Skip to main content

Advertisement

SpringerLink
Log in

Reliability of B-line quantification by different-level observers and a software algorithm using point-of-care lung ultrasound

  • Original Research
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Quantification of B-lines on lung ultrasonographs is operator-dependent and considered a semi-quantitative method. To avoid this variability, we designed a software algorithm for counting B-lines. We compared the number of B-lines obtained in real-time by observers with three different levels of experience and by the software algorithm, and analyzed intra-rater variability in terms of the estimated number of B-lines in two successive examinations. Forty mechanically ventilated adult (≥ 18 years) intensive care unit patients were included in this prospective study. All patients underwent two consecutive ultrasound examinations for B-lines detection by three human observers (OB1 = high, OB2 = medium, OB3 = low level of experience) and by the software (OBS). Ultrasound scans were obtained on the anterior right and left thoracic side along the midclavicular line, in the second and fourth intercostal space; B-lines counting for each position lasted 10 s. To assess intra-observer variability, a second ultrasound scan was obtained 15–30 min after the first scan. For all lung zones, the intraclass correlation for B-lines counting between OB1 and OB2 was 0.663; between OB1 and OB3, 0.559; and between OB1 and OBS, 0.710. OBS had a better concordance coefficient (0.752) between the first and the second measurements than did the human observers. Our results show that the software algorithm for B-lines counting is a potentially promising alternative when observers have little lung ultrasound experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577–91.

    Article  Google Scholar 

  2. Enghard P, Rademacher S, Nee J, Hasper D, Engert U, Jörres A, Kruse JM. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care. 2015;19:36. https://doi.org/10.1186/s13054-015-0756-5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Baldi G, Gargani L, Abramo A, D’Errico L, Caramella D, Picano E, Giunta F, Forfori F. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med. 2013;39:74–84.

    Article  Google Scholar 

  4. Miglioranza MH, Picano E, Badano LP, Sant’Anna R, Rover M, Zaffaroni F, Sicari R, Kalil RK, Leiria TL, Gargani L. Pulmonary congestion evaluated by lung ultrasound predicts decompensation in heart failure outpatients. Int J Cardiol. 2017;240:271–8.

    Article  Google Scholar 

  5. Pivetta E, Goffi A, Lupia E, Castagno D, Tozzetti C, Tizzani P, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest. 2015;148:202–10.

    Article  Google Scholar 

  6. Bedetti G, Gargani L, Corbisiero A, Frassi F, Poggianti E, Mottola G. Evaluation of ultrasound lung comets by hand-held echocardiography. Cardiovasc Ultrasound. 2006;4:34. https://doi.org/10.1186/1476-7120-4-34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Anderson KL, Fields JM, Panebianco NL, Jenq KY, Marin J, Dean AJ. Inter-rater reliability of quantifying pleural B-lines using multiple counting methods. J Ultrasound Med. 2013;32:115–20.

    Article  Google Scholar 

  8. Sperandeo M, Trovato GM, Catalano D. Quantifying B-lines on lung sonography: insufficient evidence as an objective, constructive, and educational tool. J Ultrasound Med. 2014;33:362–5.

    Article  Google Scholar 

  9. Gullett J, Donnelly JP, Sinert R, Hosek B, Fuller D, Hill H, Feldman I, Galetto G, Auster M, Hoffmann B. Inter-observer agreement in the evaluation of B-lines using bedside ultrasound. J Crit Care. 2015;30:1395–9.

    Article  Google Scholar 

  10. Šustić A, Protić A, Juranić J, Matić Z. Software support for precise analysis of the lung ultrasound comet-tail artifact (B-line). Signa Vitae. 2014;9:76.

    Article  Google Scholar 

  11. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;2016(315):801–10.

    Article  Google Scholar 

  12. Lichtenstein D, Meziere G. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134:117–25.

    Article  Google Scholar 

  13. Lichtenstein D, Meziere G. Diagnosis of cardiogenic pulmonary edema by sonography limited to the anterior lung. Chest. 2009;135:883–4.

    Article  Google Scholar 

  14. Li H, Li YD, Zhu WW, Kong LY, Ye XG, Cai QZ, et al. A simplified ultrasound comet tail grading scoring to assess pulmonary congestion in patients with heart failure. Biomed Res Int. 2018. https://doi.org/10.1155/2018/8474839.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ferre A, Guillot M, Lichtenstein D, Meziere G, Richard C, Teboul JL, Monnet X. Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema. Intensive Care Med. 2019;45:601–8.

    Article  Google Scholar 

  16. Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994;6:284–90.

    Article  Google Scholar 

  17. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155–63.

    Article  Google Scholar 

  18. Dietrich CF, Mathis G, Blaivas M, Volpicelli G, Seibel A, Wastl D, Atkinson NS, Cui XW, Fan M, Yi D. Lung B-line artefacts and their use. J Thorac Dis. 2016;8:1356–65.

    Article  Google Scholar 

  19. Soldati G, Copetti R, Sher S. Can lung comets be counted as “objects”? JACC Cardiovasc Imaging. 2011;4:438–9.

    Article  Google Scholar 

  20. Vizioli L, Ciccarese F, Forti P, Chiesa AM, Giovagnoli M, Mughetti M, Zompatori M, Zoli M. Integrated use of lung ultrasound and chest x-ray in the detection of interstitial lung disease. Respiration. 2017;93:15–22.

    Article  Google Scholar 

  21. Yamaga S, Ohshimo S, Shime N. Is lung ultrasonography really useful for diagnosing weaning-induced pulmonary oedema? Intensive Care Med. 2019;45:1329.

    Article  CAS  Google Scholar 

  22. Tardella M, Di Carlo M, Carotti M, Filippucci E, Grassi W, Salaffi F. Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis: cut-off point definition for the presence of significant pulmonary fibrosis. Medicine. 2018;97:18(e0566). https://doi.org/10.1097/md.0000000000010566.

    Article  Google Scholar 

  23. Raso R, Tartarisco G, Matucci Cerinic M, Pioggia G, Picano E, Gargani L. A soft computing–based B-line analysis for objective classification of severity of pulmonary edema and fibrosis. JACC Cardiovasc Imaging. 2015;9:495–6.

    Article  Google Scholar 

  24. Brattain LJ, Telfer BA, Liteplo AS, Noble VE. Automated B-line scoring on thoracic sonography. J Ultrasound Med. 2013;32:2185–90.

    Article  Google Scholar 

  25. Pirompanich P, Karakitsos D, Alharthy A, Gillman LM, Blaivas M, Buchanan BM, Brindley PG, Wattanathum A. Evaluating extravascular lung water in sepsis: three lung-ultrasound techniques compared against transpulmonary thermodilution. Indian J Crit Care Med. 2018;22:650–5.

    Article  Google Scholar 

  26. Luce JM. Pathogenesis and management of septic shock. Chest. 1987;91:883–8.

    Article  CAS  Google Scholar 

  27. Price S. Myocardial dysfunction in sepsis: mechanisms and therapeutic implications. Eur Heart J. 1999;20:715–24.

    Article  CAS  Google Scholar 

  28. Merx MW, Weber C. Sepsis and the heart. Circulation. 2007;116:793–802.

    Article  CAS  Google Scholar 

  29. Hunter JD, Doddi M. Sepsis and the heart. Br J Anaesth. 2010;104:3–11.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Emir Festić for helpful advice and critical review of the article.

Funding

The authors declare that no funding was obtained for this research.

Author information

Author notes

  1. Ana Pičuljan and Marko Šustić have contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, Reanimatology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Rijeka, Br. Branchetta 20, Rijeka, 51000, Croatia

    Ana Pičuljan, Janja Kuharić & Alan Šustić

  2. Department of Histology and Embryology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia

    Marko Šustić

  3. Department of Basic Medical Science, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia

    Gordana Brumini

  4. Department of Clinical Medical Science II, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia

    Alan Šustić

Authors
  1. Ana Pičuljan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marko Šustić
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gordana Brumini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Janja Kuharić
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alan Šustić
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alan Šustić.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the University’s Hospital Ethics Committee (KBC Rijeka, Croatia; 12/12/2016, No.: 2170-29-02/1-16-2). All data obtained were handled according to current data protection guidelines.

Informed consent

The need to obtain informed consent was waived by the ethics committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 1859 kb)

Supplementary material 2 (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pičuljan, A., Šustić, M., Brumini, G. et al. Reliability of B-line quantification by different-level observers and a software algorithm using point-of-care lung ultrasound. J Clin Monit Comput 34, 1259–1264 (2020). https://doi.org/10.1007/s10877-019-00440-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-019-00440-7

Keywords

Search

Navigation