Investigation and analysis of ultrasound physicians' understanding of biliary atresia

Luyu LIU; Yedi WANG; Zijian ZHANG; Zelong JIN; Ya MA

ABSTRACT

Objective:

To elucidate the current proficiency level in diagnosing pediatric biliary atresia among Chinese sonographers and to identify contributing factors that may influence their diagnostic capabilities.

Methods:

A cross-sectional internet-based survey was conducted from November 6, 2021, to December 12, 2021. The online questionnaire was disseminated to a national cohort of sonographers via WeChat groups. The survey encompassed three domains demographic data of the participants, clinical and ultrasonographic knowledge pertaining to biliary atresia, and the cognitive understanding of biliary atresia. Descriptive statistics were utilized for the evaluation of demographic information and sonographers' clinical and ultrasonographic comprehension concerning biliary atresia. A generalized linear model was employed to ascertain the determinants influencing sonographers' expertise in clinical management and ultrasonographic diagnosis of biliary atresia.

Results:

A total of 511 valid responses were collated. Approximately 64.77% (331/511) of sonographers indicated a lack of comprehensive understanding of the essential parameters for ultrasonographic diagnosis of biliary atresia. Regression analysis revealed that sonographers affiliated with lower-tier hospitals ( β=-0.344, P=0.002), non-pediatric institutions ( β=-0.747, P=0.004), and those with less than 15 years of professional experience ( β=0.952, P<0.001) exhibited diminished proficiency in diagnosing biliary atresia. Upon encountering suspected cases, a mere 5.48% (28/511) of sonographers expressed complete confidence in their diagnostic capabilities. Lower professional grade ( β=-0.572, P<0.001) and lack of prior experience with suspected cases of biliary atresia ( β=-0.693, P<0.001) contributed to reduced diagnostic self-assurance among sonographers. Regarding the clinical and ultrasonographic intricacies associated with biliary atresia, only 3.33% (17/511) of sonographers had a full understanding of the diagnostic significance of hepatic fibrous plaques on ultrasound for biliary atresia.

Conclusion:

The study underscores a pervasive inadequacy in the understanding and diagnostic confidence among sonographers in relation to pediatric biliary atresia. Various pragmatic factors, including hospital tier, years of experience, and professional ranking, exert a direct impact on the sonographers' diagnostic acumen. Given these findings, there is an exigent need for targeted educational initiatives to enhance the diagnostic proficiency in biliary atresia among sonographers.