Simulation-Based Training of Ultrasound-Guided Procedures in Radiology – A Systematic Review

Abstract

Purpose To perform a systematic review of the effect of simulation-based training (SBT) of percutaneous abdominal and thoracic ultrasound-guided procedures and to assess the transfer of procedural competence to a clinical context. Materials and Methods This systematic review was conducted in accordance with the PRISMA statement. Pubmed, Embase, Web of Science, and the Cochrane Library were searched for studies assessing procedural competence after SBT. Two authors independently reviewed all studies and extracted data. Risk of bias was assessed using the Cochrane tool for randomized studies (RoB) and non-randomized studies (ROBINS-I). Quality of evidence was assessed using the GRADE approach. Results 42 studies were included. 6 were randomized controlled, 3 non-randomized controlled, and 33 non-randomized non-controlled. 26 studies examined US-guided abdominal procedures, 13 examined thoracic procedures, and 3 examined both. The results favored SBT compared to other educational interventions and found that training was superior to no training. Only two studies examined the transfer of procedural skills to a clinical context. All studies had a high or critical risk of bias. Thus, the quality of evidence for the effect of SBT on procedural competence was low, and evidence for its transfer to a clinical context was very low. Conclusion The evidence supporting SBT of percutaneous abdominal and thoracic US-guided procedures remains insufficient due to methodological problems and a high risk of bias. Future studies should be randomized and single-blinded, use assessment tools supported by validity evidence, compare different educational strategies, and examine the transfer of skills to a clinical setting.

Ultrasound-guided interventions with augmented reality in situ visualisation: a proof-of-mechanism phantom study

“…4). The number of needle passes were also reduced using AR in situ US (1 [1][2][3][4], median [range]) compared to conventional US (1 [1-8], Fig. 5).…”

“…Experienced radiologists were faster and needed less needle passes when performing the punctures with the conventional US (time 10.5 s ; needle passes, 1 [1,2]) compared to the untrained operators (time 21.5 s ; needle passes, 1 [1][2][3][4][5][6][7][8]) (Fig. 6).…”

“…Although ultrasound (US) technology is radiation free and cost-effective, it is subject to experience dependency and highly dependent on the level of training [1,2]. In some institutions, diagnostic and therapeutic joint injections are performed under fluoroscopic guidance [3][4][5], even if US guidance for most joints would be possible [6,7].…”

Simulation-Based Virtual-Reality Patient-Specific Rehearsal Prior to Endovascular Procedures: A Systematic Review

“…Only two studies in this review exceeded 15 patients in their cohorts, and several studies did not result in significant p-values, i.e., underpowered study designs. Third, simulation can be used to assess competency, and several studies have demonstrated this in ultrasound procedures in radiology [ 35 , 36 , 37 ]. However, the assessment tools must be valid and, thus, careful background studies on assessment must be performed [ 38 ].…”

Editorial

“…Their perception of the videos was evaluated by a questionnaire. The use of videos may be further examined, improved and maybe introduced as educational material, so that for instance ultrasound teaching in the future could rely on students' reading, videos and training with a simulator: a method, which has been well studied in several papers [1,2].…”