Using Immersive Virtual Reality Simulation to Ensure Competence in Contrast-Enhanced Ultrasound

Niels Jacobsen*, Jonas D Larsen, Casper Falster, Christian P Nolsøe, Lars Konge, Ole Graumann, Christian B Laursen

*Corresponding author for this work

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Contrast-enhanced ultrasonography (CEUS) is used in various medical specialties as a diagnostic imaging tool and for procedural guidance. Experience in the procedure is currently attained via supervised clinical practice that is challenged by patient availability and risks. Prior simulation-based training and subsequent assessment could improve and ensure competence before performance on patients, but no simulator currently exists. Immersive virtual reality (IVR) is a new promising simulation tool that can replicate complex interactions and environments that are unfeasible to achieve by traditional simulators. This study was aimed at developing an IVR simulation-based test for core CEUS ultrasonography competencies and gathering validity evidence for the test in accordance with Messick's framework. The test was developed by IVR software specialists and clinical experts in CEUS and medical education and imitated a CEUS examination of a patient with a focal liver lesion with emphasis on the pre-contrast preparations. Twenty-five medical doctors with varying CEUS experience were recruited as test participants, and their results were used to analyze test quality and to establish a pass/fail standard. The final test of 23 test items had good internal reliability (Cronbach's α = 0.85) and discriminatory abilities. The risks of false positives and negatives (9.1% and 23.6%, respectively) were acceptable for the test to be used as a certification tool prior to supervised clinical training in CEUS ultrasonography.

Original languageEnglish
JournalUltrasound in Medicine & Biology
Issue number5
Pages (from-to)912-923
Publication statusPublished - May 2022

Bibliographical note

Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.


  • Contrast-enhanced ultrasound
  • Immersive virtual reality
  • Medical education
  • Simulation-based medical education
  • Ultrasound contrast agent
  • Validity evidence
  • Clinical Competence
  • Reproducibility of Results
  • Humans
  • Simulation Training/methods
  • Computer Simulation
  • Ultrasonography
  • Virtual Reality


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