Heterogeneity in patient diagnostic pathways: an example from contrast-enhanced ultrasound diagnostic scans for focal liver lesions

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• 作者：Adam B Smith ; Alexandra Filby ; Louise M Carr
• 关键词：Contrast ; enhanced ultrasound ; MR ; CT ; Imaging modalities
• 刊名：BMC Research Notes
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：7
• 期：1
• 全文大小：343 KB
• 参考文献：1. Ooi, CC, Low, SC, Schneider-Kolsky, M, Lombardo, P, Lim, SY, Abu Bakar, R, Lo, RH (2010) Diagnostic accuracy of contrast-enhanced ultrasound in differentiating benign and malignant focal liver lesions: a retrospective study. J Med Imaging Radiat Oncol 54: pp. 421-30 CrossRef
  2. Beaton, C, Cochlin, D, Kumar, N (2010) Contrast enhanced ultrasound should be the initial radiological investigation to characterise focal liver lesions. Eur J Surg Oncol 36: pp. 43-6 CrossRef
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  4. Albrecht, T, Hohmann, J, Oldenburg, A, Skrok, J, Wolf, KJ (2004) Detection and characterisation of liver metastases. Eur Radiol 14: pp. P25-33
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  SonoVue (sulphur hexafluoride microbubbles) -contrast agent for contrastenhanced ultrasound imaging of the liver. NICE Diag Guid.
  7. EnglandMonthlyDiagnosticsData2012-3. http://www.england.nhs.uk/statistics/statisticalwork-areas/diagnostics-waiting-times-and-activity/monthly-diagnostics-waitingtimes-and-activity/monthly-diagnostics-data-2012-3/. Accessed 01.04.2014
  
• 刊物主题：Biomedicine general; Medicine/Public Health, general; Life Sciences, general;
• 出版者：BioMed Central
• ISSN：1756-0500

文摘

Background The UK’s National Institute for Health and Care Excellence (NICE) has recommended contrast-enhanced ultrasound (CEUS) for the characterisation of focal liver lesions where the results of standard unenhanced ultrasound are inconclusive. A further recommendation is for CEUS to replace other imaging modalities. However, little is currently known about the diagnostic pathways in the National Health Service (NHS) followed by patients with potential liver lesions. The aim of this study was to identify the diagnostic pathways for a number of representative hospital trusts and record the clinicians-views on patient experiences of these processes through a series of semi-structured interviews with UK clinicians (radiologists and sonographers) (N--). This study was undertaken in the broader context of a larger research project where the overarching research question is focused on patient preferences for CEUS and other imaging modalities, and how these impact on patient quality of life (QOL). Results The results from the semi-structured interviews with UK clinicians revealed that there is a great deal of heterogeneity in diagnostic pathways followed by patients with potential liver lesions which differ both within and between hospitals. In terms of the patient experience, the clinicians believed that a combination of the more patient-friendly ultrasound process, and the fact that scan results are given to patients in 80-90% of cases on the day, as well as the problems inherent to other scan modalities (claustrophobia, anxiety) would lead to patients preferring ultrasound compared with other imaging modalities (CT or MR). However, current clinical practice means that patient choice is virtually non-existent. Conclusions The significant variation in diagnostic pathways across the NHS will require further standardisation through local agreements if contrast-enhanced ultrasound is to replace other imaging modalities in characterising focal liver lesions in line with NICE Diagnostics Guidance. The gradual development of patient choice of modalities may necessitate a change of practice in radiology processes.