Intensive training program for ultrasound
diagnosis of adnexal masses: protocol and
preliminary results
J. L. Alcazar, L. ...
Ultrasound is a first-line imaging technique for discriminating between
benign and malignant adnexal masses
Timmerman D et...
No specific training program for assessing adnexal masses
ISUOG Education Commitee UOG 1996, Di Renzo GC and Clerici G, AN...
• Theoretical ultrasound teaching does not improve the performance of
pattern recognition in the hands of trainees
• Pract...
Objective:To assess the feasibility of a specific training program for
ultrasound diagnosis of adnexal masses.
Objective
I...
Real-time ultrasound
Specific training program developed
+ Offline evaluation of 3D
volumes
Objective 1:
To train examiner...
Two trainees included in specific training program:
Specialist with experience in transabdominal obstetrical ultrasound bu...
Three phases of the training program
clinical and ultrasound issues
related to adnexal masses
25-30 adnexal masses
evaluat...
Training program: Phase 1
Intensive training program for ultrasound diagnosis of adnexal masses: protocol and
preliminary ...
Training program: Phase 2
Training in real-time ultrasound:
•Performing transabdominal and transvaginal ultrasound, princi...
Training program: Phase 3
Assessment of stored 3D ultrasound volumes :
•Half-day course with training on the use of dedica...
Training program: Phase 3
Intensive training program for ultrasound diagnosis of adnexal masses: protocol and
preliminary ...
Case 1. Unilocular cyst with
internal wall irregularities
Case 3. Multilocular cyst
Case 4. Irregular solid tumor Case 5. ...
Provide confidence level
in classification:
•Certainly benign
•Probably benign
•Uncertain
•Probably malignant
•Certainly m...
Analysis of diagnostic performance of each trainee
Sensitivity, speificity, LRs for each 3D volume set
Learning curve cumu...
Results
Diagnostic performance of trainees A and B
Sensitivity (%) Specificity (%) LR+ LR-
Set 1 74 83 4.4 0.31
Set 3 97 9...
Trainee A reached
performance after case 170
Trainee B reached
performance after case 185
Learning curve for discriminatin...
• Training is based on static 3D volumes
• Limited training of dynamic aspects of real-time ultrasound
• Difficult cases n...
Proposed training program for ultrasound assessment of adnexal masses
is feasible and renders good results.
A similar prog...
Intensive training program for ultrasound diagnosis of adnexal masses: protocol and
preliminary results
Alcazar et al., UO...
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UOG Journal Club: Intensive training program for ultrasound diagnosis of adnexal masses

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UOG Journal Club August 2013
Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results
J. L. Alcázar, L. Díaz, P. Flórez, S. Guerriero and M. Jurado
Link to the article (open access):
onlinelibrary.wiley.com/doi/10.1002/uog.12440/abstract

Published in: Business, Technology

UOG Journal Club: Intensive training program for ultrasound diagnosis of adnexal masses

  1. 1. Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results J. L. Alcazar, L. Diaz, P. Florez, S. Guerriero and M. Jurado Volume 42, Issue 2, Date: August 2013, pages 218–223 Journal Club slides prepared by Dr Ligita Jokubkiene (UOG Editor for Trainees) UOG Journal Club: August 2013
  2. 2. Ultrasound is a first-line imaging technique for discriminating between benign and malignant adnexal masses Timmerman D et al., UOG 1999, Guerriero S et al., J womens Health 2009 et 2011 et Ultrasound Med Biol 2008, Van Holsbeke C et al., UOG 2009 et Gynecol Obstet Invest 2010 BUT….. • Highly dependent on the expertise of the examiner • Poorer reproducibility, diagnostic performance and examiner’s confidence in providing diagnosis in non-expert examiners Background
  3. 3. No specific training program for assessing adnexal masses ISUOG Education Commitee UOG 1996, Di Renzo GC and Clerici G, ANN N Y Acad Sci 1998, Calhoun BC and Hume RF UOG 2000, Salvesen et al., UOG 2010, Sidhu et al., J Ultrasound Med 2012, Tutschek et al., UOG 2012 BUT….. Several programs for ultrasound training in obstetrics and gynecology and simulators for basic gynecological ultrasound training have been proposed Background
  4. 4. • Theoretical ultrasound teaching does not improve the performance of pattern recognition in the hands of trainees • Practical training is important to optimize diagnostic performance Van Holsbeke C et al., UOG 2009 Background
  5. 5. Objective:To assess the feasibility of a specific training program for ultrasound diagnosis of adnexal masses. Objective Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013
  6. 6. Real-time ultrasound Specific training program developed + Offline evaluation of 3D volumes Objective 1: To train examiners with no or very little experience in ultrasound assessment of adnexal masses. Objective 2: For trainees to achieve diagnostic performance with sensitivity of > 95% and specificity of > 90%. Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Methods
  7. 7. Two trainees included in specific training program: Specialist with experience in transabdominal obstetrical ultrasound but with very little experience in gynecological ultrasound 3rd year resident in radiology with no experience in gynecological ultrasound Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Trainee 1 Trainee 2
  8. 8. Three phases of the training program clinical and ultrasound issues related to adnexal masses 25-30 adnexal masses evaluated 500 adnexal masses, 28-35% malignancies in each set Phase 1 1-day theoretical course Phase 2 4 weeks real-time training Phase 3 Half-day course 4 weeks offline training: 100 3D volumes 100 3D volumes 100 3D volumes 100 3D volumes 100 3D volumes
  9. 9. Training program: Phase 1 Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Theoretical lectures on: •Epidemiology of ovarian cancer and adnexal masses •Surgical management of ovarian cancer and adnexal masses •Principles of gray-scale and color Doppler ultrasound •Use of ultrasound for assessing adnexal masses (pattern recognition)
  10. 10. Training program: Phase 2 Training in real-time ultrasound: •Performing transabdominal and transvaginal ultrasound, principles of gray- scale and Doppler ultrasound •Assessment of adnexal masses by gray-scale and Doppler ultrasound, dynamic aspects as mobility and tenderness •Application of machine settings in gray-scale and Doppler ultrasound •Supervision by an ultrasound expert with > 20 years experience Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013
  11. 11. Training program: Phase 3 Assessment of stored 3D ultrasound volumes : •Half-day course with training on the use of dedicated software for assessing 3D volumes •4 weeks for assessment of five sets of 100 3D volumes each •Excel file with clinical data of patient (age, menopausal status, symptoms) Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013
  12. 12. Training program: Phase 3 Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Analysis of 3D ultrasound volumes:
  13. 13. Case 1. Unilocular cyst with internal wall irregularities Case 3. Multilocular cyst Case 4. Irregular solid tumor Case 5. Cystic solid mass Case 2. Septated cyst Cases 1–5 for which 3D volumes are provided in Supplementary Material.
  14. 14. Provide confidence level in classification: •Certainly benign •Probably benign •Uncertain •Probably malignant •Certainly malignant Based on pattern recognition trainees had to: Classify tumors as benign or malignant, despite uncertainty Review cases with incorrect diagnosis with a trainer Training program: Phase 3 Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013
  15. 15. Analysis of diagnostic performance of each trainee Sensitivity, speificity, LRs for each 3D volume set Learning curve cumulative summation (LC-CUSUM) test to assess learning curve for each trainee Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Acceptable failure rate: 15% Unacceptable failure rate: 25%
  16. 16. Results Diagnostic performance of trainees A and B Sensitivity (%) Specificity (%) LR+ LR- Set 1 74 83 4.4 0.31 Set 3 97 95 21.7 0.03 Set 5 100 92 12.6 - Trainee A Set 1 76 88 6.5 0.27 Set 3 91 89 8.6 0.1 Set 5 100 90 8.9 - Trainee B
  17. 17. Trainee A reached performance after case 170 Trainee B reached performance after case 185 Learning curve for discriminating between benign and malignant adnexal masses Results
  18. 18. • Training is based on static 3D volumes • Limited training of dynamic aspects of real-time ultrasound • Difficult cases not addressed • Only one trainer and two trainees, no control group Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Limitations of the training program
  19. 19. Proposed training program for ultrasound assessment of adnexal masses is feasible and renders good results. A similar program could be implemented for training in ultrasound assessment for other gynecological conditions. Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Conclusions
  20. 20. Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results Alcazar et al., UOG 2013 Discussion points • Do we need distinct or separate ultrasound training in assessing adnexal masses? • What are the phases of the suggested training program? • How many adnexal masses cases are thought to be required on average during training to reach a satisfactory level of competence? • Was there any difference in diagnostic performance between experienced and not-experienced trainee in assessing adnexal masses? • What are the limitations of this training program?

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