Effect of Machine Settings on Ultrasound Assessment of B‐lines

OBJECTIVES: B‐lines are a lung ultrasound (LUS) artifact that often indicate pathology. Little is known about the optimal ultrasound machine settings to assess B‐lines. We compared settings typically used to evaluate B‐lines at our institution with adjusted settings based on recent studies. METHODS: In order to determine typical settings for B‐line assessment, we retrospectively reviewed LUS images obtained at our institution. We then prospectively performed LUS with both typical and adjusted settings, using curvilinear and phased array probes, in 20 patients presenting to the emergency department with shortness of breath. The prospectively obtained clips were rated for quality and quantity of B‐lines by 14 clinicians with experience in LUS, with 1 assigned for typical settings “much greater,” 2 for typical settings “slightly greater,” 3 for both settings “similar,” 4 for adjusted settings “slightly greater,” and 5 for adjusted settings “much greater.” RESULTS: Mean ratings and 95% confidence intervals significantly exceeded the null value of 3 for both B line quality (curvilinear probe: 4.68, 4.50–4.85; phased array probe: 4.02, 3.70–4.35) and B line quantity (curvilinear probe: 4.16, 3.84–4.49; phased array probe: 3.68, 3.41–3.96). CONCLUSIONS: B‐line quality and quantity were rated higher using adjusted settings based on recently published evidence than when using settings that are typically employed in our institution. Our findings suggest that B‐line assessment should be performed with focal zone at the level of the pleura, harmonics off, and gain increased in the far field.