Key result
Novel duplex ultrasound simulator replicates computational flow velocities within ~8% deviation during expert testing.
Why the study?
Duplex ultrasound scanning relies on blood flow velocity measurements for vascular diagnosis, but training tools for scanning skills are limited.
A newly developed duplex ultrasound simulator can accurately generate real-time color Doppler and spectral waveforms with a mean absolute error in velocity measurement of less than 10%.
Simulator objectively assesses examiner accuracy in complex DAF targets; leaves open whether training improves clinical outcomes.
OBJECTIVE: Duplex ultrasound scanning with B-mode imaging and both color Doppler and Doppler spectral waveforms is relied upon for diagnosis of vascular pathology and selection of patients for further evaluation and treatment. In most duplex ultrasound applications, classification of disease severity is based primarily on alterations in blood flow velocities, particularly the peak systolic velocity (PSV) obtained from Doppler spectral waveforms. We developed a duplex ultrasound simulator for training and assessment of scanning skills. METHODS: Duplex ultrasound cases were prepared from 2-dimensional (2D) images of normal and stenotic carotid arteries by reconstructing the common carotid, internal carotid, and external carotid arteries in 3 dimensions and computationally simulating blood flow velocity fields within the lumen. The simulator displays a 2D B-mode image corresponding to transducer position on a mannequin, overlaid by color coding of velocity data. A spectral waveform is generated according to examiner-defined settings (depth and size of the Doppler sample volume, beam steering, Doppler beam angle, and pulse repetition frequency or scale). The accuracy of the simulator was assessed by comparing the PSV measured from the spectral waveforms with the true PSV which was derived from the computational flow model based on the size and location of the sample volume within the artery. RESULTS: Three expert examiners made a total of 36 carotid artery PSV measurements based on the simulated cases. The PSV measured by the examiners deviated from true PSV by 8% ± 5% (N = 36). The deviation in PSV did not differ significantly between artery segments, normal and stenotic arteries, or examiners. CONCLUSION: To our knowledge, this is the first simulation of duplex ultrasound that can create and display real-time color Doppler images and Doppler spectral waveforms. The results demonstrate that an examiner can measure PSV from the spectral waveforms using the settings on the simulator with a mean absolute error in the velocity measurement of less than 10%. With the addition of cases with a range of pathologies, this duplex ultrasound simulator will be a useful tool for training health-care providers in vascular ultrasound applications and for assessing their skills in an objective and quantitative manner.
No takes yet. Share an insight, caveat, or question.
Zierler et al. (2016) studied Carotid artery disease (simulated) (n=3). Duplex ultrasound simulator vs. True PSV derived from computational flow model was evaluated on Deviation of measured peak systolic velocity (PSV) from true PSV. Peak systolic velocity measured by expert examiners using a novel duplex ultrasound simulator deviated from the true computational flow model velocity by 8% ± 5%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: