key: cord-0005019-t4ro1rl9
authors: Corradi, F.; Via, G.; Forfori, F.; Brusasco, C.; Tavazzi, G.
title: Lung ultrasound and B-lines quantification inaccuracy: B sure to have the right solution
date: 2020-03-18
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06005-6
sha: 7e7ca65fe4c9b146a13b29b9e88f98881c42aa94
doc_id: 5019
cord_uid: t4ro1rl9

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between two B-lines may not be reliably assessed visually and may change over the respiratory cycle; (2) "coalescence" between two B-lines may be an arguable concept, considering that the same artifact could be interpreted as two close B-lines or a wide B-line; (3) rating all coalescences with the same score, regardless of the percentage of pleura involved, may lead to overestimation of the pathology when this is focal and not ubiquitous, as in ARDS.

The lack of a reference method to objectively quantify B-lines may thus have affected the interpretation of the supposed differences in visualizating them with different probes reported by Haaksma et al.

We believe that the absence of a quantitative scoring system may be overcome by computer-aided measurements of the percentage of pleural line presenting B-line artifacts. This has already been shown to provide a promising and reliable operator-independent assessment of lung surface density (Fig. 1) , which seems to outperform previously described subjective scores [4] [5] [6] .

The next mandatory step will be the automation of this technique, by developing a computer-based clinically easy-to-use tool able to grant an objective pleural line artifacts evaluation. This would reduce inter-and intraobserver variability and create a unique quantification system in order to standardize diagnostic and monitoring scores. Such methodology, supported by artificialintelligence software, has been successfully tested for other ultrasound automated techniques [7] . The potential advantages in terms of faster data collection without increased costs and patients risks are intuitive. The clinical usefulness and importance for lung disease diagnosis and monitoring, in an era fraught with the challenge of pandemic infectious interstitial diseases (such as , are easy to guess. 

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