Education, learning, and competence assessment in contrast-enhanced ultrasound

Niels Jacobsen

Research output: ThesisPh.D. thesis

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Abstract

Conventional ultrasound has been used for more than half a century in numerous medical specialties but cannot be used for assessment of vascular phases and blood perfusion of organs and tissue. Contrast-enhanced ultrasound (CEUS) is an add-on application to conventional ultrasound in which highly echogenic microbubbles are injected into the blood stream to serve as ultrasound contrast agents. They do not leak from the blood vessels and thus can function as strong blood enhancers, enabling real-time assessment of blood supply in a target area or organ.


A systematic review was conducted in the first study to provide an up-to-date overview of the current clinical applications of CEUS in respiratory medicine.


The current use includes guidance during biopsy procedures to avoid areas with no blood flow, and potential use to predict malignancy via interpretation of blood flow patterns, but the studies are small and with high risk of bias, ratifying the need for more research to establish the role of CEUS in respiratory medicine.


Proper education, training, and assessment of CEUS operators are important because errors can have severe consequences, such as incorrectly interpreting a malignant lesion as benign or vice versa.
Learning objectives for CEUS operators, however, vary significantly between medical specialties due to divergence in contrast patterns among organ systems but core competencies such as correct handling of contrast agents are uniform, regardless of specialty.


In the second study, an international team of clinical experts in CEUS and medical education was assembled to construct a syllabus defining core competencies in CEUS in order to establish an optimal framework for subsequent development of competency assessment tests.


In the third study, a theoretical test to assess core competencies in CEUS was developed via an international team of clinical experts in CEUS and medical education. The test proved adequate to serve as a stop-test for learners before beginning practical simulation-based training in CEUS but should not be used as a certification tool due to a relatively high risk of letting doctors with no CEUS experience pass the test (false positives).


In the fourth and final study, we developed a simulation-based test for assessment of practical competences in CEUS using novel Immersive Virtual Reality (IVR) technology. A tutorial in basic
IVR navigation was also developed to minimize the influence of the participants aptitude in simulation technology on test results. The test proved adequate to serve as a certification tool for
learners before advancing to supervised clinical training in the procedure.


Future tasks rising from this thesis includes investigating whether skills obtained in the simulationbased environment can be transferred to clinical practice, and if acquired competences are retained after completion of the training.


Achieving these tasks could pave the way for modernizing educational standards for this growing imaging modality.
Translated title of the contributionUddannelse, læring og kompetencevurdering i kontrastforstærket ultralydsskanning
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Laursen, Christian Borbjerg, Principal supervisor
  • Konge, Lars, Co-supervisor
  • Graumann, Ole, Co-supervisor
  • Nolsøe, Christian Pallson, Co-supervisor, External person
Date of defence25. Mar 2022
Publisher
DOIs
Publication statusPublished - 15. Mar 2022

Keywords

  • Contrast-enhanced ultrasound
  • Medical education
  • Simulation
  • Simulation-based medical education
  • Competence assessment
  • Curriculum development
  • Virtual Reality
  • Immersive Virtual Reality

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