Abstract
BackgroundThe 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 = 7). 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).ResultsThe 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.ConclusionsThe 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.
Highlights
IntroductionThe National Institute for Health and Care Excellence (NICE) guidance recommended the use of SonoVue® for a number of diagnostic processes: 1) the characterisation of incidentally detected focal liver lesions in adults where an unenhanced ultrasound has been inconclusive, and 2) in patients undergoing surveillance for cirrhosis or metastatic disease for whom contrast-enhanced (CE) computed tomography (CT) or magnetic resonance imaging (MR) is not clinically appropriate, accessible or acceptable (to the patient)
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
The NICE guidance suggests that CEUS may be used in the diagnostic pathway to replace contrast-enhanced Computerised tomography (CT) (CECT) and contrast enhanced MR (CEMR)
Summary
The NICE guidance recommended the use of SonoVue® for a number of diagnostic processes: 1) the characterisation of incidentally detected focal liver lesions in adults where an unenhanced ultrasound has been inconclusive, and 2) in patients undergoing surveillance for cirrhosis or metastatic disease for whom contrast-enhanced (CE) computed tomography (CT) or magnetic resonance imaging (MR) is not clinically appropriate, accessible or acceptable (to the patient). The latter is indicated where a contrast agent is required for further diagnosis and an unenhanced US scan is unsatisfactory or inconclusive. A scoping search identified that little is currently known about the diagnostic pathways that patients follow when undergoing unenhanced/enhanced imaging for focal liver lesions
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