Key result
A two-hour standardised teaching session for complete beginners significantly improved endocardial Dice Similarity Coefficient by 0.14 (p < 0.001), though high bias and low precision remained.
Why the study?
Does a standard two-hour initial teaching session improve the accuracy and precision of left ventricular volume measurements by CMR in beginner observers?
Observational (n=15)
Blinded to previous assessments and other observers
No
Does a standard two-hour initial teaching session improve the accuracy and precision of left ventricular volume measurements by CMR in beginner observers?
Answers are grounded in this paper and cite their sources.
A standard two-hour basic CMR teaching session improves accuracy for complete beginners but is insufficient to achieve high precision and low bias, highlighting the need for continued training and high-quality feedback.
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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Hedström et al. (2017) conducted an observational in Stable angina and known or suspected coronary artery disease (n=15). Standardised CMR teaching session vs. Before teaching was evaluated on Improvement in endocardial Dice Similarity Coefficient (DSC) for complete beginners (p=<0.001). A two-hour standardised teaching session for complete beginners significantly improved endocardial Dice Similarity Coefficient by 0.14 (p < 0.001), though high bias and low precision remained.
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