Simulation-based education in ultrasound - diagnostic and interventional abdominal focus. / Simulationsbasierte Ausbildung im Ultraschall ­ Fokus auf der diagnostischen und interventionellen Abdomen-Sonografie.

Simulation-based training (SBT) is increasingly acknowledged worldwide and has become a popular tool for ultrasound education. Ultrasound simulation involves the use of technology and software to create a virtual training setting. Simulation-based training allows healthcare professionals to learn, practice, and improve their ultrasound imaging skills in a safe learning-based environment. SBT can provide a realistic and focused learning experience that creates a deep and immersive understanding of the complexity of ultrasound, including enhancing knowledge and confidence in specific areas of interest. Abdominal ultrasound simulation is a tool to increase patient safety and can be a cost-efficient training method. In this paper, we provide an overview of various types of abdominal ultrasound simulators, and the benefits, and challenges of SBT. We also provide examples of how to develop SBT programs and learning strategies including mastery learning. In conclusion, the growing demand for medical imaging increases the need for healthcare professionals to start using ultrasound simulators in order to keep up with the rising standards.

Correction: Hands-On Time in Simulation-Based Ultrasound Training - A Dose-Related Response Study.

[This corrects the article DOI: 10.1055/a-1795-5138.].

Four Virtual-Reality Simulators for Diagnostic Abdominal Ultrasound Training in Radiology.

Ultrasound exams need skilled examiners, and simulation-based training could provide standardized and safe skill training. This study aims to give an overview of different types of virtual-reality simulators for use in abdominal diagnostic ultrasound training in radiology. Fifteen specialized radiologists and radiological residents were presented with two similar cases on four different simulators for abdominal ultrasound training. A feedback sheet for each individual simulator and for an overall comparison was filled out by all participants. All means of scores were compared, and simulators were ranked from least to most favorable. One simulator was ranked most favorable in seven out of nine questions, but none of the mean scores had statistically significant differences. All simulators were recommended for training radiologists, and all simulators were perceived to benefit trainees more than experienced ultra-sonographers.

Determining procedures for simulation-based training in radiology: a nationwide needs assessment.

OBJECTIVES: New training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum. METHODS: A needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures. RESULTS: Response rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound. CONCLUSION: A needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs. KEY POINTS: • Simulation-based training can supplement training on patients in radiology. • Development of simulation-based training should follow a structured approach. • The CAMES Needs Assessment Formula explores needs for simulation training. • A national Delphi study identified and prioritized procedures suitable for simulation training. • The prioritized list serves as guide for development of courses in radiology.

[Gastric bezoar caused by barium sulphate]. / Ventrikelbezoar forårsaget af bariumsulfat.

We present the first case of a gastric bezoar caused by barium sulphate acting as an intermittently occluding mass in a patient who had undergone small bowel follow-through on suspicion of small bowel obstruction (SBO) after total pancreatectomy. The patient underwent acute surgery but intermittent symptoms of SBO persisted. A barium bezoar was seen on plain abdominal film and afterwards diluted and fragmented gastroscopically. A barium bezoar giving rise to SBO is a possible complication to barium follow-through in patients with impaired gastric transit time.

The diagnostic value of adding dynamic scintigraphy to standard delayed planar imaging for sentinel node identification in melanoma patients.

PURPOSE: The aim of this study was to compare early dynamic imaging combined with delayed static imaging and single photon emission computed tomography (SPECT)/CT with delayed, planar, static imaging alone for sentinel node (SN) identification in melanoma patients. METHODS: Three hundred and seven consecutive melanoma patients referred for SN biopsy (SNB) were examined using combined imaging. Secondary interpretation of only the delayed static images was subsequently performed. In 220 patients (72%), complete surgical and pathological information relating to the SNB was available. The number of SNs identified and number of patients with positive SNs were compared between the two interpretations of the imaging studies and, when available, related to pathology data. RESULTS: A slightly higher number of SNs (mean 0.12/patient) was identified when interpreting only delayed static images compared to combined imaging. In a direct patient-to-patient comparison, the number of SN(s) identified on the combined vs static images only showed moderate agreement (kappa value 0.56). In 38 patients (17%), positive SNs were identified by the combined procedure compared to 35 (16%) by static imaging only. Thus by static imaging only, tumour-positive SNs were not identified in 3 of 38 patients (8%). CONCLUSION: For SN identification in melanoma patients, dynamic imaging combined with delayed static imaging and SPECT/CT is superior to delayed static imaging only because the latter is more likely to fail to identify SNs containing metastases.

Studies on radionuclide imaging and contrast ultrasound for sentinel node diagnostics in breast cancer and melanoma.

UNLABELLED: Malignant involvement of the regional lymph nodes in breast cancer, melanoma and other cancers is considered an important prognostic factor and determines the further treatment of the patient. Currently two methods are most often combined for SN detection, intra-operative blue dye injection around the tumour site and the radionuclide technique. The aims of this thesis were to evaluate the possibility of optimising the radionuclide SN procedures in patients with breast cancer and melanoma, and to examine the possibility of using contrast enhanced lympho-ultrasonography (CELUS) for SN detection. The radionuclide method was evaluated in patients with breast cancer (study I) and in melanoma patients (study II). CELUS was tested in animals (pigs and mice, study III and IV) and in melanoma patients (study IV). I. We investigated the influence on axillary SN biopsy in breast cancer patients of: a) Preoperative scintigraphy, used by some, but omitted by other centres, b) The variable activity remaining in the patient at surgery, due to differences in activity administered and to time to surgery. II. This study compared the interpretation of delayed static imaging alone with the interpretation of early dynamic and delayed static imaging in combination with SPECT/CT in the SN diagnostics in melanoma. III. This study describes the possibility of using CELUS to detect SNs in a pig model. The method worked well for SN detection in this model, in agreement with previous studies in pigs and other animals. IV. In this study we examined the possibility of using CELUS with micro bubbles to detect SN in melanoma patients. CONCLUSIONS: In breast cancer patients it is essential for SN detection that the injected activity is high enough for optimal SN detection, preoperative scintigraphy may be of some clinical value. A combination of the three imaging modalities works only slightly better for SN detection than a simple static gamma camera imaging in patients with melanoma, the combined procedure used as gold standard identifies 1% more patients with malignant SNs. CELUS as performed in our study worked well for SN detection in a pig model, but could not be used to detect SN in patients.

Biopsy guided by real-time sonography fused with MRI: a phantom study.

OBJECTIVE: The purpose of our study was to test the accuracy of sonographically guided biopsies in a phantom of structures not visible on sonography but shown on MRI by using commercially available sonography systems with image fusion software. MATERIALS AND METHODS: A previously recorded MRI examination from a custom-made phantom was loaded into the sonography system. The phantom contained spheres that were invisible to sonography and contained red dye. The red dye was visible in the biopsy if it was successful. The images were coregistered using structures visible on both sonography and MRI, and biopsies were taken. The biopsy procedure was continued until a biopsy was successful, and the number of needle passes and time spent were registered. RESULTS: A total of 130 targets were hit. Ten minutes was used for loading the MRI data set and the coregistration; 94 of the 130 biopsies (72.3%) were successful at the first needle pass. The median number of needle passes until a successful biopsy was obtained was one (range, 1-7). CONCLUSION: The described method was successful in obtaining an adequate sample in a phantom.

Examples of in vivo blood vector velocity estimation.

In this paper, a case study of in-vivo blood vector velocity images of the carotid artery are presented. The transverse oscillation (TO) method for blood vector velocity estimation has been used to estimate the vector velocities. The carotid arteries of three healthy volunteers are scanned in-vivo at three different positions by experienced sonographers. The scanning regions are: 1) the common carotid artery at 88 degrees beam to flow angle, 2) the common carotid artery and the jugular vein at approximately 90 degrees beam to flow angle and 3) the bifurcation of the carotid artery. The resulting velocity estimates are displayed as vector velocity images, where the velocity vector is superimposed on a B-mode image showing the tissue structures. The volume flow is found for case 1) and when compared with MRI from the literature, a bias of approximately approximately 20% is found. The maximum flow velocity within the carotid artery is found to be 0.8 m/s, which is normal for a healthy person. In case 3), the estimated vector velocities are compared with numerical simulations. Qualitatively similar flow pattern can be seen in both simulations and in the vector velocity images. Furthermore, a vortex is identified in the carotid sinus at the deceleration phase after the peak systole. This vortex is seen in all of the three acquired cardiac cycles.