Improving the quality of breast ultrasound examination performed by inexperienced ultrasound doctors with synchronous tele-ultrasound: a prospective, parallel controlled trial
Yi-Kang Sun1,2,3,4 , Xiao-Long Li1,2,4 , Qiao Wang2,3,4 , Bo-Yang Zhou1,4 , An-Qi Zhu2,3,4 , Chuan Qin5 , Le-Hang Guo3 , Hui-Xiong Xu1,2,4
1Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
2Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
3Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
4National Clinical Research Center for Interventional Medicine, Shanghai, China
5Department of Ultrasound, Karamay Center Hospital, Karamay, China
Corresponding Author: Le-Hang Guo ,Tel: +86-13764538305, Fax: +86-021-66307539, Email:
Received: April 10, 2021;  Accepted: August 15, 2021.  Published online: August 15, 2021.
This prospective study explored the value of synchronous tele-ultrasound (US) to aid doctors inexperienced in US with breast US examinations.
In total, 99 patients were enrolled. Two trainee doctors who were inexperienced in US (trainee A [TA] and trainee B [TB]) and one doctor who was an expert in US completed the US examinations sequentially. TA completed the US examinations independently, while TB was instructed by the expert using synchronous tele-US. Subsequently, the expert performed on-site US examinations in person. Separately, they selected the most clinically significant nodule as the target nodule. Consistency with the expert and image quality were compared between TA and TB to evaluate tele-US. Furthermore, TB and the patients evaluated tele-US through questionnaires.
TB demonstrated higher consistency with the expert in terms of target nodule selection than TA (93.3% vs. 63.3%, P<0.001). TB achieved good inter-observer agreement (>0.75) with the expert on five US features (5/9, 55.6%), while TA only did so for one (1/9, 11.1%) (P=0.046). TB’s image quality was higher than TA’s in gray value, time gain compensation, depth, color Doppler adjustment, and the visibility of key information (P=0.018, P<0.001, P<0.001, P=0.033, and P=0.006, respectively). The comprehensive assessment score was higher for TB than for TA (3.96±0.82 vs. 3.09±0.87, P<0.001). Tele-US was helpful in 69.7% of US examinations and had a training effect in 68.0%. Furthermore, 63.6% of patients accepted tele-US and 60.6% were willing to pay.
Tele-US can help doctors inexperienced in US to perform breast US examinations.
Keywords: Telemedicine; Tele-ultrasound; Breast ultrasound; Synchronous Tele-ultrasound
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