Abstract
Contrast-enhanced ultrasound (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 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.
Highlights
Contrast-enhanced ultrasound (CEUS) is an imaging technique that combines ultrasound with the use of ultrasound contrast agents (UCAs), which are predominantly administered intravenously (Sidhu et al 2018; Dietrich et al 2020)
An initial Immersive virtual reality (IVR) test room was developed by N.J. in cooperation with a company that specializes in development of IVR software for medical educational purposes (VitaSim, Odense, Denmark)
Phase 1 The developed IVR scenario consisted of (i) two tutorial rooms with a total of 12 learning stations and (ii) one test room with a total of 33 data points distributed as eight multiplechoice questions (MCQs) (24%) and 25 action points (76%)
Summary
Contrast-enhanced ultrasound (CEUS) is an imaging technique that combines ultrasound with the use of ultrasound contrast agents (UCAs), which are predominantly administered intravenously (Sidhu et al 2018; Dietrich et al 2020). Microbubbles have excellent echogenic properties, which can be exploited in various ways using contrast-specific software (Chong et al 2018) Because of their confinement to the blood pool with no extravasation (except for some agents that are phagocytosed by reticuloendothelial cells in the liver), they allow for real-time visualization of blood perfusion in organs, as well as depiction of macrovascular features (Chong et al 2018; Barr et al 2020; Wilson et al 2020). Their current uses include diagnostic imaging in numerous medical specialties, guidance during biopsy procedures and ablation therapies and in sonoporation therapy where the bio-effects of microbubble fragmentation are used (Dimcevski et al 2016; Nolsoe et al 2018; Sidhu et al 2018; Dietrich et al 2020).
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