Table 2.
Overview of the main recommendations for thoracic ultrasound methodology of examination and reporting derived from analysis of the literature
| Issue | Recommendations |
|---|---|
| Technical issues | |
| Probe | 3.5–5 MHz Convex |
| Depth | Between 12 and 18 cm |
| Gain | Between 50 and 90% |
| Time-gain compensation | High, especially in the deeper portions |
| Focus | Set on the pleural line |
| Preset | Specific (e.g., thorax, if available) |
| Methodology of examination | |
| Exam execution | 12-field study protocol (6 fields per hemithorax: 2 anterior, 2 lateral, 2 posterior) |
| Reporting | |
| General recommendations for reporting |
- Indicate the reason why the examination was performed - Indicate patient position during examination - State any technical difficulty encountered - Description of normal findings can be omitted - Reasons for incomplete assessment of thoracic fields should be provided - Use anatomical landmarks (rib spaces, anatomical lines) to describe the position of abnormal findings - Include a conclusion section, providing clinical interpretation of the visualized findings - Diagnostic hypotheses should be based on integration of ultrasound imaging with clinical and laboratory findings |
| Reporting of pleural abnormalities |
- Absence of pleural sliding should be always reported - Any irregularity or thickening in pleural line should be always reported, specifying the affected areas |
| Reporting of pleural effusions |
- Always indicate the patient position during assessment of effusions - Estimation of volume of effusions with validated formulas should be preferred - A semi-quantitative evaluation (minimal, moderate, extensive; count of rib spaces involved) can be also accepted - Echogenicity characteristics (cellular, septated, iso-hyperechoic, etc.) should be described |
| Reporting of interstitial syndrome |
- Qualitative or semi-quantitative method of evaluation of B lines should be preferred over a quantitative one - Lung Ultrasound Score (LUS), consisting in grading interstitial syndrome from 0 to 4 for each thoracic field, should be reported to facilitate follow-up |
| Reporting of consolidations |
- Quantitative measures of consolidation size is not recommended - Semi-quantitative description of consolidations (small, moderate, extensive; presence of static or dynamic air bronchogram) should be preferred |