Question No. Clinical Aspect Drop-Down List Response Q1 Primary indication for liver biopsy from original request form Deranged LFTs
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1 Appendix E1 Questionnaire A: Organizational Questionnaire Question No. Question Q1 How many image-guided/assisted liver biopsies in total were performed in your department from 1/1/ /12/2008? Q2 How many different radiology operators (include in the number consultant & trainee radiologists) undertook these biopsies? Q3 How many consultant radiologists perform liver biopsies in your department? Q4 What was the minimum number of liver biopsies performed by the radiology operators? Q5 What was the maximum number of liver biopsies performed by the radiology operators? Q6 Do clinicians from other specialties (eg, gastroenterologists) undertake image-guided liver biopsies? Q7 Do clinicians from other specialties undertake nonguided liver biopsies? Q8 Are liver biopsies done without image guidance/assistance? Q9 Have radiographic staff been trained to perform image-assisted liver biopsy? Q10 Have radiographic staff been trained to perform image-guided focal lesion liver biopsy? Q11 Do you have the facility to offer transjugular liver biopsy? Q12 Do you have the facility to offer plugged liver biopsy? Q13 Are your data from a specialist liver unit? Q14 Are all liver biopsies in your department undertaken by interventional radiologists? Questionnaire B: Clinical Aspects of Biopsy Questionnaire Question No. Clinical Aspect Drop-Down List Response Q1 Primary indication for liver biopsy from original request form Deranged LFTs Q2 If answer to Q1 is other, please specify Focal lesion? malignant Focal lesion? benign Q3 Focal lesion present on imaging Yes/No Q4 Size of focal lesion biopsied (cm) Less than Greater than 10.0 Page 1 of 5
2 Not applicable Q5 Imaging modality Ultrasound guided Ultrasound assisted CT guided CT assisted MR guided Transjugular Q6 Biopsy plugged Yes/No/Don t know Q7 Operator grade Consultant radiologist Consultant GI Consultant (other) Radiology trainee GI trainee Trainee (other) Radiographer Q8 If answer to Q7 is other, please specify Q9 How was procedure undertaken Day case In-patient Q10 Completed consent form in patient record in notes Yes/No Q11 Evidence of postprocedural instructions in notes Yes/No Q12 What anesthesia was used? None Local anesthesia Local anesthesia & oral sedation Local anesthesia & IM sedation Local anesthesia & IV sedation Regional anesthesia General anesthesia Oral sedation IM sedation IV sedation Q13 Needle gauge (biopsy) Q14 If answer to Q13 is other, please specify Q15 Number of passes (biopsy) Greater than 3 Page 2 of 5
3 Q16 Type of needle (biopsy) Side-cutting (eg, Tru-cut) End-cutting (eg, Menghini) Q17 If answer to Q16 is other, please specify Q18 Categorise histology into one group from drop-down list Insufficient for diagnosis I/C necrotic tissue Inflammation only Normal liver Fatty infiltration Abscess Cirrhosis-no cause specified Fibrosis-no cause specified Benign non-neoplastic-other Adenoma Haemangioma Focal nodular hyperplasia Benign neoplasm-other Metastases Primary hepatocellular carcinoma Lymphoma Malignant neoplasm-other Q19 If answer to Q18 is -other (eg, benign neoplasm-other), please specify Q20 Was there subsequent amended, benign/malignant diagnosis on Yes/No/Don t know review of follow up imaging, biopsy, surgery, etc Q21 If answer to Q20 is yes, what was final histologic diagnosis Inflammation only Normal liver Fatty infiltration Abscess Cirrhosis-no cause specified Fibrosis-no cause specified Benign non-neoplastic-other Adenoma Haemangioma Focal nodular hyperplasia Page 3 of 5
4 Benign neoplasm-other Metastases Primary hepatocellular carcinoma Lymphoma Malignant neoplasm-other Not applicable Q22 If answer to Q21 is -other (eg, benign neoplasm-other), please specify Q23 Was the current liver biopsy of (a) a previous nondiagnostic focal lesion biopsy or (b) a previous insufficient nonfocal lesion biopsy Yes/No/Don t know Q24 Were there postbiopsy complications or procedures (see protocol Yes/No/Don t know for list of included postbiopsy complications and procedures) Q25 Was patient aged 16 years or over at biopsy Yes/No Q26 Minor abdominal/shoulder pain postbiopsy Yes/No/Don t know Q27 Severe pain needing IV/IM analgesia postbiopsy Yes/No/Don t know Q28 Hypotension, likely vasovagal needing IV fluids postbiopsy Yes/No/Don t know Q29 Significant hemorrhage (hb decreased > 2g/dL) postbiopsy Yes/No/Don t know Q30 Haemobilia postbiopsy Yes/No/Don t know Q31 Puncture kidney postbiopsy Yes/No/Don t know Q32 Puncture bowel postbiopsy Yes/No/Don t know Q33 Puncture gallbladder postbiopsy Yes/No/Don t know Q34 Puncture lung postbiopsy Yes/No/Don t know Q35 Puncture other organ postbiopsy Yes/No/Don t know Q36 If answer to Q35 is yes, please specify Q37 Death postbiopsy Yes/No/Don t know Q38 Blood transfusion postbiopsy Yes/No/Don t know Q39 Percutaneous drainage fluid/bile postbiopsy Yes/No/Don t know Q40 Laparotomy postbiopsy Yes/No/Don t know Q41 Embolisation postbiopsy Note. GI = gastrointestinal, IM = intramuscular, IV = intravenous, LFT = liver function test. Page 4 of 5
5 Questionnaire C: Coagulation Data Questionnaire Question No. Question Response Q1 Did patient have FBC checked preprocedure? Yes/No/Don t know Q2 Did patient have INR checked preprocedure? Yes/No/Don t know Q3 When was most recent FBC undertaken in relation to biopsy? Same day Previous day Previous week Previous month >1 month Q4 When was most recent INR undertaken in relation to biopsy? Same day Previous day Previous week Previous month >1 month Q5 Were platelet results in normal range? Yes/No/Don t know Q6 If platelets < 100 please give results (x10 9 /L). Q7 Were INR results in normal range? Yes/No/Don t know Q8 If INR > 1.2 please give results. Q9 Ascites present at time of biopsy None Q10 Q11 If patient had serious complication, on review of patient records/imaging report, were technical difficulties encountered at time of biopsy (eg, poor co-operation, movement, obesity)? If answer to Q10 is yes, please specify. Note. FBC = full blood count, INR = international normalized ratio. Trace Moderate Extensive Yes/No/Don t know/not applicable Page 5 of 5
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