TY  - JOUR
A1  - Hedström, Erik
A1  - Ishida, Masaki
A1  - Sepúlveda-Martínez, Alvaro
A1  - Ryd, Daniel
A1  - Sperling, Johannes
A1  - Engblom, Henrik
A1  - Nagel, Eike
T1  - 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
T2  - BMC medical imaging
N2  - 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.
KW  - CMR
KW  - Teaching
KW  - Cine
KW  - Function
KW  - Beginners
Y1  - 2017
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/75164
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-751649
SN  - 1471-2342
N1  - Funding: European Union Grant ; 224495
N1  - Funding: British Heart Foundation ; Research Excellence Award RE/08/003 and FS/10/029/28253
N1  - Funding: Biomedical Research Centre ; BRC-CTF 196
N1  - Funding: Wellcome Trust and EPSRC ; WT 088641/Z/09/Z
N1  - Funding: Lund University Medical Faculty and Lund University Hospital, Sweden
N1  - Funding: Foundation BLANCEFLOR Boncompagni-Ludovisi, née Bildt, Sweden
N1  - Funding: Swedish societies of Medicine, Cardiology, and Radiology
N1  - Funding: Erasmus Mundus + Programme of the European Union ; 2013–0040
N1  - Funding: German Centre for Cardiovascular Research (DZHK)
N1  - The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
VL  - 17
IS  - art .33
SP  - 1
EP  - 11
PB  - BioMed Central
CY  - London
ER  -