학술논문
Quality control of B-lines analysis in stress Echo 2020
Document Type
Report
Author
Scali, Maria Chiara; Ciampi, Quirino; Picano, Eugenio; Bossone, Eduardo; Ferrara, Francesco; Citro, Rodolfo; Colonna, Paolo; Costantino, Marco Fabio; Cortigiani, Lauro; Andrea, Antonello D'.; Severino, Sergio; Dodi, Claudio; Gaibazzi, Nicola; Galderisi, Maurizio; Barbieri, Andrea; Monte, Ines; Mori, Fabio; Reisenhofer, Barbara; Re, Federica; Rigo, Fausto; Trambaiolo, Paolo; Amor, Miguel; Lowenstein, Jorge; Merlo, Pablo Martin; Daros, Clarissa Borguezan; de Castro e Silva Pretto, José Luis; Miglioranza, Marcelo Haertel; Torres, Marco A. R.; de Azevedo Bellagamba, Clarissa Carmona; Chaves, Daniel Quesada; Simova, Iana; Varga, Albert; ÄelutkienÄ, Jelena; Kasprzak, Jaroslaw D.; Wierzbowska-Drabik, Karina; Lipiec, Piotr; Weiner-Mik, Paulina; Szymczyk, Eva; Wdowiak-Okrojek, Katarzyna; Djordjevic-Dikic, Ana; Dekleva, Milica; Stankovic, Ivan; Neskovic, Aleksandar N.; Zagatina, Angela; Di Salvo, Giovanni; Perez, Julio E.; Camarozano, Ana Cristina; Corciu, Anca Irina; Boshchenko, Alla; Lattanzi, Fabio; Cotrim, Carlos; Fazendas, Paula; Haberka, Maciej; Sobkowic, Bozena; Kosmala, Wojciech; Witkowski, Tomasz; Gosciniak, Piotr; Salustri, Alessandro; Rodriguez-Zanella, Hugo; Leal, Luis Ignacio Martin; Nikolic, Alexandra; Gligorova, Suzana; Urluescu, Madalina-Loredana; Fiorino, Maria; Novo, Giuseppina; Preradovic-Kovacevic, Tamara; Ostojic, Miodrag; Beleslin, Branko; Villari, Bruno; De Nes, Michele; Paterni, Marco; Carpeggiani, Clara
Source
Cardiovascular Ultrasound. September 25, 2018, Vol. 16 Issue 1
Subject
Language
English
Abstract
Author(s): Maria Chiara Scali[sup.17,40] , Quirino Ciampi[sup.1,2] , Eugenio Picano[sup.1] , Eduardo Bossone[sup.18] , Francesco Ferrara[sup.18] , Rodolfo Citro[sup.3] , Paolo Colonna[sup.4] , Marco Fabio Costantino[sup.5] , Lauro Cortigiani[sup.6] , [...]
Background The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module (http://se2020.altervista.org). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading [+ or -]1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 ([greater than or equai to] 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 [+ or -] 3 vs 29 [+ or -] 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly. Keywords: Certification, Lung comets, Quality control, Stress echocardiography, Wall motion
Background The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module (http://se2020.altervista.org). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading [+ or -]1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 ([greater than or equai to] 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 [+ or -] 3 vs 29 [+ or -] 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly. Keywords: Certification, Lung comets, Quality control, Stress echocardiography, Wall motion