Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program


Por: Guerriero, S, Pascual, MA, Ajossa, S, Rodriguez, I, Zajicek, M, Rolla, M, Llop, NR, Yulzari, V, Bardin, R, Buonomo, F, Comparetto, O, Perniciano, M, Saba, L, Mais, V, Alcazar, JL

Publicada: 1 ago 2019
Resumen:
Objective To assess the learning curves of trainees during a structured offline/hands-on training program for the ultrasonographic diagnosis of deep infiltrating endometriosis (DIE). Methods Four trainees (all Ob/Gyn postgraduates with at least 5 years' experience in ultrasonography in obstetrics and gynecology, but with no experience of sonographic examination of DIE) participated in the study. They underwent a 2-week training program with a single trainer. Day 1 was devoted to theoretical issues and guided offline analysis of 10 three-dimensional ultrasound volumes. During the following days, four sessions of real-time sonographic examinations were performed in a DIE referral center ultrasound unit. In between these sessions, the trainees analyzed four datasets offline, each containing 25 volumes. At the end of each set, misinterpreted volumes were reassessed with the trainer. Presence or absence of DIE at surgery was considered the gold standard. The trainees' learning process was evaluated by learning-curve cumulative summation (LC-CUSUM) and the deviations of the trainees' level of performance at the control stage was assessed by CUSUM (standard CUSUM), for different locations of DIE. Results The trainees reached competence after an average of 17 (range, 14-21) evaluations for bladder, 40 (range, 30-60) for rectosigmoid, 25 (range, 14-34) for forniceal, 44 (range, 25-66) for uterosacral ligament (USL) and 21 (range, 14-43) for rectovaginal septum (RVS) locations of DIE, and then kept the process under control, with error levels of less than 4.5% until the end of the test. The overall accuracy for each trainee in diagnosis of DIE at the different locations ranged from 0.91 to 0.98 for bladder DIE, from 0.80 to 0.94 for rectosigmoid DIE, from 0.90 to 0.94 for forniceal DIE, from 0.79 to 0.82 for USL DIE and from 0.89 to 0.98 for RVS DIE. Conclusions The suggested 2-week training program, based on a mixture of offline and live scanning sessions, is feasible and apparently provides effective training for the ultrasonographic diagnosis of DIE. Copyright (c) 2018 ISUOG. Published by John Wiley & Sons Ltd.

Filiaciones:
Guerriero, S:
 Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy

Pascual, MA:
 Hosp Univ Dexeus, Dept Obstet Gynecol & Reprod, Barcelona, Spain

Ajossa, S:
 Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy

Rodriguez, I:
 Hosp Univ Quiron Dexeus, Dept Obstet Ginecol & Reprod, Unidad Epidemiol & Estadist, Barcelona, Spain

Zajicek, M:
 Tel Aviv Univ, Chaim Sheba Med Ctr, Obstet & Gynecol Ultrasound Unit, Tel Hashomer, Israel

Rolla, M:
 Univ Parma, Dept Surg Sci, Obstet & Gynecol Unit, Parma, Italy

Llop, NR:
 Hosp Santa Creu & Sant Pau, Seccio Ecog, Serv Ginecol & Obstet, Barcelona, Spain

Yulzari, V:
 Sheba Med Ctr, Ob Gyn Ultrason Imaging Unit, Tel Hashomer, Israel

Bardin, R:
 Hellen Schneider Hosp Women, Rabin Med Ctr, Petah Tiqwa, Israel

 Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel

Buonomo, F:
 IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Trieste, Italy

Comparetto, O:
 Univ Parma, Dept Surg Sci, Obstet & Gynecol Unit, Parma, Italy

Perniciano, M:
 Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy

Saba, L:
 Azienda Osped Univ Cagliari, Dept Radiol, Cagliari, Italy

Mais, V:
 Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy

Alcazar, JL:
 Univ Navarra, Sch Med, Clin Univ Navarra, Dept Obstet & Gynecol, Pamplona, Spain
ISSN: 09607692





ULTRASOUND IN OBSTETRICS & GYNECOLOGY
Editorial
WILEY, 111 RIVER ST, HOBOKEN 07030-5774, NJ USA, Estados Unidos America
Tipo de documento: Article
Volumen: 54 Número: 2
Páginas: 262-269
WOS Id: 000478739500015
ID de PubMed: 30426587
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