The AP-IJV max and the CSA-IJV max measurements showed excellent inter-observer reproducibility, suggesting the use of point-of-care ultrasound protocols for non-invasive volume assessment, particularly at the neck’s base or cricoid level.
Abstract
This study evaluates inter-observer variability in measuring internal jugular vein (IJV) ultrasonographic parameters using images obtained from medical ward patients. A cross-sectional study was conducted across 4 Italian hospitals. After brief training, 8 expert sonographers and 11 novices measured at the supraclavicular, cricoid, and submandibular levels, the anteroposterior expiratory maximum diameter (AP-IJV max), maximum cross-sectional area (CSA-IJV max), aspect ratio (AP-IJV max to latero-lateral diameter), and collapsibility index (IJV-c) on 60 IJV ultrasound images from 10 patients. Inter-observer reliability was assessed using the intraclass correlation coefficient. No significant differences were observed between experts and novices for AP-IJV max, CSA-IJV max, or aspect ratio across the different views. The lowest inter-examiner variability was found for AP-IJV max and CSA-IJV max at the supraclavicular level. Aspect ratio showed moderate reliability among experts but poor reproducibility among novices. The IJV-c demonstrated the highest inter-examiner variability in both groups. To our knowledge, this is the first multicenter study aimed at evaluating the method's reliability of different non-invasive acoustic measurements and windows to identify IJV dimensions better to use mainly in case of hypovolemia or fluid challenge. The AP-IJV max and the CSA-IJV max measurements showed excellent inter-observer reproducibility, suggesting the use of point-of-care ultrasound protocols for non-invasive volume assessment, particularly at the neck’s base or cricoid level.
Objectives: This study aimed to examine the intra- and inter-rater reliabilities of panoramic ultrasonographic measurements of the pectoralis minor length (Pm_L), pectoralis minor thickness (Pm_T), and pectoralis minor cross-sectional area (Pm_CSA). Methods: Twenty young male participants aged 19–35 years were recruited for this study. All participants had asymptomatic rounded shoulder posture (RSP), with a mean acromion-to-table distance of 59.316 ± 9.631 mm. Longitudinal panoramic scans of the Pm of the dominant arm were acquired in three trials of four measurements for all participants. The first two measurements were examined by the same rater on the same day, and the third measurement was performed by a different rater. The same procedure was carried out by the first rater after 30 days for inter-day reliability. Intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs), and minimal detectable changes (MDCs) were calculated to estimate the reliabilities. Results: The intra- and inter-rater reliabilities of Pm_L, Pm_T and Pm_CSA were excellent (all ICC > 0.932; all SEM < 7.4%; all MDC < 20%). Bland–Altman plots demonstrated good agreement with nearly zero mean differences between measurements. Conclusions: Using panoramic ultrasonography to measure Pm_L, Pm_T and Pm_CSA may be considered a reliable method with excellent inter-day, intra- or inter-rater reliabilities.
R. Rijal, H. Chai, Jiu-Jenq Lin et al.· Journal of Functional Morpho...· 0 citations
OBJECTIVE
To assess the interobserver reproducibility of preperitoneal fat thickness measurement using a convex ultrasound probe in pregnant women at 12 weeks of gestation.
METHODS
We conducted a prospective, cross-sectional observational study involving 50 women with singleton pregnancies between 11 + 5 and 12 + 6 weeks of gestation. Preperitoneal fat thickness was measured independently by three observers: one expert in obstetric ultrasound and two experienced obstetricians. Measurements were performed using a standardized protocol with a convex transducer at the midpoint between the xiphoid process and the umbilicus. Reproducibility was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman analysis.
RESULTS
The technique demonstrated excellent interobserver reproducibility. The (ICC) were 0.985, 0.989, and 0.980 for pair comparisons observer 1-observer 2, observer 1-observer 3, and observer 2-observer 3, respectively. Mean difference ranged from -0.0063 to -0.0102 mm, suggesting minimal dispersion and no systematic bias.
CONCLUSION
Ultrasound-based measurement of preperitoneal fat using a convex probe is a highly reproducible and reliable technique across different observers. Given its noninvasive nature, accessibility, and excellent reproducibility, this method can be confidently implemented in routine clinical practice for the early identification of pregnant women at increased metabolic and obstetric risk.
R. Orozco, Juana Aranda, Ana Isabel Navas et al.· Journal of Clinical Ultrasou...· 0 citations
Background: Internal jugular vein (IJV) cannulation is widely performed, yet complication rates remain substantial, often associated with anatomical variation. Existing evidence is predominantly derived from non-African populations and frequently lacks bilateral, multi-level assessment. A clearer understanding of IJV–common carotid artery (CCA) relationships in African patients is needed to support safer vascular access.
Aim: To characterise sonographic anatomical variations of the IJV–CCA relationship across three cervical levels and both sides of the neck in adult surgical patients.
Setting: Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Methods: A cross-sectional ultrasound study was conducted in 178 adults. A point-of-care ultrasound (POCUS) certified investigator performed bilateral scans at the upper thyroid cartilage, cricoid cartilage and Sedillot’s triangle. Radial IJV position, vessel diameters, depth from skin, centre-to-centre distance, degree of overlap and atypical variants were recorded.
Results: Typical IJV position was consistently more frequent on the right (upper = 84.3%, middle = 70.8%, lower = 52.8%) than on the left (66.9%, 52.8%, 16.3%). Overlap > 50% occurred less often on the right at all levels (0.7% – 34.3%) compared with the left (24.2% – 67.4%). The IJV was larger on the right at all depths, while CCA depth differed significantly between sides. Atypical variants, including absence, duplication, bifurcation or valves, were rare (2.3%). Increasing age and body mass index were associated with greater overlap and deeper vessel position.
Conclusion: Marked variability exists in IJV–CCA relationships, with the right side demonstrating more favourable anatomy for cannulation.
Contribution: This study provides the first bilateral, multi-level sonographic dataset from an African cohort.
Gouws L. Germishuys, B. Korda· Southern African Journal of...· 0 citations
BACKGROUND
This study aimed to (1) assess the inter-rater reliability of lateral atlantodental distance measurements in digital open-mouth radiographs of infants with upper cervical spine dysfunction, and (2) investigate correlations between lateral atlantodental distance values and clinical findings.
METHODS
72 digital radiographs of the odontoid region from infants aged 3-12 months were analyzed (Aug 2021-Dec 2023). Lateral atlantodental distance was measured bilaterally by three independent raters. Inter-rater reliability and measurement precision was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Side differences were evaluated using paired t-tests. Mean lateral atlantodental distance values were further examined for their association with the clinically assessed side of cervical rotational malposition using logistic regression and receiver operating characteristic (ROC) analysis.
RESULTS
Inter-rater reliability was excellent for right (ICC=0.91 [95% CI: 0.86 - 0.94]) and left (ICC=0.91 [95% CI: 0.86 - 0.95]). The SEM was 0.62 mm for both sides, the MDC was 1.72 mm (right) and 1.73 mm (left). In infants with left-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the left side, whereas in infants with right-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the right side. Right-sided lateral atlantodental distance was a significant predictor of clinically assessed right-sided cervical rotational malposition (OR 1.80, 95% CI 1.14-2.84, P=0.01). ROC analysis demonstrated moderate discriminatory performance (AUC = 0.74), meaning that the model is reasonably capable of distinguishing patients with right-sided cervical rotational malposition from those without.
CONCLUSIONS
Although lateral atlantodental distance measurements showed excellent inter-rater reliability, the SEM was relatively large compared with the small absolute values of the measurements (in millimeters), which limits the ability to detect subtle side-to-side asymmetries. Lateral atlantodental distance should be interpreted as a reproducible radiographic finding associated with cervical rotational malposition rather than as an independent diagnostic marker or pathognomonic sign in infants.
TRIAL REGISTRATION
ClinicalTrials.gov ID NCT04981782 (28.07.2021).
Jan Peter, Miklos Csato, Inga Paravicini et al.· Pediatric Radiology· 1 citation
Cobb angle measurement is essential for diagnosing and monitoring scoliosis; however, its accuracy varies with observer experience. In many healthcare systems, including Oman, initial measurements are commonly performed by residents and influence referral urgency, follow-up intervals, and bracing decisions, where even small inaccuracies may alter clinical pathways. This study evaluated the inter- and intra-observer reliability of Cobb angle measurement among orthopaedic residents and spine specialists. A prospective comparative reliability study was conducted including 18 OMSB orthopaedic residents (PGY2-5) and five spine specialists. Each participant measured Cobb angles on five standardised standing scoliosis radiographs on two occasions, four weeks apart. Inter- and intra-observer reliability were assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects, single-measurement, absolute-agreement model [ICC(2,1)], and Bland-Altman plots were used to assess intra-observer reproducibility. Mean Cobb angles ranged from 45° to 56°. Inter-observer reliability was poor among residents (ICC = -0.219; 95% CI -1.41 to 0.485) and remained low among specialists (ICC = 0.120; 95% CI -2.28 to 0.898). Intra-observer variation averaged approximately 5°, with a Bland-Altman mean bias close to zero and limits of agreement of ±5%. Negative ICC values indicated that between-observer variability exceeded within- observer consistency. Residents demonstrated markedly poorer inter-observer reliability compared to specialists, highlighting the impact of clinical experience on accurate end-vertebra selection and angle measurement. Targeted training modules and structured exposure during residency may improve measurement consistency, referral accuracy, and overall scoliosis management pathways.
A. Al Alawi, S. Al Kalbani, A. Al Barwani et al.· Acta orthopaedica Belgica· 0 citations
Ultrasonographic skin-to-epiglottis depth (SED) has been proposed as a predictor of difficult laryngoscopy (DL). Most studies have evaluated transverse measurements at a single anatomical level, and the influence of parasagittal imaging and measurement level on diagnostic performance remains unclear. This study aimed to assess anatomical level–dependent variation in parasagittal SED and to compare its diagnostic accuracy for predicting DL.
In this prospective observational study, 150 adult patients undergoing elective surgery under general anaesthesia were evaluated preoperatively. Parasagittal SED was measured at three anatomical landmarks: the upper hyoid border (HUB), lower hyoid border (HLB), and thyrohyoid membrane (THM). Difficult laryngoscopy was defined as Cormack–Lehane grade III–IV. Diagnostic performance was analysed using receiver operating characteristic analysis.
DL occurred in 32 patients (21.3%). Parasagittal SED differed significantly across anatomical levels. HUB measurements demonstrated superior predictive performance [area under the curve (AUC) 0.86; 95% confidence interval 0.79–0.92] compared with HLB (AUC 0.75) and THM (AUC 0.65). The HUB/THM ratio showed similarly high discrimination (AUC 0.86). Conventional airway tests showed modest predictive values (AUC 0.62–0.72). Multivariable analysis identified HUB SED >24 mm, inter-incisor distance ≤4 cm, and upper lip bite test class II–III as independent predictors of DL.
Parasagittal SED demonstrates anatomical level–dependent variability that affects diagnostic performance. Assessment at the upper hyoid border provides the highest discrimination and may improve ultrasound-based airway risk stratification.
Çağdaş Savran, Özge Köner, Sibel Temür et al.· Indian Journal of Anaesthesi...· 0 citations
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