Automated 3D ultrasound bridges the gap between novices and experts in diameter assessment of abdominal aortic aneurysms.

Abstract

The current management of abdominal aortic aneurysm (AAA) hinges upon assessing diameter using ultrasound (US). Diameter reproducibility with conventional two-dimensional ultrasound (2D-US) is challenging and requires experienced operators. A novel automatic three-dimensional ultrasound (3D-US) system enables on-cart software-assisted diameter estimation (3D-SAUS), potentially facilitating more precise diameter measurements than 2D-US. This study aimed to assess the variance of AAA diameter measurements among US novices and experts by comparing 2D-US with 3D-SAUS in a clinical setting. A total of 580 US scans were scheduled by 29 US operators (13 experts and 16 novices) on 10 patients with AAAs. Experts and novices measured all patients' AAA anterior-posterior (AP) diameters with 2D-US and 3D-SAUS. Outcomes were limits of agreement (LoA) using a mixed-effects model. In total, 564 of 580 planned US scans were performed. 500 US scans were automatically analyzed by the software and included. When using 3D-SAUS instead of 2D-US, novices reduced their LoA from ±16.5% to ±10.2% (P<0.001), reaching the experts' LoA of ±10.5% (P=0.782 for difference). The experts' LoA was ±10.5% for 2D-US and ±9.7% for 3D-SAUS, with no statistically significant difference between the two modalities (P=0.423). Clinical implementation of the 3D-SAUS demonstrates a substantial reduction in variance in AAA diameter measurements among novice sonographers, surpassing the performance of conventional 2D-US techniques. Additionally, using the 3D-SAUS tool enables novice sonographers to achieve proficiency levels comparable to those of experts employing conventional 2D-US.