What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B-lines?
What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B-lines?
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DOI：
10.1002/ehf2.12907
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发表时间：
2020-10
影响因子：
3.8
通讯作者：
Pang PS
中科院分区：
文献类型：
--
作者：
Russell FM;Ferre R;Ehrman RR;Noble V;Gargani L;Collins SP;Levy PD;Fabre KL;Eckert GJ;Pang PS
本研究的目的是确定与专家口译相比，初学者达到B线量化熟练程度所需的扫描次数。这是一项前瞻性、多中心观察性研究，研究对象包括来自三个学术机构的新手学习者、医生和非医生。学员接受了为期2小时的肺超声（LUS） B线评估培训课程，包括讲座、视频复习练习计数和实际患者扫描。学习者在疑似急性心力衰竭患者中使用八区扫描方案量化B线。超声（US）机器设置标准化，深度为18 cm，夹长为6 s，组织谐波和多波束成形器停用。为了量化，每个区域内B‐线数量最多的肋间空间用于评分。每个区域根据在一个呼吸周期内所计数到的最大B线数进行0-20分。B线评分通过将B线填充的肋间隙的百分比乘以20来确定。我们比较了每个肺区扫描的学习者B线计数与盲法专家审查员（五名接受过美国奖学金培训的教师，具有50年临床经验）；熟练度定义为班级内相关系数为bb0.0.7。采用累积和法构建每个学习者的学习曲线进行统计分析。使用Wilcoxon秩和检验比较不同学习者类型达到熟练程度所需的扫描次数。29名学习者（21名研究助理，5名住院医生和3名非美国培训的急诊医学教师）扫描了2629个急性肺水肿的肺区。在平均扫描10.8个（标准差14.0）LUS区域后，学习者达到了预定的熟练程度标准。达到熟练程度所需的扫描区域数量在医生和非医生之间没有显著差异（P = 0.26），没有先前的美国经验的学习者vs.有25个先前的患者扫描（P = 0.64），没有先前的vs.一些先前的美国经验（P = 0.59）。学习者和专家之间的一致性的总体类内相关系数为0.74，专家之间为0.80。我们的研究结果表明，经过短期的结构化训练，新手学习者能够在扫描11个区域后熟练地在LUS上量化B线。这些发现支持非医生在临床和研究应用中使用LUS进行B线定量。
The goal of this study was to determine the number of scans needed for novice learners to attain proficiency in B‐line quantification compared with expert interpretation. This was a prospective, multicentre observational study of novice learners, physicians and non‐physicians from three academic institutions. Learners received a 2 h lung ultrasound (LUS) training session on B‐line assessment, including lecture, video review to practice counting and hands‐on patient scanning. Learners quantified B‐lines using an eight‐zone scanning protocol in patients with suspected acute heart failure. Ultrasound (US) machine settings were standardized to a depth of 18 cm and clip length of 6 s, and tissue harmonics and multibeam former were deactivated. For quantification, the intercostal space with the greatest number of B‐lines within each zone was used for scoring. Each zone was given a score of 0–20 based on the maximum number of B‐lines counted during one respiratory cycle. The B‐line score was determined by multiplying the percentage of the intercostal space filled with B‐lines by 20. We compared learner B‐line counts with a blinded expert reviewer (five US fellowship‐trained faculty with > 5 years of clinical experience) for each lung zone scanned; proficiency was defined as an intraclass correlation of > 0.7. Learning curves for each learner were constructed using cumulative sum method for statistical analysis. The Wilcoxon rank‐sum test was used to compare the number of scans required to reach proficiency between different learner types. Twenty‐nine learners (21 research associates, 5 residents and 3 non‐US‐trained emergency medicine faculty) scanned 2629 lung zones with acute pulmonary oedema. After a mean of 10.8 (standard deviation 14.0) LUS zones scanned, learners reached the predefined proficiency standard. The number of scanned zones required to reach proficiency was not significantly different between physicians and non‐physicians (P = 0.26), learners with no prior US experience vs. > 25 prior patient scans (P = 0.64) and no prior vs. some prior LUS experience (P = 0.59). The overall intraclass correlation for agreement between learners and experts was 0.74 and 0.80 between experts. Our results show that after a short, structured training, novice learners are able to achieve proficiency for quantifying B‐lines on LUS after scanning 11 zones. These findings support the use of LUS for B‐line quantification by non‐physicians in clinical and research applications.
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影响因子：
18.2
作者：
Gargani, L.;Frassi, F.;Picano, E.
通讯作者：
Picano, E.
影响因子：
6.1
作者：
Gargani, Luna;Sicari, Rosa;Zoccali, Carmine
通讯作者：
Zoccali, Carmine
影响因子：
8.8
作者：
Komatsu, Ryu;Kasuya, Yusuke;Ozaki, Makoto
通讯作者：
Ozaki, Makoto
DOI：
10.1016/j.echo.2005.05.019
发表时间：
2006-03-01
影响因子：
6.5
作者：
Picano, E;Frassi, F;Mottola, G
通讯作者：
Mottola, G
影响因子：
3.5
作者：
Cogliati, Chiara;Casazza, Giovanni;Montano, Nicola
通讯作者：
Montano, Nicola