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

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.

Reliability and accuracy of ultrasound image analyses completed manually versus an automated tool

“…Brightness mode ultrasound is a reliable tool for measuring skeletal muscle morphology ( Carr et al, 2021 ; Van Hooren, Teratsias & Hodson-Tole, 2020 ; Kwah et al, 2013 ; May, Locke & Kingsley, 2021 ; Rosenberg et al, 2014 ; De Souza Silva et al, 2018 ). In the current study, manual ultrasound analyses indicated good reliability when assessing muscle architecture ( i.e ., FA and FL) (ICC 2,1 = 0.75–0.86) with low absolute error (SEM% = 9.99–13.69).…”

“…However, these previous ( Van Hooren, Teratsias & Hodson-Tole, 2020 ; Kellis et al, 2009 ) works do suggest ultrasound to be a valid technique to assess muscle architecture. While the automatic tool used in the present study is valid when compared to the manual method, future studies may wish to validate this technique against other imaging modalities ( i.e ., MRI) and using different ultrasound operators ( Carr et al, 2021 ).…”

“…Analysis of B-mode ultrasound-captured FA and FL was classically performed manually using a protractor and printed image ( Kawakami, Ichinose & Fukunaga, 1998 ), though contemporary computer-based image analysis options exist and are more frequently used ( Carr et al, 2021 ). For instance, computer programs such as ImageJ (National Institutes of Health) or Photoshop (Adobe) include angle and straight line measurement tools which may be used to calculate FA and FL.…”

“…While the automatic image analysis programs may bring many benefits to future studies, insufficient data exists regarding reliability and accuracy of automatic ultrasound analysis tools compared to manual techniques. Also, there is not a clear consensus in regard to the ultrasound frequency that should be utilized as previous studies have used 10 MHz ( Carr et al, 2021 ; Ryan et al, 2016 ), while 12 MHz is also common ( Mota & Stock, 2017 ) and may uniquely impact image quality. Therefore, the primary purpose of this study was to determine the test-retest reliability of a novel, automatic ultrasound analysis tool for the assessment of vastus lateralis muscle architecture ( i.e ., FA, FL).…”

Hamstring muscle architecture assessed sonographically using wide field of view: A reliability study

“…The primary author (sonographer with >200 hrs hamstring scanning experience) performed all assessments and collated and digitised all sonograms for subsequent analysis. Experienced sonographers, when compared to novice sonographers, generate higher quality sonograms which permits reliable skeletal muscle image acquisition and architectural analysis [ 34 ].…”