• Maria Chiara Scali
  • Quirino Ciampi
  • Eugenio Picano
  • Eduardo Bossone
  • Francesco Ferrara
  • Rodolfo Citro
  • Paolo Colonna
  • Marco Fabio Costantino
  • Lauro Cortigiani
  • Antonello D. Andrea
  • Sergio Severino
  • Claudio Dodi
  • Nicola Gaibazzi
  • Maurizio Galderisi
  • Andrea Barbieri
  • Ines Monte
  • Fabio Mori
  • Barbara Reisenhofer
  • Federica Re
  • Fausto Rigo
  • Paolo Trambaiolo
  • Miguel Amor
  • Jorge Lowenstein
  • Pablo Martin Merlo
  • Clarissa Borguezan Daros
  • José Luis De Castro E Silva Pretto
  • Marcelo Haertel Miglioranza
  • Marco A.R. Torres
  • Clarissa Carmona De Azevedo Bellagamba
  • Daniel Quesada Chaves
  • Iana Simova
  • Albert Varga
  • Jelena Čelutkiene
  • Jaroslaw D. Kasprzak
  • Karina Wierzbowska-Drabik
  • Piotr Lipiec
  • Paulina Weiner-Mik
  • Eva Szymczyk
  • Katarzyna Wdowiak-Okrojek
  • Ana Djordjevic-Dikic
  • Milica Dekleva
  • Ivan Stankovic
  • Aleksandar N. Neskovic
  • Giovanni Di Salvo
  • Julio E. Perez
  • Ana Cristina Camarozano
  • Anca Irina Corciu
  • Alla Boshchenko
  • Fabio Lattanzi

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 ±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 (≥ 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 ± 3 vs 29 ± 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.

Original languageEnglish
Article number20
JournalCardiovascular Ultrasound
Volume16
Issue number1
DOIs
StatePublished - 25 Sep 2018

    Research areas

  • Certification, Lung comets, Quality control, Stress echocardiography, Wall motion

    Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

ID: 43611500