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The effect of initial teaching on evaluation of left ventricular volumes by cardiovascular magnetic resonance imaging : Comparison between complete and intermediate beginners and experienced observers

Hedström, Erik LU ; Ishida, Masaki; Sepúlveda-Martínez, Alvaro; Salehi, Daniel; Sperling, Johannes; Engblom, Henrik LU and Nagel, Eike (2017) In BMC Medical Imaging 17(1).
Abstract

Background: High 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. Methods: Standard 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... (More)

Background: High 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. Methods: Standard 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. Results: Endocardial 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. Conclusions: Initial 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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Beginners, Cine, CMR, Function, Teaching
in
BMC Medical Imaging
volume
17
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85019613201
  • wos:000401602700001
ISSN
1471-2342
DOI
10.1186/s12880-017-0197-5
language
English
LU publication?
yes
id
08acffba-6756-43d2-af3c-bf79be1c39f3
date added to LUP
2017-07-03 15:44:26
date last changed
2018-01-07 12:10:14
@article{08acffba-6756-43d2-af3c-bf79be1c39f3,
  abstract     = {<p>Background: High 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. Methods: Standard 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. Results: Endocardial DSC improved after teaching (+0.14 ± 0.17;p &lt; 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. Conclusions: Initial 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.</p>},
  articleno    = {33},
  author       = {Hedström, Erik and Ishida, Masaki and Sepúlveda-Martínez, Alvaro and Salehi, Daniel and Sperling, Johannes and Engblom, Henrik and Nagel, Eike},
  issn         = {1471-2342},
  keyword      = {Beginners,Cine,CMR,Function,Teaching},
  language     = {eng},
  month        = {05},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Medical Imaging},
  title        = {The effect of initial teaching on evaluation of left ventricular volumes by cardiovascular magnetic resonance imaging : Comparison between complete and intermediate beginners and experienced observers},
  url          = {http://dx.doi.org/10.1186/s12880-017-0197-5},
  volume       = {17},
  year         = {2017},
}