Klinischer Ultraschall (ClinUS) – Konzepte und Kontroversen

Dieter Nürnberg; Christian Jenssen; Claudia Lucius; Rolf Klingenberg-Noftz; Matthias Wüstner; Hans Worlicek; Daniel Merkel; Nicole Eder; Hendra Lo; Maria Nürnberg; Christoph F. Dietrich

doi:10.1055/a-2495-2677

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2025; 63(03): 279-292
DOI: 10.1055/a-2495-2677

Übersicht

Klinischer Ultraschall (ClinUS) – Konzepte und Kontroversen

Clinical Ultrasound (ClinUS) – Concepts and Controversies

Dieter Nürnberg ^*

¹Medizinische Hochschule Brandenburg Theodor Fontane (MHB), Institut für Klinischen Ultraschall (BIKUS), Fakultät für Medizin und Psychologie, Neuruppin, Deutschland (Ringgold ID: RIN0009-0009-3594-8284)

²Medizinische Hochschule Brandenburg, Fakultät für Gesundheitswissenschaften, Neuruppin, Deutschland

,

Christian Jenssen ^*

¹Medizinische Hochschule Brandenburg Theodor Fontane (MHB), Institut für Klinischen Ultraschall (BIKUS), Fakultät für Medizin und Psychologie, Neuruppin, Deutschland (Ringgold ID: RIN0009-0009-3594-8284)

³Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Strausberg, Deutschland (Ringgold ID: RIN0000-0002-7008-6650)

,

Claudia Lucius

⁴CED-Zentrum Berlin-Nord, Poliklinik Gastroenterologie, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland (Ringgold ID: RIN0000-0003-2640-011)

,

Rolf Klingenberg-Noftz

⁵Klinik für Innere Medizin und Gastroenterologie, DRK Krankenhaus, Grevesmühlen, Deutschland

,

Matthias Wüstner

⁶Zentrale interdisziplinäre Sonographie, Krankenhaus der Barmherzigen Brüder Trier, Trier, Deutschland (Ringgold ID: RIN0000-0003-2068-5222)

,

Hans Worlicek

⁷Beauftragter des Vorstands der DEGUM für Ultraschall in der Praxis, Regensburg, Deutschland

,

Daniel Merkel

¹Medizinische Hochschule Brandenburg Theodor Fontane (MHB), Institut für Klinischen Ultraschall (BIKUS), Fakultät für Medizin und Psychologie, Neuruppin, Deutschland (Ringgold ID: RIN0009-0009-3594-8284)

⁸Immanuel Klinik Rüdersdorf, Rüdersdorf, Deutschland (Ringgold ID: RIN0000-0001-9615-3017)

,

Nicole Eder

¹Medizinische Hochschule Brandenburg Theodor Fontane (MHB), Institut für Klinischen Ultraschall (BIKUS), Fakultät für Medizin und Psychologie, Neuruppin, Deutschland (Ringgold ID: RIN0009-0009-3594-8284)

³Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Strausberg, Deutschland (Ringgold ID: RIN0000-0002-7008-6650)

,

Hendra Lo

⁹Klinik für Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland

,

Maria Nürnberg

¹Medizinische Hochschule Brandenburg Theodor Fontane (MHB), Institut für Klinischen Ultraschall (BIKUS), Fakultät für Medizin und Psychologie, Neuruppin, Deutschland (Ringgold ID: RIN0009-0009-3594-8284)

¹⁰Medizinische Klinik B, Universitätsklinikum Ruppin-Brandenburg, Neuruppin, Deutschland

,

Christoph F. Dietrich

¹¹Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz (Ringgold ID: RIN0000-0001-6015-6347)

› Author Affiliations

Abstract

Zusammenfassung

Unter Klinischem Ultraschall (ClinUS) wird die Integration der Ultraschalldiagnostik in die klinische Untersuchung verstanden. Diese Übersicht stellt im Vergleich zu anderen Modellen der Ultraschalldiagnostik ein Konzept vor, das Point-of-Care-Ultraschall, die umfassende fachgebietsspezifische Ultraschalluntersuchung, wie auch den spezialisierten multiparametrischen Ultraschall integriert. Insbesondere am Beispiel der Gastroenterologie und der Allgemeinmedizin werden Anwendungen, Vorteile und Herausforderungen des Klinischen Ultraschalls und dessen Besonderheiten im Vergleich zu anderen Schnittbildverfahren diskutiert.

Abstract

Clinical ultrasound (ClinUS) is the integration of ultrasound diagnostics into the clinical examination. By comparing clinical ultrasound with other models of ultrasound diagnostics, this overview presents a concept that integrates point-of-care ultrasound, comprehensive specialty-specific ultrasound examinations and specialized multiparametric ultrasound. The applications, advantages and challenges of clinical ultrasound and its special features in comparison to other cross-sectional imaging modalities are discussed using the example of gastroenterology and general medicine in particular.

Schlüsselwörter

Ultraschall - Point of Care - Radiologie - Klinische Medizin - Gastroenterologie - Allgemeinmedizin

Keywords

Ultrasound - Point of Care - Radiology - Clinical Medicine - Gastroenterology - General Practice

Full Text

References

Literatur
1 Roguin A. Rene Theophile Hyacinthe Laennec (1781–1826): the man behind the stethoscope. Clin Med Res 2006; 4: 230-235
2 Tomos I, Karakatsani A, Manali ED. et al. Celebrating Two Centuries since the Invention of the Stethoscope. Rene Theophile Hyacinthe Laennec (1781–1826). Ann Am Thorac Soc 2016; 13: 1667-1670
3 Drouin E, Chambellan A, Hautecoeur P. Laennecs’ mediate auscultation: Child’s play. Am Heart J 2023; 255: 52-57
4 Thomsen C, Wich M. Körperliche Untersuchungen – Anleitung in Bildern für Studium und Praxis. 2. Auflage ed. Berlin/Boston: Walter de Gruyter GmbH & Co KG; 2018
5 Linton O. History of radiology. Acad Radiol 2012; 19: 1304
6 Linton O. Radiology grows ahead in a second century. Acad Radiol 2013; 20: 1323
7 Sanghvi D, Harisinghani MG. Modalities in modern radiology: a synopsis. J Postgrad Med 2010; 56: 85-87
8 Frentzel-Beyme B, Jakobeit C, Lutz H. et al. Zur Geschichte der Ultraschalldiagnostik. Die Entwicklung des medizinischen Ultraschalls aus deutscher Sicht. In. Ultraschallmuseum e.V. Lennep. 2020
9 Krause W, Soldner R. Ultraschallschnittbildverfahren (B-Scan) mit hoher Bildfrequenz für medizinische Diagnostik. Electromedica 1967; 4: 8
10 Patzold J, Krause W, Kresse H. et al. Present state of an ultrasonic cross-section procedure with rapid image rate. IEEE Trans Biomed Eng 1970; 17: 263-265
11 Hofmann D, Holländer HJ, Weiser P. Neue Möglichkeiten der Ultraschalldiagnostik in der Gynäkologie und Geburtshilfe. Fortschr Med 1966; 84: 689-693
12 Rettenmaier G. Sonographischer Oberbauchstatus, Aussagefähigkeit und Indikationen der Ultraschall-Schnittbilduntersuchung des Oberbauches. Internist (Berlin) 1976; 17 (11) 549-564
13 Seitz K. In memoriam Professor Dr. med. Gerhard Rettenmaier 9. April 1929 –7. Dezember 2015. Z Gastroenterol 2016; 54: 177
14 Wastl D, Lowe A, Dietrich CF. Echoscopy in scanning cardiac diseases in critical care medicine. Med Klin Intensivmed Notfmed 2023; 118: 293-300
15 Wastl D, Lowe A, Dietrich CF. Echoscopy in scanning abdominal diseases in a critical care setting. Med Klin Intensivmed Notfmed 2023; 118: 228-235
16 Barreiros AP, Dong Y, Ignee A. et al. EchoScopy in scanning abdominal diseases; a prospective single center study. Med Ultrason 2019; 21: 8-15
17 Arienti V, Di Giulio R, Cogliati C. et al. Bedside ultrasonography (US), Echoscopy and US point of care as a new kind of stethoscope for Internal Medicine Departments: the training program of the Italian Internal Medicine Society (SIMI). Intern Emerg Med 2014; 9: 805-814
18 Barreiros AP, Cui XW, Ignee A. et al. EchoScopy in scanning abdominal diseases: initial clinical experience. Z Gastroenterol 2014; 52: 269-275
19 EFSUMB. Birth of „Echoscopy“–The EFSUMB Point of View. Ultraschall in Med 2013; 34: 92
20 Dietrich CF, Bulla P, Dudwiesus H. et al. Perspectives and Challenges of hand-held Ultrasound. Z Gastroenterol 2023; 61: 836-851
21 Ligtvoet C, Rijsterborgh H, Kappen L. et al. Real time ultrasonic imaging with a hand-held scanner. Part I--technical description. Ultrasound Med Biol 1978; 4: 91-92
22 Roelandt J, Bom K, Hugenholtz PG. The ultrasound cardioscope: a hand-held scanner for real-time cardiac imaging. J Clin Ultrasound 1980; 8: 221-225
23 Roelandt J, Wladimiroff JW, Baars AM. Ultrasonic real time imaging with a hand-held-scanner. Part II--initial clinical experience. Ultrasound Med Biol 1978; 4: 93-97
24 Henriksson L, Marsal K. Bedside ultrasound diagnosis of residual urine volume. Arch Gynecol 1982; 231: 129-133
25 Gussenhoven WJ, Kappen L, Ligtvoet CM. et al. Clinical evaluation of a hand-help ultrasound device in pediatric cardiology. Ultrasound Med Biol 1980; 6: 271-277
26 Merten DF, Palmer PE, Sweet EM. et al. Rational use of diagnostic imaging in paediatrics. The report of a World Health Organization Study Group. Pediatr Radiol 1989; 19: 216-218
27 A rational approach to radiodiagnostic investigations. World Health Organ Tech Rep Ser 1983; 689: 1-49
28 Future use of new imaging technologies in developing countries. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser 1985; 723: 1-67
29 Bondar RL, Stein F, Vaitkus PJ. et al. Transcranial Doppler studies of flow velocity in middle cerebral artery in weightlessness. J Clin Pharmacol 1990; 30: 390-395
30 Baribeau Y, Sharkey A, Chaudhary O. et al. Handheld Point-of-Care Ultrasound Probes: The New Generation of POCUS. J Cardiothorac Vasc Anesth 2020; 34: 3139-3145
31 Seitz K, Braun B. Sonografie kompetent. In: . Stuttgart, New York: Georg Thieme Verlag; 2016: 516
32 Dietrich CF, Hocke M, Braden B. Echoscopy. Praxis (Bern 1994) 2015; 104: 1005-1012
33 EFSUMB. Birth of “Echoscopy”-The EFSUMB Point of View. Ultraschall Med 2013; 34: 92
34 Maio G. Medicine and the holistic understanding of the human being: ultrasound examination as dialog. Ultraschall Med 2014; 35: 98-107
35 Merz E, Evans DH, Dong Y. et al. History of ultrasound in obstetrics and gynaecology from 1971 to 2021 on occasion of the 50 years anniversary of EFSUMB. Med Ultrason 2023; 25: 175-188
36 Dietrich CF, Bolondi L, Duck F. et al. History of Ultrasound in Medicine from its birth to date (2022), on occasion of the 50 Years Anniversary of EFSUMB. A publication of the European Federation of Societies for Ultrasound In Medicine and Biology (EFSUMB), designed to record the historical development of medical ultrasound. Med Ultrason 2022; 24: 434-450
37 Saverymuttu SH, Grundy A, Joseph AE. Endoscopic ultrasound: radiologist or endoscopist, not both. Lancet 1987; 2: 794
38 Morgan MA, Twine CP, Lewis WG. et al. Prognostic significance of failure to cross esophageal tumors by endoluminal ultrasound. Dis Esophagus 2008; 21: 508-513
39 Kawamoto K, Yamada Y, Utsunomiya T. et al. Gastrointestinal submucosal tumors: evaluation with endoscopic US. Radiology 1997; 205: 733-740
40 Aakjaer Andersen C, Jensen MBB, Toftegaard BS. et al. Primary care physicians’ access to in-house ultrasound examinations across Europe: a questionnaire study. BMJ Open 2019; 9: e030958
41 Touhami D, Merlo C, Hohmann J. et al. The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland. BMC Fam Pract 2020; 21: 127
42 Rollins SD. Ultrasound-guided fine-needle aspiration by cytopathologist-Lessons learned in building a successful practice. Cytopathology 2024;
43 Lieu D. FNA 2.0: Value of cytopathologist-performed ultrasound-guided core-needle biopsy. Semin Diagn Pathol 2022; 39: 426-435
44 Abele JS. Building an USGFNA clinic from scratch: A recipe from the USGFNA cookbook for successes. Semin Diagn Pathol 2022; 39: 421-425
45 Brunnstrom H, Darai-Ramqvist E, Domanski HA. Interventional and EBUS cytology in Sweden. Semin Diagn Pathol 2022; 39: 458-462
46 Diaz-Gomez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. N Engl J Med 2021; 385: 1593-1602
47 Schleifer J, Recker F, Breitkreutz R. SonoABCD. 2020
48 Wilkinson JN, Saxhaug LM. Handheld ultrasound in training – The future is getting smaller!. J Intensive Care Soc 2021; 22: 220-229
49 Michels G, Greim CA, Krohn A. et al. Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ALRD, DGU, DIVI and DGIIN. Anaesthesiologie 2023; 72: 654-661
50 Sidhu PS. Multiparametric Ultrasound (MPUS) Imaging: Terminology Describing the Many Aspects of Ultrasonography. Ultraschall Med 2015; 36: 315-317
51 Scalea TM, Rodriguez A, Chiu WC. et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma 1999; 46: 466-472
52 Dietrich CF, Goudie A, Chiorean L. et al. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2017; 43 (01) 49-58
53 Goudie A, Blaivas M, Horn R. et al. Ultrasound during Advanced Life Support-Help or Harm?. Diagnostics (Basel) 2024; 14 (06) 593
54 Dietrich CF, Westerway S, Nolsoe C. et al. Commentary on the World Federation for Ultrasound in Medicine and Biology Project „Incidental Findings“. Ultrasound Med Biol 2020; 46: 1815-1820
55 Jenssen C, Lorentzen T, Dietrich CF. et al. Incidental Findings of Gallbladder and Bile Ducts-Management Strategies: General Aspects, Gallbladder Polyps and Gallbladder Wall Thickening-A World Federation of Ultrasound in Medicine and Biology (WFUMB) Position Paper. Ultrasound Med Biol 2022; 48: 2355-2378
56 Bledsoe A, Zimmerman J. Ultrasound: The New Stethoscope (Point-of-Care Ultrasound). Anesthesiol Clin 2021; 39: 537-553
57 McLeod P, Beck S. Update on echocardiography: do we still need a stethoscope?. Intern Med J 2022; 52: 30-36
58 Ramos-Hernandez C, Botana-Rial M, Nunez-Fernandez M. et al. Validity of Lung Ultrasound: Is an Image Worth More Than a Thousand Sounds?. J Clin Med 2021; 10 (11) 2292
59 Hubmayr RD. The times are a-changin’: should we hang up the stethoscope?. Anesthesiology 2004; 100: 1-2
60 Ozkan B, Unluer EE, Akyol PY. et al. Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial. Eur J Emerg Med 2015; 22: 440-443
61 Vasudevan RS, Horiuchi Y, Torriani FJ. et al. Persistent Value of the Stethoscope in the Age of COVID-19. Am J Med 2020; 133: 1143-1150
62 Lo H, Eder N, Boten D. et al. Handheld Ultrasound (HHUS): Potential for Home Palliative Care. Ultrasound Int Open 2022; 8: E68-E76
63 Lo H, Frauendorf V, Wischke S. et al. Ambulatory Use of Handheld Point-of-Care Ultrasound (HH-POCUS) in Rural Brandenburg – A Pilot Study. Ultraschall Med 2022; 43: 584-591
64 Merkel D, Zullich TF, Schneider C. et al. Prospective Comparison of Handheld Ultrasound Devices from Different Manufacturers with Respect to B-Scan Quality and Clinical Significance for Various Abdominal Sonography Questions. Diagnostics (Basel) 2023; 13 (24) 3622
65 Soni NJ, Schnobrich D, Mathews BK. et al. Point-of-Care Ultrasound for Hospitalists: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14: E1-E6
66 Perez-Sanchez A, Jensen TP, Soni NJ. Clinical progress note: 5 Essential point-of-care ultrasound skills for hospitalists. J Hosp Med 2024;
67 Pathan F, Fonseca R, Marwick TH. Usefulness of Hand-Held Ultrasonography as a Gatekeeper to Standard Echocardiography for “Rarely Appropriate” Echocardiography Requests. Am J Cardiol 2016; 118: 1588-1592
68 Giangregorio F, Mosconi E, Debellis MG. et al. Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The “Bed Med-Us” Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients. Ultrasound Int Open 2024; 10: a21961599
69 Helmberger H, Kammer B. Radiologic diagnostics of the gall bladder and bile ducts-part 1 : Imaging techniques-normal variants and congenital disorders-cholelithiasis. Radiologe 2018; 58: 1021-1034
70 Rickes S, Treiber G, Monkemuller K. et al. Impact of the operator’s experience on value of high-resolution transabdominal ultrasound in the diagnosis of choledocholithiasis: a prospective comparison using endoscopic retrograde cholangiography as the gold standard. Scand J Gastroenterol 2006; 41: 838-843
71 Judmaier G, Seitz K. How reliable is sonography of the upper abdomen with portable sonographic units? What does the future hold?. Ultraschall Med 2004; 25: 408-410
72 Merkel D, Schneider C, Ludwig M. Internet-based digital video atlas of sonographic findings for clinical and educational purposes. J Ultrason 2020; 20: e24-e28
73 Lucius C, Koch JBH, Jenssen C. et al. State of the art: Simulation in US. Z Gastroenterol 2024; 62: 723-736
74 Pedersen MRV, Ostergaard ML, Nayahangan LJ. et al. Simulation-based education in ultrasound – diagnostic and interventional abdominal focus. Ultraschall Med 2024; 45: 348-366
75 Blank V, Strobel D, Karlas T. Digital Training Formats in Ultrasound Diagnostics for physicians: What options are available and how can they be successfully integrated into current DEGUM certified course concepts?. Ultraschall Med 2022; 43: 428-434
76 Todsen T, Ewertsen C, Jenssen C. et al. Head and Neck Ultrasound – EFSUMB Training Recommendations for the Practice of Medical Ultrasound in Europe. Ultrasound Int Open 2022; 8: E29-E34
77 Wustner M, Radzina M, Calliada F. et al. Professional Standards in Medical Ultrasound – EFSUMB Position Paper (Long Version) – General Aspects. Ultraschall Med 2022; 43: e36-e48
78 Ernst BP, Dorsching C, Bozzato A. et al. Structured Reporting of Head and Neck Sonography Achieves Substantial Interrater Reliability. Ultrasound Int Open 2023; 9: E26-E32
79 Ernst BP, Strieth S, Kunzel J. et al. Evaluation of optimal education level to implement structured reporting into ultrasound training. Med Ultrason 2020; 22: 445-450
80 Lowe A, Jenssen C, Huske S. et al. “Knobology” in Doppler Ultrasound. Med Ultrason 2021; 23: 480-486
81 Zander D, Huske S, Hoffmann B. et al. Ultrasound Image Optimization (“Knobology”): B-Mode. Ultrasound Int Open 2020; 6: E14-E24
82 European Society of R. The identity and role of the radiologist in 2020: a survey among ESR full radiologist members. Insights Imaging 2020; 11: 130
83 Derchi LE, Claudon M. Ultrasound: a strategic issue for radiology?. Eur Radiol 2009; 19: 1-6
84 Lockhart ME. The role of radiology in the future of sonography. AJR Am J Roentgenol 2008; 190: 841-842
85 European Society of R. Organisation and practice of radiological ultrasound in Europe: a survey by the ESR Working Group on Ultrasound. Insights Imaging 2013; 4: 401-407
86 Dietrich CF, Lorentzen T, Appelbaum L. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Short Version). Ultraschall Med 2016; 37: 27-45
87 Dietrich CF, Lorentzen T, Appelbaum L. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Long Version). Ultraschall Med 2016; 37: E1-E32
88 Dietrich CF, Lorentzen T, Sidhu PS. et al. An Introduction to the EFSUMB Guidelines on Interventional Ultrasound (INVUS). Ultraschall Med 2015; 36: 460-463
89 Lorentzen T, Nolsoe CP, Ewertsen C. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (long Version). Ultraschall Med 2015; 36: E1-14
90 Lorentzen T, Nolsoe CP, Ewertsen C. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (Short Version). Ultraschall Med 2015; 36: 464-472
91 Sidhu PS, Brabrand K, Cantisani V. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Long Version). Ultraschall Med 2015; 36: E15-35
92 Sidhu PS, Brabrand K, Cantisani V. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Short Version). Ultraschall Med 2015; 36: 566-580
93 Paetzold K. Analyse des Verantwortungs- und Tätigkeitsbereichs des Berufsbilds „Sonographer“ und Möglichkeiten der Umsetzung in Deutschland. Endo-Praxis 2024; 40: 41-48
94 Baker JP. The history of sonographers. J Ultrasound Med 2005; 24: 1-14
95 Pedersen MRV, Kraus B, Santos R. et al. Radiographers’ individual perspectives on sonography – A survey of European Federation of Radiographer Societies (EFRS). Radiography (Lond) 2022; 28: 31-38
96 Miles N, Cowling C, Lawson C. The role of the sonographer – An investigation into the scope of practice for the sonographer internationally. Radiography (Lond) 2022; 28: 39-47
97 Edwards HM, Sidhu PS. Who’s doing your scan? A European perspective on ultrasound services. Ultraschall Med 2017; 38: 479-482
98 Parker PC, Harrison G. Educating the future sonographic workforce: membership survey report from the British Medical Ultrasound Society. Ultrasound 2015; 23: 231-241
99 Watanabe H. Ultrasound. Med Biol 2004; 30 (09) 1251-1254
100 Statement from the DEGUM board regarding the editorial entitled “Who’s Doing Your Scan? A European Perspective on Ultrasound Services”. Ultraschall Med 2018; 39: 11-13
101 Seitz K. Who’s Doing Your Scan? The German Perspective on Ultrasound Services: Ultrasound is More Than a Technique, it’s a Medical Art. Ultraschall Med 2017; 38: 661-663
102 Seitz K, Piscaglia F. Ultrasound: the Only „One Stop Shop“ for Modern Management of Liver Disease. In: Ultraschall Med. Stuttgart / New York: Georg Thieme Verlag KG; 2013: 500-503
103 Leslie A, Lockyer H, Virjee JP. Who should be performing routine abdominal ultrasound? A prospective double-blind study comparing the accuracy of radiologist and radiographer. Clin Radiol 2000; 55: 606-609
104 Bates JA, Conlon RM, Irving HC. An audit of the role of the sonographer in non-obstetric ultrasound. Clin Radiol 1994; 49: 617-620
105 Weston MJ, Morse A, Slack NF. An audit of a radiographer based ultrasound service. Br J Radiol 1994; 67: 665-667
106 Cummings J, Edwards H. Local Investigation of outcomes Based on Ultrasound Examinations for Suspected Inguinal Hernia Performed by Sonographers and Radiologists. Ultrasound 2013; 21: 12-15
107 Riley SJ, Groves CJ, Chandramohan M. Musculoskeletal Ultrasound: Audit of Sonographer Reporting. Ultrasound 2010; 18: 36-40
108 Hofmann B, Vikestad KG. Accuracy of upper abdominal ultrasound examinations by sonographers in Norway. Radiography 2013; 19: 186-189
109 Lo RHG, Chan PP, Chan LP. et al. Routine abdominal and pelvic ultrasound examinations: an audit comparing radiographers and radiologists. Ann Acad Med Singap 2003; 32 (01) 126-128
110 Gilligan LA, Trout AT, Davenport MS. et al. Predictors of Clinical Outcomes in Pediatric Appendicitis: Role of the Individual Sonographer and Radiologist When Using a First-Line Ultrasound Approach. J Am Coll Radiol 2021; 18: 1128-1138
111 Gilligan LA, Trout AT, Davenport MS. et al. Variation in imaging outcomes associated with individual sonographers and radiologists in pediatric acute appendicitis: a retrospective cohort of 9271 examinations. Eur Radiol 2021; 31: 8565-8577
112 Williams I, Baird M, Schneider M. Comparison between radiographers with sonography education working in remote Australia and radiologists’ interpretation of ultrasound examinations. J Med Radiat Sci 2022; 69: 293-298
113 Freeman S, Cantin P, Gutteridge C. et al. Image and report quality in non-obstetric ultrasound examinations undertaken by sonographers: Results of an audit of 3731 cases. Ultrasound 2022; 30: 28-35
114 Seifert P, Maikowski I, Winkens T. et al. Ultrasound Cine Loop Standard Operating Procedure for Benign Thyroid Diseases-Evaluation of Non-Physician Application. Diagnostics (Basel) 2021; 11
115 Kendall JL, Shimp RJ. Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians. J Emerg Med 2001; 21: 7-13
116 Dupriez F, Geukens P, Penaloza A. et al. Agreement of emergency physician-performed ultrasound versus RADiology-performed UltraSound for cholelithiasis or cholecystitis: a systematic review. Eur J Emerg Med 2021; 28: 344-351
117 MacDonald AA, Richardson M, Sue L. et al. Bedside ultrasonography for acute gallstone disease: a diagnostic accuracy study of surgical registrars and emergency medicine physicians. ANZ J Surg 2020; 90: 2467-2471
118 Noble VE, Liteplo AS, Nelson BP. et al. The impact of analgesia on the diagnostic accuracy of the sonographic Murphy’s sign. Eur J Emerg Med 2010; 17: 80-83
119 Torres-Macho J, Anton-Santos JM, Garcia-Gutierrez I. et al. Initial accuracy of bedside ultrasound performed by emergency physicians for multiple indications after a short training period. Am J Emerg Med 2012; 30: 1943-1949
120 Tootian Tourghabe J, Arabikhan HR, Alamdaran A. et al. Emergency Medicine Resident versus Radiologist in Detecting the Ultrasonographic Signs of Acute Cholecystitis; a Diagnostic Accuracy Study. Emerg (Tehran) 2018; 6: e19
121 Gustafsson C, Lindelius A, Torngren S. et al. Surgeon-Performed Ultrasound in Diagnosing Acute Cholecystitis and Appendicitis. World J Surg 2018; 42: 3551-3559
122 Summers SM, Scruggs W, Menchine MD. et al. A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ann Emerg Med 2010; 56: 114-122
123 Gaszynski R, Lim C, Chan DL. et al. Surgical ultrasonography at the bedside: a comparison of surgical trainees with trained sonographers for symptomatic cholelithiasis – a first Australian experience. ANZ J Surg 2019; 89: 492-496
124 Jang TB, Ruggeri W, Kaji AH. Emergency ultrasound of the gall bladder: comparison of a concentrated elective experience vs. longitudinal exposure during residency. J Emerg Med 2013; 44: 198-203
125 Irkorucu O, Reyhan E, Erdem H. et al. Accuracy of surgeon-performed gallbladder ultrasound in identification of acute cholecystitis. J Invest Surg 2013; 26: 85-88
126 Hasani SA, Fathi M, Daadpey M. et al. Accuracy of bedside emergency physician performed ultrasound in diagnosing different causes of acute abdominal pain: a prospective study. Clin Imaging 2015; 39: 476-479
127 Soiva M, Haveri M, Taavitsainen M. et al. The value of routine sonography in clinically suspected acute cholecystitis. Scand J Gastroenterol 1986; 21: 70-74
128 Gustafsson C, McNicholas A, Sonden A. et al. Accuracy of Surgeon-Performed Ultrasound in Detecting Gallstones: A Validation Study. World J Surg 2016; 40: 1688-1694
129 Ahmad S, Zafar A, Ahmad M. et al. Accuracy of surgeon-performed abdominal utrasound for gallstones. J Ayub Med Coll Abbottabad 2005; 17: 70-71
130 Durston W, Carl ML, Guerra W. et al. Comparison of quality and cost-effectiveness in the evaluation of symptomatic cholelithiasis with different approaches to ultrasound availability in the ED. Am J Emerg Med 2001; 19: 260-269
131 Tajoddini S, Shams Vahdati S. Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency physicians and radiologists. Eur J Trauma Emerg Surg 2013; 39: 9-13
132 Ghafouri HB, Zare M, Bazrafshan A. et al. Diagnostic accuracy of emergency-performed focused assessment with sonography for trauma (FAST) in blunt abdominal trauma. Electron Physician 2016; 8: 2950-2953
133 Lanoix R, Leak LV, Gaeta T. et al. A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program. Am J Emerg Med 2000; 18: 41-45
134 Soundappan SV, Holland AJ, Cass DT. et al. Diagnostic accuracy of surgeon-performed focused abdominal sonography (FAST) in blunt paediatric trauma. Injury 2005; 36: 970-975
135 Burford JM, Dassinger MS, Smith SD. Surgeon-performed ultrasound as a diagnostic tool in appendicitis. J Pediatr Surg 2011; 46: 1115-1120
136 Wyrick DL, Smith SD, Burford JM. et al. Surgeon-performed ultrasound: accurate, reproducible, and more efficient. Pediatr Surg Int 2015; 31: 1161-1164
137 Shahbazipar M, Seyedhosseini J, Vahidi E. et al. Accuracy of ultrasound exam performed by emergency medicine versus radiology residents in the diagnosis of acute appendicitis. Eur J Emerg Med 2019; 26: 272-276
138 Fox JC, Solley M, Anderson CL. et al. Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur J Emerg Med 2008; 15: 80-85
139 Karimi E, Aminianfar M, Zarafshani K. et al. The Accuracy of Emergency Physicians in Ultrasonographic Screening of Acute Appendicitis; a Cross Sectional Study. Emerg (Tehran) 2017; 5: e22
140 Chan I, Bicknell SG, Graham M. Utility and diagnostic accuracy of sonography in detecting appendicitis in a community hospital. AJR Am J Roentgenol 2005; 184: 1809-1812
141 Jahn H, Mathiesen FK, Neckelmann K. et al. Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis: experience with a score-aided diagnosis. Eur J Surg 1997; 163: 433-443
142 Pohl D, Golub R, Schwartz GE. et al. Appendiceal ultrasonography performed by nonradiologists: does it help in the diagnostic process?. J Ultrasound Med 1998; 17: 217-221
143 Soundappan SS, Karpelowsky J, Lam A. et al. Diagnostic accuracy of surgeon performed ultrasound (SPU) for appendicitis in children. J Pediatr Surg 2018; 53: 2023-2027
144 Lehmann B, Koeferli U, Sauter TC. et al. Diagnostic accuracy of a pragmatic, ultrasound-based approach to adult patients with suspected acute appendicitis in the ED. Emerg Med J 2022; 39: 931-936
145 Sivitz AB, Cohen SG, Tejani C. Evaluation of acute appendicitis by pediatric emergency physician sonography. Ann Emerg Med 2014; 64: 358-364 e354
146 Verroken R, Penninckx F, Van Hoe L. et al. Diagnostic accuracy of ultrasonography and surgical decision-making in patients referred for suspicion of appendicitis. Acta Chir Belg 1996; 96: 158-160
147 Thomas PR, Shaw JC, Ashton HA. et al. Accuracy of ultrasound in a screening programme for abdominal aortic aneurysms. J Med Screen 1994; 1: 3-6
148 Durston WE, Carl ML, Guerra W. et al. Ultrasound availability in the evaluation of ectopic pregnancy in the ED: comparison of quality and cost-effectiveness with different approaches. Am J Emerg Med 2000; 18: 408-417
149 Rottenstreich A, Yanai N, Yagel S. et al. The Accuracy of Sonographic Assessment for Fetal Weight: Technicians versus Ultrasound-Certified Physicians. Isr Med Assoc J 2019; 21: 801-805
150 Frezza EE, Ferone T, Martin M. Surgical residents and ultrasound technician accuracy and cost-effectiveness of ultrasound in trauma. Am Surg 1999; 65: 289-291
151 Gurien LA, Smith SD, Dassinger MS. et al. Suspected appendicitis pathway continues to lower CT rates in children two years after implementation. Am J Surg 2019; 218: 716-721
152 Beltzer CR, Zischek C, Schmidt R. et al. The Relevance of Surgeon-performed Ultrasound For the Detection of Acute Appendicitis: a Review of the Literature and a Practical Diagnostic Algorithm. Zentralblatt für Chirurgie 2017; 142 (04) 395-403
153 Carroll PJ, Gibson D, El-Faedy O. et al. Surgeon-performed ultrasound at the bedside for the detection of appendicitis and gallstones: systematic review and meta-analysis. Am J Surg 2013; 205: 102-108
154 Concannon E, McHugh S, Healy DA. et al. Diagnostic accuracy of non-radiologist performed ultrasound for abdominal aortic aneurysm: systematic review and meta-analysis. Int J Clin Pract 2014; 68: 1122-1129
155 Huang SS, Lin KW, Liu KL. et al. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg 2023; 18: 54
156 Nurnberg D, Jung A, Schmieder C. et al. What’s the price of routine sonography--results of an analysis of costs and processes in a district hospital. Ultraschall Med 2008; 29: 405-417
157 Schuler A, Reuss J, Delorme S. et al. Costs of clinical ultrasound examinations – an economical cost calculation and analysis. Ultraschall Med 2010; 31: 379-386
158 Nogueras Gimeno MA, Marron Penon MC, Guinda Sevillano C. et al. Cost-effectiveness of ultrasound in a urology department. Arch Esp Urol 2006; 59: 325-331
159 European Society of R. Position statement and best practice recommendations on the imaging use of ultrasound from the European Society of Radiology ultrasound subcommittee. Insights Imaging 2020; 11: 115
160 Sidhu PS, Ewertsen C, Piskunowicz M. et al. Diversity of current ultrasound practice within and outside radiology departments with a vision for 20 years into the future: a position paper of the ESR ultrasound subcommittee. Insights Imaging 2023; 14: 202
161 Clevert DA, Jung EM, Weber MA. et al. Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology. Rofo 2022; 194: 1322-1332