j.ultrasmedbio.2023.01.005. Epub 2023 Feb 19.

Lung Ultrasound Protocol and Quality Control of Image Interpretation Using an Adjudication Panel in the Household Air Pollution Intervention Network (HAPIN) Trial

Suzanne M Simkovich¹, Shakir Hossen², Eric D McCollum³, Ashley K Toenjes⁴, John P McCracken⁵, Lisa M Thompson⁶, Adly Castañaza⁷, Anaite Diaz⁷, Ghislaine Rosa⁸, Miles A Kirby⁹, Alexie Mukeshimana¹⁰, Rachel Myers⁴, Patricia M Lenzen⁴, Rachel Craik¹¹, Shirin Jabbarzadeh¹², Lisa Elon¹², Sarada S Garg¹³, Kalpana Balakrishnan¹³, Gurusamy Thangavel¹³, Jennifer L Peel¹⁴, Thomas F Clasen¹⁵, Victor G Dávila-Román⁴, Aris T Papageorghiou¹¹, Lisa de las Fuentes⁴, William Checkley¹⁶; HAPIN Investigators

Affiliations

¹ Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Healthcare Delivery, MedStar Health Research Institute, Hyattsville, MD, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, DC, USA.
² Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
³ Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Global Program on Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁴ Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
⁵ Global Health Institute, Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
⁶ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
⁷ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁸ Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
⁹ Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
¹⁰ Eagle Research Center, Kigali, Rwanda.
¹¹ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹² Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹³ Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
¹⁴ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
¹⁵ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹⁶ Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. Electronic address: wcheckl1@jhmi.edu.

PMID: 36801180
PMCID: PMC10631486
DOI: 10.1016/j.ultrasmedbio.2023.01.005

Lung Ultrasound Protocol and Quality Control of Image Interpretation Using an Adjudication Panel in the Household Air Pollution Intervention Network (HAPIN) Trial

Suzanne M Simkovich et al. Ultrasound Med Biol. 2023 May.

. 2023 May;49(5):1194-1201.

doi: 10.1016/j.ultrasmedbio.2023.01.005. Epub 2023 Feb 19.

Authors

Affiliations

¹ Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Healthcare Delivery, MedStar Health Research Institute, Hyattsville, MD, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, DC, USA.
² Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
³ Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Global Program on Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁴ Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
⁵ Global Health Institute, Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
⁶ Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
⁷ Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
⁸ Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
⁹ Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
¹⁰ Eagle Research Center, Kigali, Rwanda.
¹¹ Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
¹² Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹³ Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India.
¹⁴ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
¹⁵ Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹⁶ Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. Electronic address: wcheckl1@jhmi.edu.

PMID: 36801180
PMCID: PMC10631486
DOI: 10.1016/j.ultrasmedbio.2023.01.005

Abstract

Objective: Lung ultrasound (LUS) is an alternative to chest radiography to confirm a diagnosis of pneumonia. For research and disease surveillance, methods to use LUS to diagnose pneumonia are needed.

Methods: In the Household Air Pollution Intervention Network (HAPIN) trial, LUS was used to confirm a clinical diagnosis of severe pneumonia in infants. We developed a standardized definition of pneumonia, protocols for recruitment and training of sonographers, along with LUS image acquisition and interpretation. We use a blinded panel approach to interpretation with LUS cine-loops randomized to non-scanning sonographers with expert review.

Discussion: We obtained 357 lung ultrasound scans: 159, 8 and 190 scans were collected in Guatemala, Peru and Rwanda, respectively. The diagnosis of primary endpoint pneumonia (PEP) required an expert tie breaker in 181 scans (39%). PEP was diagnosed in 141 scans (40%), not diagnosed in 213 (60%), with 3 scans (<1%) deemed uninterpretable. Agreement among the two blinded sonographers and the expert reader in Guatemala, Peru and Rwanda was 65%, 62% and 67%, with a prevalence-and-bias-corrected kappa of 0.30, 0.24 and 0.33, respectively.

Conclusion: Use of standardized imaging protocols, training and an adjudication panel resulted in high confidence for the diagnosis of pneumonia using LUS.

Trial registration: ClinicalTrials.gov NCT02944682.

Keywords: Developing countries; Imaging; Infant; Pneumonia; Research protocol; Respiratory tract infections; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest The authors declare no competing interests.

Figures

**Figure 1.. Examples of Primary Endpoint Pneumonia (PEP).**
Left Upper Corner: This image shows the presence of a consolidation with air bronchograms indicating PEP. Right Upper Corner: This image shows the presence of a pleural effusion associated with a consolidation indicating PEP. Left Lower Corner: This image shows a pleural effusion with pleural abnormalities (i.e. shred sign). Right Lower Corner: This image shows a pleural effusion with interstitial infiltrates defined by ≥ B-lines.

**Figure 2.. Workflow for Image Interpretation.**
This flow chart demonstrates the step-by-step process for the acquisition of the cine-loop image by the scanning sonographer, randomization to the two blinded sonographers, expert quality control, and determination of the final diagnosis.

**Figure 3.. LUS Adjudication Diagram.**
This consort diagram demonstrates the number of ultrasounds acquired by IRC, randomization, interpretation and determination of final diagnosis within our panel.

See this image and copyright information in PMC

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Lung Ultrasound Protocol and Quality Control of Image Interpretation Using an Adjudication Panel in the Household Air Pollution Intervention Network (HAPIN) Trial

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Lung Ultrasound Protocol and Quality Control of Image Interpretation Using an Adjudication Panel in the Household Air Pollution Intervention Network (HAPIN) Trial

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