scholarly journals P018: Blocked practice outperforms random practice for learning resuscitative transesophageal echocardiography: a randomized controlled trial

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S63-S63
Author(s):  
J. Chenkin ◽  
R. Brydges ◽  
T. Jelic ◽  
E. Hockmann
Keyword(s):  
Emergency Medicine ◽  
Image Quality ◽  
Transesophageal Echocardiography ◽  
Confidence Level ◽  
Transfer Test ◽  
Controlled Trial ◽  
Skill Assessment ◽  
Ultrasound Images ◽  
Point Scale ◽  
Scan Time

Introduction: Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively new ultrasound application, however the optimal teaching methods have not been determined. Previous studies have demonstrated that random practice (RP), which increases the variability of training, may improve learning of procedural skills compared with blocked practice (BP). We compared RP and BP for teaching a resuscitative TEE protocol to emergency medicine residents using a simulator. Methods: We recruited emergency medicine residents with no prior TEE experience from a university-affiliated hospital. Participants completed a questionnaire and baseline skill assessment on a simulator, then were randomized to one of two groups. The BP group completed 10 repetitions of a fixed 5-view TEE sequence with instructor feedback, while the RP group completed 10 different random 5-view TEE sequences with feedback. Participants completed a simulation-based performance assessment immediately, and a transfer test consisting of a simulated patient encounter 1-2 weeks after training. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. Our primary outcome was the percentage of successful views on the transfer test, and secondary outcomes included participants confidence level, image quality, percentage of correct diagnoses, and efficiency of movement. We compared all scores using two-tailed, independent samples t-tests. Results: 22 participants completed the study (11 in the RP group, 11 in the BP group). There were no significant baseline differences between the groups. The BP group had a higher rate of successful views compared with the RP group on the transfer test (92.7% vs 80.9%, p=0.02). While not statistically significant, the BP group had higher image quality on a 5-point scale (3.2 vs 2.9, p=0.09), and fewer probe accelerations (297 vs 403, p=0.09). The groups did not differ in rate of correct diagnoses (77.3% vs 72.7%, p=0.73), confidence level on a 10-point scale (6.2 vs 6.2, p=1.0), or scan time (173 vs 199 seconds, p=0.28). Conclusion: Emergency medicine residents randomized to BP had a higher success rate on a transfer test, compared to RP when learning resuscitative TEE using a simulator. We consider this pilot work that can inform future studies in both simulation and real clinical settings.

scholarly journals LO23: A brief educational session is effective for teaching emergency medicine residents resuscitative transesophageal echocardiography

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S35
Author(s):  
J. Chenkin ◽  
E. Hockmann
Keyword(s):  
Emergency Medicine ◽  
Image Quality ◽  
Transesophageal Echocardiography ◽  
Confidence Level ◽  
Transfer Test ◽  
Rating Scale ◽  
Training Session ◽  
Skill Assessment ◽  
Brief Training ◽  
The Mean

Introduction: Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively new ultrasound application that has the potential to guide the management of critically ill patients in the emergency department. The objective of this study was to determine the effectiveness of a brief training workshop for teaching a resuscitative TEE protocol to emergency medicine residents using a simulator. Methods: Emergency medicine residents with no prior TEE experience from a university-affiliated hospital were invited to participate in the study. Participants completed a questionnaire and baseline skill assessment using a high-fidelity simulator. The training session included a 20-minute lecture followed by 10 simulated repetitions of a 5-view TEE sequence with instructor feedback. Learning was evaluated by a skill assessment immediately after training and a transfer test 1-2 weeks after the training session. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. The primary outcome of this study was the percentage of successful views before and after training. Secondary outcomes included confidence level, image quality, percentage of correct diagnoses, and efficiency of movement. Assessment scores were compared using a two-tailed t-test. Results: 10 of 11 (91%) of invited residents agreed to participate in the study. Confidence level on a 10-point numeric rating scale (NRS) increased from a baseline of 1.0 (SD 0) to 7.0 (SD 1.9) after training (p<0.01). The mean duration between training and transfer test was 9.6 days (SD 1.9). The percentage of successful views increased from 44% at baseline to 100% after training, and 90% on the transfer test (p<0.01). The mean image quality on a 5-point scale was 2.2 (SD 1.0) at baseline, 3.8 (SD 0.7) after training (p<0.01), and 3.1 (SD 0.6) on the transfer test (p<0.01). The mean number of transducer accelerations were 524 (SD 202) at baseline, 219 (SD 54) after training (p<0.01), and 400 (SD 149) on the transfer test (p=0.13). Participants made the correct diagnosis in 70% of cases on the transfer test. Conclusion: After a brief training session using a simulator, emergency medicine residents were able to generate adequate TEE images on a delayed transfer test. Future studies are needed to determine effective strategies for maintaining motion efficiency and imaging quality.

scholarly journals MP21: A brief educational session is effective for teaching emergency medicine residents resuscitative transesophageal echocardiography

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S49-S50
Author(s):  
J. Chenkin ◽  
T. Jelic ◽  
E. Hockmann
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Transesophageal Echocardiography ◽  
Success Rate ◽  
Transfer Test ◽  
Correct Diagnosis ◽  
Training Session ◽  
Skill Assessment ◽  
High Fidelity ◽  
Ultrasound Images

Innovation Concet: Resuscitative clinician-performed transesophageal echocardiography (TEE) is a relatively new ultrasound application that has the potential to guide the management of critically ill patients in the emergency department. The objective of this study was to determine the effectiveness of a brief training workshop for teaching a resuscitative TEE protocol to emergency medicine residents using a high-fidelity simulator. Methods: Emergency medicine residents with no prior TEE experience that were rotating through a university-affiliated emergency department were invited to participate in the study. Participants completed a questionnaire and baseline skill assessment using a high-fidelity simulator. The training session included a 20 minute lecture followed by 10 simulated repetitions of a 5-view TEE sequence with instructor feedback. Learning was evaluated by a skill assessment immediately after training and a transfer test 1-2 weeks after the training session. Ultrasound images and transducer motion metrics were captured by the simulator for blinded analysis. The primary outcome of this study was the percentage of successful views before and after training as determined by two blinded reviewers using an anchored scoring tool. Secondary outcomes included time to scan completion and diagnostic accuracy on the transfer test. Assessment scores were compared using a two-tailed t-test. Curriculum, Tool or Material: 22 of 25 (88%) of invited residents agreed to participate in the study. Percentage of successful views increased from 44.5% (SD 27.9) at baseline to 98.6% (SD 3.5) after training (p < 0.001), and was 86.8% (SD 12.1) on transfer testing (p < 0.001). Time to complete the scan was 330 seconds at baseline, 125 seconds after training (p < 0.001), and 184 seconds (p < 0.001) in the transfer test. Participants made the correct diagnosis in 75% (SD 25.6) of the cases in the simulated patient encounter. The descending aorta view had the highest success rate (93.2%) and the midesophageal long axis view had the lowest success rate (75.0%). Conclusion: A brief simulation-based workshop was effective for teaching emergency medicine residents a five-view resuscitative TEE protocol. Future studies are needed to determine optimal methods for long-term skill retention.

Effect of Image Compression on Telepathology

2000 ◽  
Vol 124 (11) ◽  
pp. 1653-1656 ◽  
Author(s):  
Alvin Marcelo ◽  
Paul Fontelo ◽  
Miguel Farolan ◽  
Hernani Cualing
Keyword(s):  
Image Quality ◽  
Image Compression ◽  
Confidence Level ◽  
Controlled Trial ◽  
Optimization Methods ◽  
Joint Photographic Expert Group ◽  
Double Blind ◽  
Significant Difference ◽  
Store And Forward ◽  
The University

Abstract Context.—For practitioners deploying store-and-forward telepathology systems, optimization methods such as image compression need to be studied. Objective.—To determine if Joint Photographic Expert Group (JPG or JPEG) compression, a lossy image compression algorithm, negatively affects the accuracy of diagnosis in telepathology. Design.—Double-blind, randomized, controlled trial. Setting.—University-based pathology departments. Participants.—Resident and staff pathologists at the University of Illinois, Chicago, and University of Cincinnati, Cincinnati, Ohio. Intervention.—Compression of raw images using the JPEG algorithm. Main Outcome Measures.—Image acceptability, accuracy of diagnosis, confidence level of pathologist, image quality. Results.—There was no statistically significant difference in the diagnostic accuracy between noncompressed (bit map) and compressed (JPG) images. There were also no differences in the acceptability, confidence level, and perception of image quality. Additionally, rater experience did not significantly correlate with degree of accuracy. Conclusions.—For providers practicing telepathology, JPG image compression does not negatively affect the accuracy and confidence level of diagnosis. The acceptability and quality of images were also not affected.

scholarly journals Radial self-navigated native magnetic resonance angiography in comparison to navigator-gated contrast-enhanced MRA of the entire thoracic aorta in an aortic patient collective

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Martina Correa Londono ◽  
Nino Trussardi ◽  
Verena C. Obmann ◽  
Davide Piccini ◽  
Michael Ith ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Angiography ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Scan Time ◽  
Contrast Enhanced

Abstract Background The native balanced steady state with free precession (bSSFP) magnetic resonance angiography (MRA) technique has been shown to provide high diagnostic image quality for thoracic aortic disease. This study compares a 3D radial respiratory self-navigated native MRA (native-SN-MRA) based on a bSSFP sequence with conventional Cartesian, 3D, contrast-enhanced MRA (CE-MRA) with navigator-gated respiration control for image quality of the entire thoracic aorta. Methods Thirty-one aortic native-SN-MRA were compared retrospectively (63.9 ± 10.3 years) to 61 CE-MRA (63.1 ± 11.7 years) serving as a reference standard. Image quality was evaluated at the aortic root/ascending aorta, aortic arch and descending aorta. Scan time was recorded. In 10 patients with both MRA sequences, aortic pathologies were evaluated and normal and pathologic aortic diameters were measured. The influence of artifacts on image quality was analyzed. Results Compared to the overall image quality of CE-MRA, the overall image quality of native-SN-MRA was superior for all segments analyzed (aortic root/ascending, p < 0.001; arch, p < 0.001, and descending, p = 0.005). Regarding artifacts, the image quality of native-SN-MRA remained superior at the aortic root/ascending aorta and aortic arch before and after correction for confounders of surgical material (i.e., susceptibility-related artifacts) (p = 0.008 both) suggesting a benefit in terms of motion artifacts. Native-SN-MRA showed a trend towards superior intraindividual image quality, but without statistical significance. Intraindividually, the sensitivity and specificity for the detection of aortic disease were 100% for native-SN-MRA. Aortic diameters did not show a significant difference (p = 0.899). The scan time of the native-SN-MRA was significantly reduced, with a mean of 05:56 ± 01:32 min vs. 08:51 ± 02:57 min in the CE-MRA (p < 0.001). Conclusions Superior image quality of the entire thoracic aorta, also regarding artifacts, can be achieved with native-SN-MRA, especially in motion prone segments, in addition to a shorter acquisition time.

Minimizing table time in patients with claustrophobia using focused ferumoxytol-enhanced MR angiography (f-FEMRA): a feasibility study

2021 ◽  
Vol 94 (1125) ◽  
pp. 20210430
Author(s):  
Puja Shahrouki ◽  
Kim-Lien Nguyen ◽  
John M. Moriarty ◽  
Adam N. Plotnik ◽  
Takegawa Yoshida ◽  
...  
Keyword(s):  
Image Quality ◽  
Mr Angiography ◽  
Signal To Noise Ratio ◽  
Diagnostic Image Quality ◽  
Diagnostic Confidence ◽  
Motion Artefact ◽  
Scan Time ◽  
Wilcoxon Rank Sum Test ◽  
Significant Difference ◽  
Noise Ratio

Objectives: To assess the feasibility of a rapid, focused ferumoxytol-enhanced MR angiography (f-FEMRA) protocol in patients with claustrophobia. Methods: In this retrospective study, 13 patients with claustrophobia expressed reluctance to undergo conventional MR angiography, but agreed to a trial of up to 10 min in the scanner bore and underwent f-FEMRA. Thirteen matched control patients who underwent gadolinium-enhanced MR angiography (GEMRA) were identified for comparison of diagnostic image quality. For f-FEMRA, the time from localizer image acquisition to completion of the angiographic acquisition was measured. Two radiologists independently scored images on both f-FEMRA and GEMRA for arterial and venous image quality, motion artefact and diagnostic confidence using a 5-point scale, five being best. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the aorta and IVC were measured. The Wilcoxon rank-sum test, one-way ANOVA with Tukey correction and two-tailed t tests were utilized for statistical analyses. Results: All scans were diagnostic and assessed with high confidence (scores ≥ 4). Average scan time for f-FEMRA was 6.27 min (range 3.56 to 10.12 min), with no significant difference between f-FEMRA and GEMRA in diagnostic confidence (4.86 ± 0.24 vs 4.69 ± 0.25, p = 0.13), arterial image quality (4.62 ± 0.57 vs 4.65 ± 0.49, p = 0.78) and motion artefact score (4.58 ± 0.49 vs 4.58 ± 0.28, p > 0.99). f-FEMRA scored significantly better for venous image quality than GEMRA (4.62 ± 0.42 vs 4.19 ± 0.56, p = 0.04). CNR in the IVC was significantly higher for steady-state f-FEMRA than GEMRA regardless of the enhancement phase (p < 0.05). Conclusions: Comprehensive vascular MR imaging of the thorax, abdomen and pelvis can be completed in as little as 5 min within the magnet bore using f-FEMRA, facilitating acceptance by patients with claustrophobia and streamlining workflow. Advances in knowledge: A focused approach to vascular imaging with ferumoxytol can be performed in patients with claustrophobia, limiting time in the magnet bore to 10 min or less, while acquiring fully diagnostic images of the thorax, abdomen and pelvis.

scholarly journals k-t GRAPPA accelerated four-dimensional flow MRI in the aorta: Effect on scan time, image quality, and quantification of flow and wall shear stress

2013 ◽  
Vol 72 (2) ◽  
pp. 522-533 ◽  
Author(s):  
Susanne Schnell ◽  
Michael Markl ◽  
Pegah Entezari ◽  
Riti J. Mahadewia ◽  
Edouard Semaan ◽  
...  
Keyword(s):  
Shear Stress ◽  
Image Quality ◽  
Wall Shear Stress ◽  
Dimensional Flow ◽  
Scan Time ◽  
Flow Mri ◽  
Wall Shear ◽  
Time Image

Denoising Ultrasound Medical Images

2017 ◽  
pp. 761-775
Author(s):  
A.S.C.S. Sastry ◽  
P.V.V. Kishore ◽  
Ch. Raghava Prasad ◽  
M.V.D. Prasad
Keyword(s):  
Image Quality ◽  
Medical Images ◽  
Ultrasound Image ◽  
Similarity Index ◽  
Speckle Noise ◽  
Ultrasound Images ◽  
Medical Ultrasound ◽  
Soft Thresholding ◽  
Block Based

Medical ultrasound imaging has revolutioned the diagnostics of human body in the last few decades. The major drawback of ultrasound medical images is speckle noise. Speckle noise in ultrasound images is because of multiple reflections of ultrasound waves from hard tissues. Speckle noise degrades the medical ultrasound images lessening the visible quality of the image. The aim of this paper is to improve the image quality of ultrasound medical images by applying block based hard and soft thresholding on wavelet coefficients. Medical ultrasound image transformation to wavelet domain uses debauchee's mother wavelet. Divide the approximate and detailed coefficients into uniform blocks of size 8×8, 16×16, 32×32 and 64×64. Hard and soft thresholding on these blocks of approximate and detailed coefficients reduces speckle noise. Inverse transformation to original spatial domain produces a noise reduced ultrasound image. Experiments on medical ultrasound images obtained from diagnostic centers in Vijayawada, India show good improvements to ultrasound images visually. Quality of improved images in measured using peak signal to noise ratio (PSNR), image quality index (IQI), structural similarity index (SSIM).

A Real-Time Approach To Detect Seal Defects in Food Packages Using Ultrasonic Imaging

2001 ◽  
Vol 64 (9) ◽  
pp. 1392-1398 ◽  
Author(s):  
NEIL N. SHAH ◽  
PAUL K. ROONEY ◽  
AYHAN OZGULER ◽  
SCOTT A. MORRIS ◽  
WILLIAM D. O'BRIEN
Keyword(s):  
Image Quality ◽  
Ultrasonic Inspection ◽  
Spatial Sampling ◽  
Ultrasonic Frequency ◽  
Ultrasound Images ◽  
Inspection Method ◽  
Raster Scanning ◽  
Food Packages ◽  
Inspection Systems ◽  
Scanning Geometry

The microbial integrity of many types of flexible food packages depends on a zero defect level in the fused seam seal. Human inspection for defects in these seals is marginal at best, and secondary incubation protocols are often used to spot packages with compromised integrity before releasing product for sale. A new type of inspection method has been developed and is being evaluated for robustness. The purpose of the study was to evaluate a new raster scanning geometry to simulate continuous motion, online ultrasonic inspection of the seal region in flexible food package seals. A principal engineering tradeoff of scanning inspection systems is between increased line speed that results from decreased spatial sampling (less acquired data to process) and decreased image quality. The previously developed pulse-echo Backscattered Amplitude Integral (BAI) mode imaging technique is used to form ultrasound images using the new scanning geometry. At an ultrasonic frequency of 22.9 MHz, 38- and 50-μm-diameter air-filled channel defects in all-plastic transparent trilaminate are evaluated. The contrast-to-noise ratio (CNR) of the processed BAI-mode image is used to quantify image quality as a function of spatial sampling. Results show seal defects (38- and 50-μm diameter) are still detectable for undersampled conditions, although image quality degrades as spatial sampling decreases. Further, it is concluded that the raster scanning geometry is feasible for online inspection.

scholarly journals Comparative study of treatment interventions for patellar tendinopathy: a protocol for a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034304 ◽  
Author(s):  
Maria Pilar López-Royo ◽  
Eva Maria Gómez-Trullén ◽  
Maria Ortiz-Lucas ◽  
Rita Maria Galán-Díaz ◽  
Ana Vanessa Bataller-Cervero ◽  
...  
Keyword(s):  
Treatment Group ◽  
Randomised Controlled Trial ◽  
Eccentric Exercise ◽  
Short Form ◽  
Controlled Trial ◽  
Exercise Programme ◽  
Patellar Tendinopathy ◽  
Ultrasound Images ◽  
Perceived Quality Of Life ◽  
Randomised Controlled

IntroductionPatellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of this study is to determine the additional effect of two interventions combined with eccentric exercise and compare which one is the most effective at short-term and long-term follow-up for patients with patellar tendinopathy.Methods and analysisThis study is a randomised controlled trial with blinded participants. Measurements will be carried out by a specially trained blinded assessor. A sample of 57 patients with a medical diagnosis of patellar tendinopathy will participate in this study and will be divided into three treatment groups. Eligible participants will be randomly allocated to receive either: (a) treatment group with percutaneous needle electrolysis, (b) treatment group with dry needling or (c) treatment group with placebo needling. In addition, all groups will perform eccentric exercise. Functionality and muscle strength parameters, pain, ultrasound appearances and patient perceived quality of life shall be evaluated using the Victorian Institute of Sports Assessment for patellar (VISA-P), jump tests, Visual Analogue Scale, ultrasound images and Short Form-36 (SF-36), respectively. Participants will be assessed at baseline, at 10 weeks and at 22 weeks after baseline. The expected findings will allow us to advance in the treatment of this injury, as they will help determine whether a needling intervention has additional effects on an eccentric exercise programme and whether any of the needling modalities is more effective than the other.Ethics and disseminationThis protocol has been approved by the Ethics Committee of Aragon (N° PI15/0017). The trial will be conducted in accordance with the Declaration of Helsinki.Trial registration numberNCT02498795

scholarly journals 3D Dixon water-fat LGE imaging with image navigator and compressed sensing in cardiac MRI

2020 ◽  
Author(s):  
Martin Georg Zeilinger ◽  
Marco Wiesmüller ◽  
Christoph Forman ◽  
Michaela Schmidt ◽  
Camila Munoz ◽  
...  
Keyword(s):  
High Resolution ◽  
Image Quality ◽  
Compressed Sensing ◽  
Cardiac Mri ◽  
Three Dimensional ◽  
Fat Suppression ◽  
Diagnostic Confidence ◽  
Pericardial Disease ◽  
Scan Time ◽  
Wilcoxon Rank Sum Test

Abstract Objectives To evaluate an image-navigated isotropic high-resolution 3D late gadolinium enhancement (LGE) prototype sequence with compressed sensing and Dixon water-fat separation in a clinical routine setting. Material and methods Forty consecutive patients scheduled for cardiac MRI were enrolled prospectively and examined with 1.5 T MRI. Overall subjective image quality, LGE pattern and extent, diagnostic confidence for detection of LGE, and scan time were evaluated and compared to standard 2D LGE imaging. Robustness of Dixon fat suppression was evaluated for 3D Dixon LGE imaging. For statistical analysis, the non-parametric Wilcoxon rank sum test was performed. Results LGE was rated as ischemic in 9 patients and non-ischemic in 11 patients while it was absent in 20 patients. Image quality and diagnostic confidence were comparable between both techniques (p = 0.67 and p = 0.66, respectively). LGE extent with respect to segmental or transmural myocardial enhancement was identical between 2D and 3D (water-only and in-phase). LGE size was comparable (3D 8.4 ± 7.2 g, 2D 8.7 ± 7.3 g, p = 0.19). Good or excellent fat suppression was achieved in 93% of the 3D LGE datasets. In 6 patients with pericarditis, the 3D sequence with Dixon fat suppression allowed for a better detection of pericardial LGE. Scan duration was significantly longer for 3D imaging (2D median 9:32 min vs. 3D median 10:46 min, p = 0.001). Conclusion The 3D LGE sequence provides comparable LGE detection compared to 2D imaging and seems to be superior in evaluating the extent of pericardial involvement in patients suspected with pericarditis due to the robust Dixon fat suppression. Key Points • Three-dimensional LGE imaging provides high-resolution detection of myocardial scarring. • Robust Dixon water-fat separation aids in the assessment of pericardial disease. • The 2D image navigator technique enables 100% respiratory scan efficacy and permits predictable scan times.

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