The Influence of Sonographer Experience on Skeletal Muscle Image Acquisition and Analysis.

Dustin Dunnick,Gena R. Gerstner,Ryan M. Girts,Jason I. Pagan,Caleb C. Voskuil,Jonathan P. Beausejour,Kylie K. Harmon,Joshua C. Carr,Joel E. Harden,Matt S. Stock,Kristin M. Badillo

doi:10.3390/jfmk6040091

Abstract

The amount of experience with ultrasonography may influence measurement outcomes while images are acquired or analyzed. The purpose of this study was to identify the interrater reliability of ultrasound image acquisition and image analysis between experienced and novice sonographers and image analysts, respectively. Following a brief hands-on training session (2 h), the experienced and novice sonographers and analysts independently performed image acquisition and analyses on the biceps brachii, vastus lateralis, and medial gastrocnemius in a sample of healthy participants (n = 17). Test–retest reliability statistics were computed for muscle thickness (transverse and sagittal planes), muscle cross-sectional area, echo intensity and subcutaneous adipose tissue thickness. The results show that image analysis experience generally has a greater impact on measurement outcomes than image acquisition experience. Interrater reliability for measurements of muscle size during image acquisition was generally good–excellent (ICC2,1: 0.82–0.98), but poor–moderate for echo intensity (ICC2,1: 0.43–0.77). For image analyses, interrater reliability for measurements of muscle size for the vastus lateralis and biceps brachii was poor–moderate (ICC2,1: 0.48–0.70), but excellent for echo intensity (ICC2,1: 0.90–0.98). Our findings have important implications for laboratories and clinics where members possess varying levels of ultrasound experience.

Highlights

The use of ultrasonography for skeletal muscle imaging in the field of kinesiology is growing
intraclass correlation coefficients (ICCs), all variables were classified as demonstrating good–excellent reliability except medial gastrocnemius echo intensity (0.643) and biceps brachii echo intensity (0.437), and subcutaneous tissue thickness (0.740)
For analysis, vastus lateralis cross-sectional area and biceps brachii muscle thickness were significantly different between sonographers, and measures of muscle size for the vastus lateralis exhibited poor reliability (ICC2,1 < 0.65), yet interrater reliability for echo intensity was excellent (ICC2,1 > 0.90) for all muscles

Summary

Introduction

The use of ultrasonography for skeletal muscle imaging in the field of kinesiology is growing. A common scenario within a research laboratory or clinic is that its members possess varying levels of experience with a technique such as ultrasonography This presents a challenge, as a critical aspect in longitudinal studies or patient evaluation relates to the feasibility of a single experimenter performing all ultrasound scans and analyses. Clearey et al [19] recently show excellent interrater image analysis reliability for cross-sectional area, muscle thickness, and echo intensity in a group of novices when images were captured by the same, experienced sonographer. The evidence suggests that ultrasound-derived measurements of skeletal muscle size and quality exhibit acceptable interrater reliability, yet there is insufficient data on how the relative experience of a sonographer influences both image acquisition and the analysis of muscle cross-sectional area, muscle thickness, subcutaneous adipose tissue thickness, and echo intensity

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