A comparison of handheld and standard ultrasound in Swiss medical students

Teledidactic peer-tutored musculoskeletal ultrasound training for medical students-the TELMUS study

OBJECTIVES

Despite growing interest in musculoskeletal ultrasound (MSUS), training opportunities are often limited due to staff shortages and disbalances of expertise between rural and urban areas. Teledidactic approaches have the potential to expand access to training opportunities. This study aims to compare the effectiveness of teledidactic peer-tutored MSUS training to a conventional approach.

METHODS

A teledidactic course was held by a student tutor following a validated MSUS curriculum. An on-campus MSUS training taught by physician lecturers served as a control. Students were randomly assigned to one of both study groups. Objective structured clinical examinations (OSCE) were conducted before and after the training to objectively measure the learning outcome of the participants. Handheld ultrasound devices (ButterflyIQ®) and iPads (Apple Inc., eighth generation) were provided to the students for the MSUS course.

RESULTS

Thirty medical students participated in the study. Prior to the course, baseline OSCE scores were recorded as 13.03/63 (SD ± 4.20) for the on-campus cohort and 13.00/63 (SD ± 6.04) for the teledidactic group. In the post-training OSCE evaluation, the on-campus cohort attained an average score of 56.80/63 (SD ± 4.22), while the TELMUS group averagely achieved 58.53/63 points (SD ± 3.52). While all students' skills increased over time, there was no significant difference between the two cohorts either before or after the course.

CONCLUSION

Peer-tutored, teledidactic MSUS training showed to be non-inferior to the conventional approach and is a promising approach to reduce local and global disparities in educational opportunities regarding MSUS.

Phantom-based training of ultrasound-guided breast biopsy in medical education: a randomized controlled trial comparing handheld and high-end ultrasound

BACKGROUND

Modern handheld ultrasound devices (HUDs) are attractive for teaching programs in undergraduate medical education due to their miniaturization and portability along at relatively low cost. They offer high-resolution imaging and are easy to use, opening up new possibilities for training of novices in ultrasound (US)-guided percutaneous procedures. The objective of this study was to investigate if guidance by HUD is on par with a cart-based high-end ultrasound scanner (HEUS) regarding performance times and success rates in video- and phantom-based training of novices in US-guided freehand breast biopsy.

METHODS

32 medical students without any experience in performing US-guided percutaneous biopsies, who had previously completed a standardized diagnostic US training program, were randomized into either a HUD-group (n = 16) or a HEUS-group (n = 16). After a video training lecture participants performed US-guided biopsies of hypoechogenic and hyperechogenic target-lesions in a breast phantom using either a HUD or a HEUS. Performance times and success rates were primary outcomes. Participants were asked to complete a post-study questionnaire (Likert Scale and Raw NASA Workload Task Load Index) for subjective assessment of the operability and individually perceived workload of both US imaging tools and guidance-techniques as secondary outcomes.

RESULTS

Biopsy success rates were slightly higher using the HUD (79.7%) in comparison to the HEUS (68.8%, p = 0.045). Median performance times were similar for the HUD (0.63 min, interquartile range IQR = 0.37-1.08 min) compared to the HEUS (0.60 min, IQR = 0.30-2.09 min, p = 0.751). Operability and the individually perceived workload were rated equal.

CONCLUSIONS

Percutaneous biopsy performed by novices using HUDs is feasible, performance times, success rates, operability and the individually perceived workload were on par with HEUS-guidance. HUDs can be used as cost-effective tools for percutaneous biopsy training purposes in medical education.

Systematic Review of Commercially Available Clinical CMUT-Based Systems for Use in Medical Ultrasound Imaging: Products, Applications, and Performance

An emerging alternative to conventional piezoelectric technologies, which continue to dominate the ultrasound medical imaging (US) market, is Capacitive Micromachined Ultrasonic Transducers (CMUTs). Ultrasound transducers based on this technology offer a wider frequency bandwidth, improved cost-effectiveness, miniaturized size and effective integration with electronics. These features have led to an increase in the commercialization of CMUTs in the last 10 years. We conducted a review to answer three main research questions: (1) What are the commercially available CMUT-based clinical sonographic devices in the medical imaging space? (2) What are the medical imaging applications of these devices? (3) What is the performance of the devices in these applications? We additionally reported on all the future work expressed by modern studies released in the past 2 years to predict the trend of development in future CMUT device developments and express gaps in current research. The search retrieved 19 commercially available sonographic CMUT products belonging to seven companies. Four of the products were clinically approved. Sonographic CMUT devices have established their niche in the medical US imaging market mainly through the Butterfly iQ and iQ+ for quick preliminary screening, emergency care in resource-limited settings, clinical training, teleguidance, and paramedical applications. There were no commercialized 3D CMUT probes.

Handheld Ultrasound Devices Used by Newly Certified Operators for Pneumonia in the Emergency Department-A Diagnostic Accuracy Study

The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26-36) and a specificity of 82% (95% CI 78-86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27-37) and specificity of 81% (95% CI 77-85). CXR had a sensitivity of 66% (95% CI 61-72) and a specificity of 76% (95% CI 71-81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63-74) and a specificity of 68% (95% CI 62-72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR (p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard (p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators.

Efficacy of Handheld Ultrasound in Medical Education: A Comprehensive Systematic Review and Narrative Analysis

Miniaturization has made ultrasound (US) technology ultraportable and, in association with their relatively low cost, made handheld devices attractive for medical education training programs. However, performing an ultrasound requires complex skills, and it is unclear whether handheld devices are suitable for the training of novices. Our study aimed to identify to what extent handheld US devices can be employed in medical undergraduates' and residents' education. We selected studies that evaluate the results obtained by students and/or residents who have participated in ultrasound training programs using handheld devices. The studies were included if they reported post-test (pre-test optional) achievements or a comparison with a control group (a group of experts or novices who underwent a different intervention). Twenty-six studies were selected, and their characteristics were summarized. Handheld ultrasound devices were used in training programs to learn echocardiography, abdominal, and/or musculoskeletal ultrasound. Statistically significant progress was noted in the ability of naïve participants to capture and interpret ultrasound images, but training duration influenced the outcomes. While ultrasound training using handheld devices has proven to be feasible for various body regions and purposes (e.g., better understanding of anatomy, clinical applications, etc.), the long-term impacts of handheld education interventions must be considered in addition to the short-term results to outline guidelines for targeted educational needs.

Implementing a Sports Ultrasound Curriculum in Undergraduate Medical Education

ABSTRACT

The utilization of sports ultrasound in the clinical practice of sports medicine physicians is growing rapidly. Simultaneously, ultrasound is being increasingly implemented as a teaching tool in undergraduate medical education. However, a sports ultrasound curriculum for medical students has not been previously described. In this article, we describe methods as well as barriers to implementing a sports ultrasound curriculum at the medical school level. Recommended content for the curriculum also is discussed. While educational goals and resources will vary among institutions, this article may serve as a general roadmap for the creation of a successful curriculum.

Detection of pneumothorax on ultrasound using artificial intelligence

BACKGROUND

Ultrasound (US) for the detection of pneumothorax shows excellent sensitivity in the hands of skilled providers. Artificial intelligence may facilitate the movement of US for pneumothorax into the prehospital setting. The large amount of training data required for conventional neural network methodologies has limited their use in US so far.

METHODS

A limited training database was supplied by Defense Advanced Research Projects Agency of 30 patients, 15 cases with pneumothorax and 15 cases without. There were two US videos per patient, of which we were allowed to choose one to train on, so that a limited set of 30 videos were used. Images were annotated for ribs and pleural interface. The software performed anatomic reconstruction to identify the region of interest bounding the pleura. Three neural networks were created to analyze images on a pixel-by-pixel fashion with direct voting determining the outcome. Independent verification and validation was performed on a data set gathered by the Department of Defense.

RESULTS

Anatomic reconstruction with the identification of ribs and pleura was able to be accomplished on all images. On independent verification and validation against the Department of Defense testing data, our program concurred with the SME 80% of the time and achieved a 86% sensitivity (18/21) for pneumothorax and a 75% specificity for the absence of pneumothorax (18/24). Some of the mistakes by our artificial intelligence can be explained by chest wall motion, hepatization of the underlying lung, or being equivocal cases.

CONCLUSION

Using learning with limited labeling techniques, pneumothorax was identified on US with an accuracy of 80%. Several potential improvements are controlling for chest wall motion and the use of longer videos.

LEVEL OF EVIDENCE

Diagnostic Tests; Level III.