Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results
Alcázar JL, Díaz L, Flórez P, Guerriero S, Jurado M.
Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
To assess the feasibility of a specific training program for ultrasound diagnosis of adnexal masses.
A two-month intensive training program was developed. Program protocol consisted of one-day intense theoretical course focused on clinical and ultrasonography issues related to adnexal masses and ovarian cancer followed by a four-week real-time ultrasound training in a reference center (about 25-30 adnexal masses evaluated per month) and a final four-week period for off-line assessment of 3D volumes from adnexal masses. In this later period the trainee evaluated five sets of 100 3D-volumes each. 3D-volumes contained gray-scale and power Doppler information and the trainee was provided with clinical data of each case (patient's age, menopausal status and complaints). 3D-volumes were from masses surgically removed and histologic diagnosis was available or from masses followed-up until resolution. After each set assessment, trainee's diagnostic performance was calculated (sensitivity and specificity) and then the trainee evaluated with the trainer each mass incorrectly classified. The objective was to achieve a sensitivity > 95% and specificity > 90%. LC-CUSUM graphics were plotted to assess the learning curve for trainees.
One trainer and two trainees with very low experience on gynecological ultrasound (one gynecologist and one radiologist) participated in this study. LC-CUSUM graphics showed that competence was achieved after 170 examinations. The objectives for diagnostic performance were achieved after the second set of 3D volumes (200 cases) for each trainee.
The proposed training program seems feasible. High diagnostic performance can be achieved after 200 cases analyzed and it is maintained after.
CITA DEL ARTÍCULO Ultrasound Obstet Gynecol. 2013 Feb 18. doi: 10.1002/uog.12440