The CUSUM test is effective in evaluating competence in the diagnosis of uterine malformations based on 3D ultrasound
Uterine malformations of congenital origin may go unnoticed or produce gynaecological or obstetric symptoms such as infertility or repeated miscarriages. Many methods are currently available for diagnosing such malformations, though 3D ultrasound is one of the least invasive options and offers high sensitivity (83-100%) and precision. Furthermore, the technique complements very well with the magnetic resonance imaging findings in classifying the possible anomalies. The only inconvenience of 3D ultrasound is the need for specific training in order to establish the diagnosis. The CUSUM (learning curve cumulative summation) test is a statistical tool commonly used in different medical specialties to evaluate professional competence in performing a specific procedure, such as surgery for example.
For this reason, a team led by Dr. María Angela Pascual, Head of the Department of Gynaecological Imaging Diagnosis of the Women’s Health Dexeus Centre, in collaboration with experts from the University of Navarra and the University of Cagliari (Italy), have carried out a study to analyse whether the CUSUM may also be effective in evaluating whether the training received by residents in diagnosing uterine malformations based on 3D ultrasound allows them to acquire the required skills. With this purpose, three first, second and third year residents in Obstetrics and Gynaecology of the Women’s Health Dexeus Centre were selected for enrollment in a 14-hour training program including the practical interpretation of 3D images. The images contained information on 155 premenopausal women with different types of uterine malformations according to the classification of the European Society of Human Reproduction and Embryology (ESHRE).
The study showed that residents with the greatest experience (i.e., residents in later years, who already had more practice interpreting other imaging diagnostic tests such as 2D ultrasound) obtained better results than residents in earlier years. On the other hand, all the residents increased their skill and speed in establishing a correct diagnosis as training progressed. In this regard, at the end of the course, the error rate was only 4%. The authors therefore concluded that in addition to affording quantitative indicators, the CUSUM test is effective in determining whether resident training in this field is adequate for a correct diagnosis of uterine anomalies.
Training performance in diagnosis of congenital uterine anomalies with 3-dimensional sonography: A learning curve cumulative summation analysis.
Pascual MA, Alcazar JL, Graupera B, Rodriguez I, Guerriero S, Mallafre A, de Lorenzo C, Hereter L. J
Ultrasound Med. 2016 Dec;35(12):2589-2594.