Rationale and Objectives
A picture archiving and communication system (PACS)–integrated ultrasound-guided (USG) breast intervention simulation exercise was designed for radiology residency education. The purpose of this study was to describe the initial experience and determine if resident understanding of the American College of Radiology (ACR) practice guideline for the performance of USG percutaneous breast interventional procedures and procedural confidence is improved with the implementation of this simulation exercise.
Materials and Methods
Radiology residents ( n = 11) volunteered to perform percutaneous USG cyst aspiration, 14-gauge automated core biopsy, and 10-gauge vacuum core biopsy on turkey breast phantoms, with an emphasis on capturing ultrasound images demonstrating appropriate documentation of the procedure and image annotation according to the ACR practice guideline for USG percutaneous interventions. The images were transmitted to the PACS for subsequent attending radiologist review. Survey responses regarding procedural confidence and knowledge of the ACR practice guideline were compared between residents with and without the simulator experience.
Results
Residents with simulation exercise experience showed statistically significant increases in confidence performing USG core biopsies, operating biopsy devices and ultrasound equipment, and knowledge of appropriate needle positioning and image annotation and documentation according to the ACR practice guideline. The increased confidence seen in performing USG cyst aspiration barely missed statistical significance ( P = .056), likely because of residents’ baseline familiarity with the procedure.
Conclusions
A PACS-integrated USG breast intervention simulation exercise increases residents’ procedural confidence and understanding of the ACR practice guideline for the performance of USG percutaneous breast interventional procedures.
Ultrasound-guided (USG) percutaneous breast interventions are important diagnostic and therapeutic procedures performed by radiologists and offer many advantages, including real-time imaging, a lack of ionizing radiation, and increased patient tolerance for supine positioning without breast compression. Many large-scale studies have validated the diagnostic accuracy of USG percutaneous core needle biopsy compared to surgical excision . Furthermore, the performance of USG percutaneous breast interventions has been associated with a decrease in the number of surgical procedures , improved cosmesis , and lower health care costs . In addition to these diagnostic procedures, cyst aspirations are often performed for therapeutic reasons, including alleviation of pain associated with benign breast cysts.
In October 2009, the American College of Radiology (ACR) revised its practice guideline for the performance of USG percutaneous breast interventional procedures to assist practitioners in achieving the objective of appropriate radiologic care for patients . This guideline may also serve as an educational outline to define core competencies for radiology residents.
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Materials and methods
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Results
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Table 1
Survey Results From Residents ( n = 13) Who Did Not Participate in the USG Breast Intervention Simulation Exercise
Survey Item 1 (Poor) 2 3 (Average) 4 5 (Good) Mean Confidence in ability to perform vacuum core biopsy 6 (46%) 3 (23%) 2 (15%) 2 (15%) 0 (0%) 2 Confidence in ability to perform cyst aspiration 2 (15%) 0 (0%) 5 (38%) 4 (31%) 2 (15%) 3.3 Confidence in ability to perform automated core biopsy 3 (23%) 5 (38%) 1 (8%) 4 (31%) 0 (0%) 2.5 Understanding of needle positioning 2 (15%) 3 (23%) 3 (23%) 4 (31%) 1 (8%) 2.9 Comfort level operating biopsy devices 2 (15%) 6 (46%) 2 (15%) 3 (23%) 0 (0%) 2.5 Comfort level operating ultrasound equipment 2 (15%) 3 (23%) 3 (23%) 4 (31%) 1 (8%) 2.9 Understanding of ACR image documentation and annotation 5 (38%) 3 (23%) 4 (31%) 1 (8%) 0 (0%) 2.1
Percentages may not total 100% because of rounding.
ACR, American College of Radiology; USG, ultrasound-guided.
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Table 2
Survey Results From Residents ( n = 11) Who Participated in the USG Breast Intervention Simulation Exercise
Survey Item 1 (Poor) 2 3 (Average) 4 5 (Good) Mean_P_ Confidence in ability to perform vacuum core biopsy 0 (0%) 1 (9%) 7 (64%) 1 (9%) 2 (18%) 3.4 .012 Confidence in ability to perform cyst aspiration 0 (0%) 0 (0%) 0 (0%) 9 (82%) 2 (18%) 4.2 .056 Confidence in ability to perform automated core biopsy 0 (0%) 1 (9%) 4 (36%) 5 (45%) 1 (9%) 3.6 .039 Understanding of needle positioning 0 (0%) 0 (0%) 2 (18%) 5 (45%) 4 (36%) 4.2 .017 Comfort level operating biopsy devices 0 (0%) 0 (0%) 4 (36%) 4 (36%) 3 (27%) 3.9 .004 Comfort level operating ultrasound equipment 0 (0%) 0 (0%) 3 (27%) 4 (36%) 4 (36%) 4.1 .030 Understanding of ACR image documentation and annotation 0 (0%) 2 (18%) 0 (0%) 5 (45%) 4 (36%) 4 .001
Percentages may not total 100% because of rounding. P values < .05 were considered statistically significant.
ACR, American College of Radiology; USG, ultrasound-guided.
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Discussion
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Conclusions
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