JABTS Breast Ultrasound Training Course: Program and Results

JABTS Breast Ultrasound Training Course: Program and Results

Eriko Tohno

, Kiyoshi Sawai

, and the Members of the Education Committee of JABTS

101 Summary. The educational committee of the JABTS (Japanese Association of Breast and Thyroid Sonology) organized a breast ultrasound training course as a method for quality control. The course consisted of pre- and posttests, lectures, and small group learning. To simulate an actual examination, moving images of clinical cases were used in some of the small learning groups and the tests. After the course, although the specificity deteriorated from 75.4% to 68.0%, the sensitivity rose from 62.5% to 75.4%. The training course was considered to be effective in improving the ability to find lesions.

Key words. Breast, Ultrasound, Screening, Training, Efficacy

Introduction

We are now trying to introduce ultrasound as a modality of breast screening in Japan, but there are problems. If the examination is done using ordinary ultrasound equip- ment, that is, with handheld real-time scanners, cancers might be missed by techni- cal failure, or due to lack of skill of the operators. If we were to recall women in whom any lesion was found, the recall rate would be extremely high, perhaps up to 15%. So, quality control is necessary in scanning technique, evaluation of lesions, standards for recall, and so on. There are also problems in ordinary training courses. For example, lectures are usually done in large classrooms and ultrasound is taught through still images, whereas actual ultrasound examinations are done in real time. It is difficult to train personnel in ways to find lesions. Also, there is no method to evaluate the effectiveness of the course. Thus, we set up training courses to achieve these require- ments and analyzed the results.

1

Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan

2

Department of Endocrine Surgery & Breast Surgery, Kyoto Prefectural University of Medicine,

Kyoto, Japan

Materials and Methods

The educational committee was organized within JABTS, the Japanese Association of Breast and Thyroid Sonology. We, the members of the committee, planned the breast ultrasound training course. The course was held for the first time in Tsukuba from January 11 to 13, and the second one was held from April 4 to 6 in Kyoto. To provide intensive teaching, the maximum number of attendees in each course was limited to 36.

The courses consisted of pretest, lectures, small group learning, and posttest. Table 1 shows the titles of the lectures, and Table 2 shows the titles of the small group learn- ing. Following short lectures, using PC projection, attendants were asked how to analyze and categorize the ultrasound images of the cases that were distributed indi- vidually. As educational material, we provided ultrasoncgraphy (US) images of impor- tant diseases to train the ability to find lesions. Clinical cases were edited and saved on CD. Using laptop computers, the attendees observed the cases, and made the most likely diagnoses.

Before and after the course, attendees had tests to evaluate the effectiveness of the training course. Again, the attendees diagnosed moving ultrasound images of 80 cases. The average length of each case was 30 s, and the time limit for this test was 100 min.

Results

The results of the course in Tsukuba show that the sensitivity (finding lesions above category 3) rose from 62.5% to 78.1%, while the specificity dropped from 75.4% to 68.0%.

102 E. Tohno et al.

Table 1. Titles and lengths of the lectures 1. General aspects of breast diseases (30 min) 2. Scanning technique (30 min)

3. Breast ultrasound lexicon (120 min)

4. Basic aspects of ultrasound; pitfalls and artifacts (30 min) 5. US tissue characterization (30 min)

6. Standards for recall (30 min)

Table 2. Titles of the small group learning 1. Accentuating type of breast disease

2. Intermediate type and attenuating type of breast diseases 3. Nonmass-forming diseases, intraductal diseases 4. Hands-on

5. US images of important diseases

6. Practice for finding lesions

Conclusions

1. We are trying to establish an effective teaching course for quality control of breast ultrasound screening.

2. To train with real-time breast ultrasound, we made training materials consisting of moving pictures from clinical cases.

3. Pre- and posttests were done to evaluate the effectiveness of the course.

4. Although the specificity dropped, improvement of sensitivity is important to avoid missing cancers during screening.

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