V. Richardson1, J. A. Whitley2, A. Taylor2, K. Kieran1,2 1University Of Washington,Seattle, WA, USA 2Seattle Children’s Hospital,Urology,Seattle, WA, USA
Introduction: Identifying opportunities for patients to receive medical care closer to home may reduce financial and temporal costs for families. We wondered whether there were differences in imaging techniques and/or quality of radiographic interpretation among studies performed at freestanding children’s hospitals and those performed at other institutions. We undertook this study to describe differences in RBUS image and report quality associated with the type of institution where the imaging study was obtained.
Methods: We identified all new patients with RBUS seen in the urology clinic of a single free standing, university affiliated children’s hospital, (FCH) between January 1 and December 31, 2017. Patients for whom RBUS were ordered at or before the new visit and for whom radiographic interpretation was available were included. We recorded the number of longitudinal and transverse views of each renal unit and of the bladder, and the number of cine loops included in each study. We also recorded whether the interpreting radiologist commented on renal parenchymal echogenicity (RPE) and upper tract dilatation (UTD). RBUS performed at FCH and non-FCH institutions (NFCH) were compared.
Results: 637 patients met inclusion criteria. 388 (61.1%) children had RBUS at FCH. Children undergoing RBUS at FCH and NFCH were similar in age (median 5.58 [range 0-19.3] vs. 5.42 [range 0-19.6] years, p=0.58) and gender (51.7% vs 43.0% female, p=0.14). RBUS performed at FCH had similar renal imaging, but more bladder imaging (Table 1), and were less likely to have cine loops recorded (OR=0.85, 95% CI: 0.61-1.19) than RBUS from NFCH. When cine loops were recorded, NFCH recorded more loops than FCH (median 4 [range 1-20] vs 2 [range 1-10], p=0.0003). FCH radiology reports were more likely to describe RPE (OR=101.8, 95% CI: 24.8-418.7) but equally likely to comment on UTD (OR=2.87, 95% CI: 0.95-8.67) than those from NFCH. For patients with UTD, FCH reports were more likely to utilize formal nomenclature (Upper Tract Dilatation [UTD] or Society for Fetal Urology [SFU] classifications) than NFCH reports (OR=69.3, 95% CI: 34.6-138.5). When a formal classification method was utilized, more reports from FCH than NFCH utilized the newer UTD system (98.4% vs 69.2%, p<0.0001).
Conclusion: RBUS from FCH were quantitatively similar to those from NFCH, with similar static images of the kidneys but more bladder images and fewer cine loops at FCH. Radiology reports were more detailed at FCH than at NFCH, particularly regarding assessment of RPE and utilization of standardized nomenclature to describe UTD. Although RBUS are widely available and may offer cost and time savings for families, these findings should be considered by providers ordering RBUS locally.
