Optimal pleural effusion quantification and assessment. An international survey

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Thank you for participating in this survey. The aim of this questionnaire is to explore current clinical practices, perceptions, and challenges related to pleural effusion quantification, as well as the potential role of emerging technologies such as handheld ultrasound devices and AI-based tools.

Your responses will help us better understand real-world approaches and identify areas for improvement, standardization, and future research. The survey is anonymous and will take only a few minutes to complete. We greatly appreciate your time and contribution.

What is your medical specialty? *

0. Pulmonologist

1. Thoracic surgeon

2. Emergency doctor

3. Oncologist

4. Internal medicine doctor

5. Infectious disease specialist

6. Intesivist

Other:

What is your professional status? *

0. Fellow/resident

1. Consultant physician

2. Academic physician

Other:

Which continent do you currently work in? *

0. Europe

1. North America

2. South or Central America

3. Africa

4. Asia

5. Oceania

Which country do you currently work in?

What is your hospital setting? *

0. Academic Hospital

1. Non-academic secondary hospital

2. Non-academic tertiary hospital

How many years of experience do you have in clinical practice? *

0. 0-5

1. 6-10

2. 10+

How many patients with pleural effusion do you manage per year? *

0. 0-25

1. 26-50

2. 51-100

3. 100+

Do you routinely use a method to quantify pleural effusion? *

0. Always

1. Sometimes

2. Never

How important is pleural effusion quantification in your clinical practice? *

0. Not at all

1. Slightly

2. Moderatly

3. Very important

For respondents who answered “Not at all” or “Slightly” to previous question. What are the main reasons?

0. Lack of time

1. Does not influence clinical management

2. Lack of tools/training

Other:

Clear selection

Which imaging modality do you routinely use to quantify pleural effusion? *

0. Chest X-ray

1. Chest-CT

2. Chest Ultrasound

Other:

The choice of imaging modality is influenced by: *

0. Availability of the equipment

1. Type of patient (Critically ill/Inpatient/outpatient)

2. Specific clinical question

Other:

Required

In case of discrepancy between different imaging modalities in pleural effusion quantification, which modality do you rely on for therapeutic decision-making? *

0. Chest X-ray

1. Chest-CT

2. Chest Ultrasound

Other:

Which criteria do you use to quantify pleural effusion? (Multiple choice available) *

0. Mild/moderate/massive

1. Intercostal spaces counting

2. Measurment of the distance between pleural lines

3. Formulas to calculate pleural effusion quantity

Other:

Required

During pleural effusion evaluation with chest ultrasound, which probe orientation do you routinely use? *

0. Longitudinal only

1. Transverse only

2. Both longitudinal and transverse

Other:

When performing chest ultrasound for pleural effusion, which areas do you routinely scan? (Multiple choice available) *

0. Posterior

1. Lateral

2. Anterior

Required

In your opinion, what is the main barrier preventing the implementation and use of standardized and validated methods for pleural effusion quantification? (Multiple choice available) *

0. Lack of shared guidelines

1. Insufficient time during clinical practice

2. Inadequate training

3. Perceived poor reproducibility

4. Not important for clinical practice

Required

Do you use pleural effusion quantification during follow-up to monitor changes over time? *

0. Yes, always

1. Sometimes

2. No, never

Which modality do you you prefer to use for pleural effusion follow-up? *

0. Chest X-ray

1. Chest-CT

2. Chest Ultrsound

3. Physical examination

Other:

Does pleural effusion quantification influence your decisions regarding: (multiple choice available) *

0. Need foor diagnostic thoracentesis

1. Need for chest tube drainage

2. Timing for intervention

3. Choice between thoracentesis and chest-tube drainage

4. Mointor of treatment effectiveness

Required

What time interval do you use to reassess pleural effusion after an interventional procedure (thoracentesis/chest drainage)? *

0. <12h

1. 12-24h

2. 24-48h

3. >48h

Do you have access to portable/handheld ultrasound devices in your clinical practice? *

0. Yes, I routiney use them

1. Yes, they are available but I rarely use them

2. Available, but I do not use thme

3. Not available atm y istitution

4. I do not know what they are

If you use portable/handheld ultrasound devices, how do you assess their reliability for pleural effusion quantification?

0. As reliable as conventional ultrasound systems

1. Acceptable for screening, but I rely on conventional ultrasound systems

2. Poorly reliable, I do not use them

3. I do not have sufficient experience to assess their reliability

Clear selection

Which features would make handheld ultrasound devices more useful for pleural effusion quantification? (maximum 3 answers)

0. Improved image quality

1. Integrated volumetric calculation software/AI-based algorithms for automatic quantification

2. Larger screen size

3. Better integration with electronic medical records/PACS

4. Temporal comparison features (automated follow-up)

5. Integrated training-tutorial

6. They are already adequate as they are

Other:

Would you be interested in using a software/AI-based tools for automatic pleural effusion quantification? *

0. Very interested

1. Moderately interested

2. Slightly interested

3. Not interested at all

Are you aware of AI software/algorithms for automatic pleural effusion quantification? *

0. Yes, I use them in clinical practice

1. Yes, I am aware of them but do not use them

2. I have vaguely heard about them

3. No, I am not aware of them

Which features should an AI system have to be useful in your clinical practice? (maximum 3 answers) *

0. Rapid analysis (<30 seconds)

1. Integration with PACS/hospital information systems

2. Large-scale validation / strong scientific evidence

3. Use on point-of-care devices (portable ultrasound)

4. Simple and intuitive interface

5. Automatic volume calculation (mL)

6. Clinical management suggestions

7. Automated monitoring of changes over time

Other:

Required

In which clinical settings would AI be most useful for pleural effusion quantification? (Multiple choice available) *

0. Monitoring of critically ill patients in the ICU

1. Outpatient follow-up

2. Therapeutic decision-making (e.g. thoracentesis yes/no)

3. Clinical research and trials

4. Medical training/education

5. I do not see useful applications

Other:

Required

Final Question. Consider the following scenario: A handheld ultrasound device with integrated AI that automatically quantifies pleural effusion volume within 30 seconds, monitors changes over time, and integrates with the hospital information system. What impact would you expect this to have on your clinical practice?

0. Transformative – it would become a first-line tool in pleural effusion management

1. Substantial – it would significantly improve accuracy, reproducibility, and efficiency

2. Moderate – a useful adjunct to clinical assessment, particularly for follow-up

3. Limited – marginal advantage compared with current methods

4. Negligible – traditional clinical–radiological integration remains superior

5. Uncertain – robust scientific evidence would be required before drawing conclusions

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