Abstract
BackgroundHigh reproducibility and low intra- and interobserver variability are important strengths of cardiac magnetic resonance (CMR). In clinical practice a significant learning curve may however be observed. Basic CMR courses offer an average of 1.4 h dedicated to lecturing and demonstrating left ventricular (LV) function analysis. The purpose of this study was to evaluate the effect of initial teaching on complete and intermediate beginners’ quantitative measurements of LV volumes and function by CMR.MethodsStandard clinical cine CMR sequences were acquired in 15 patients. Five observers (two complete beginners, one intermediate, two experienced) measured LV volumes. Before initial evaluation beginners read the SCMR guidelines on CMR analysis. After initial evaluation, beginners participated in a two-hour teaching session including cases and hands-on training, representative for most basic CMR courses, after which it is uncertain to what extent different centres provide continued teaching and feedback in-house. Dice Similarity Coefficient (DSC) assessed delineations. Agreement, accuracy, precision, repeatability and reliability were assessed by Bland-Altman, coefficient of variation, and intraclass correlation coefficient methods.ResultsEndocardial DSC improved after teaching (+0.14 ± 0.17;p < 0.001) for complete beginners. Low intraobserver variability was found before and after teaching, however with wide limits of agreement. Beginners underestimated volumes by up to 44 ml (EDV), 27 ml (ESV) and overestimated LVM by up to 53 g before teaching, improving to an underestimation of up to 9 ml (EDV), 7 ml (ESV) and an overestimation of up to 30 g (LVM) after teaching. For the intermediate beginner, however, accuracy was quite high already before teaching.ConclusionsInitial teaching to complete beginners increases accuracy for assessment of LV volumes, however with high bias and low precision even after standardised teaching as offered in most basic CMR courses. Even though the intermediate beginner showed quite high accuracy already before teaching, precision did generally not improve after standardised teaching. To maintain CMR as a technique known for high accuracy and reproducibility and low intra- and inter-observer variability for quantitative measurements, internationally standardised training should be encouraged including high-quality feedback mechanisms. Objective measurements of training methods, training duration and, above all, quality of assessments are required.
Highlights
High reproducibility and low intra- and interobserver variability are important strengths of cardiac magnetic resonance (CMR)
To maintain CMR as a technique known for high accuracy and reproducibility and low intra- and inter-observer variability for quantitative measurements, internationally standardised training should be encouraged including high-quality feedback mechanisms
It is important to have knowledge of the impact of basic training on complete beginners’ measurements, to maintain CMR as a technique known for its high accuracy and reproducibility and low intra- and inter-observer variability
Summary
High reproducibility and low intra- and interobserver variability are important strengths of cardiac magnetic resonance (CMR). High reproducibility and low intra- and interobserver variability of cardiac magnetic resonance (CMR) assessments of quantitative data are important strengths of this technique in clinical practice and in its role as an endpoint in research studies. There are currently no international criteria to measure the quality of “sufficient” training for the individual based on accuracy and precision, but rather a time frame and number of cases performed, as presented in the guidelines for training and accreditation of CMR in Europe [2] It is the senior authors’ experience that whereas some centres have a reference population that should be accurately and precisely measured by beginners with feedback from experienced observers as part of in-house training, other centres may have no particular in-house training or validation of CMR beginners’ measurements before they are allowed to report clinically or actively participate in research studies
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