Effect of optimal operator positioning on transcranial Doppler acquisition: a randomized controlled trial

BACKGROUND: Ergonomic conditions during ultrasound procedures may influence both acquisition time and image quality. In transcranial Doppler, positioning at the patient's head could improve operator comfort and performance. This study aimed to evaluate whether a standardized seated position at the patient's head enables faster acquisition of interpretable images and could improve image quality. METHODS: We conducted a multicenter randomized controlled trial between August and December 2024 including emergency medicine residents without prior training in transcranial Doppler. Participants were randomized to either a free positioning group or a standardized seated position at the patient's head. Each participant performed bilateral acquisitions of the middle cerebral artery. Acquisition time was recorded, and image quality was assessed blindly by an expert panel using a semi-quantitative scale. RESULTS: Forty-four residents were included, yielding 88 measurements (46 in the intervention group and 42 in the control group). Baseline characteristics were similar except for a higher number of validated semesters in the intervention group. Mean acquisition time was shorter in the intervention group (99.4 ± 47.1 s) than in the control group (121.7 ± 52.9 s), with a mean difference of 22.3 s (95% CI 1.2-43.3; p = 0.038). Image quality scores did not differ significantly between groups (16.6 ± 5.0 vs. 18.0 ± 5.0; mean difference - 1.4, 95% CI -3.5-0.7; p = 0.20). CONCLUSIONS: Standardized operator positioning at the patient's head was associated with faster acquisition of transcranial Doppler images, without a significant difference in image quality.