TY - JOUR

T1 - Quality control of B-lines analysis in stress Echo 2020

AU - Scali, Maria Chiara

AU - Ciampi, Quirino

AU - Picano, Eugenio

AU - Bossone, Eduardo

AU - Ferrara, Francesco

AU - Citro, Rodolfo

AU - Colonna, Paolo

AU - Costantino, Marco Fabio

AU - Cortigiani, Lauro

AU - Andrea, Antonello D.

AU - Severino, Sergio

AU - Dodi, Claudio

AU - Gaibazzi, Nicola

AU - Galderisi, Maurizio

AU - Barbieri, Andrea

AU - Monte, Ines

AU - Mori, Fabio

AU - Reisenhofer, Barbara

AU - Re, Federica

AU - Rigo, Fausto

AU - Trambaiolo, Paolo

AU - Amor, Miguel

AU - Lowenstein, Jorge

AU - Merlo, Pablo Martin

AU - Daros, Clarissa Borguezan

AU - De Castro E Silva Pretto, José Luis

AU - Miglioranza, Marcelo Haertel

AU - Torres, Marco A.R.

AU - De Azevedo Bellagamba, Clarissa Carmona

AU - Chaves, Daniel Quesada

AU - Simova, Iana

AU - Varga, Albert

AU - Čelutkiene, Jelena

AU - Kasprzak, Jaroslaw D.

AU - Wierzbowska-Drabik, Karina

AU - Lipiec, Piotr

AU - Weiner-Mik, Paulina

AU - Szymczyk, Eva

AU - Wdowiak-Okrojek, Katarzyna

AU - Djordjevic-Dikic, Ana

AU - Dekleva, Milica

AU - Stankovic, Ivan

AU - Neskovic, Aleksandar N.

AU - Zagatina, Angela

AU - Di Salvo, Giovanni

AU - Perez, Julio E.

AU - Camarozano, Ana Cristina

AU - Corciu, Anca Irina

AU - Boshchenko, Alla

AU - Lattanzi, Fabio

PY - 2018/9/25

Y1 - 2018/9/25

N2 - 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.

AB - 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.

KW - Certification

KW - Lung comets

KW - Quality control

KW - Stress echocardiography

KW - Wall motion

UR - http://www.scopus.com/inward/record.url?scp=85053845849&partnerID=8YFLogxK

U2 - 10.1186/s12947-018-0138-7

DO - 10.1186/s12947-018-0138-7

M3 - Review article

C2 - 30249305

AN - SCOPUS:85053845849

VL - 16

JO - Cardiovascular Ultrasound

JF - Cardiovascular Ultrasound

SN - 1476-7120

IS - 1

M1 - 20

ER -