Department of Internal Medicine, LAC + USC Medical Center, Los Angeles, California.
J Am Soc Echocardiogr. 2013 Dec;26(12):1457-64. doi: 10.1016/j.echo.2013.08.009. Epub 2013 Sep 16.
Training of nonsonographer physicians or staff members is needed to implement carotid intima-media thickness (CIMT) and plaque screening by ultrasound for the assessment of subclinical atherosclerosis. The purpose of this study was to determine the effect of formal training on CIMT assessment and plaque detection by medical residents.
A medical resident (R1) was trained using an abbreviated American Society of Echocardiography CIMT protocol. CIMT and plaque assessment by R1 were compared against an expert scanner on 60 subjects using a portable US system. A second medical resident (R2) was then trained on the CIMT protocol focusing on plaque visualization after the results of the first phase of the study were analyzed, and the results were compared against an expert on an additional 10 subjects.
In the first phase of the study, a total of 106 images (94% interpretable) were available for CIMT and plaque assessment by both R1 and the expert. CIMT measurements were bioequivalent within the limits of ultrasound resolution, with 88% agreement. Variability on plaque presence was high, with only 53% agreement. R2 and the expert each scanned 10 new subjects twice, from whom 40 images were available for interpretation. R2 demonstrated CIMT agreement (93%) comparable with that observed in phase 1 but with greatly improved plaque agreement (100%). Intraobserver variability during phase 2 for both R2 and the expert was extremely low.
Medical residents can undergo rapid training for CIMT measurement and plaque visualization to detect subclinical atherosclerosis compared with an expert.
为了通过超声进行颈动脉内膜中层厚度（CIMT）和斑块筛查，以评估亚临床动脉粥样硬化，需要对非超声医师或工作人员进行培训。本研究旨在确定对住院医师进行规范化培训对 CIMT 评估和斑块检测的影响。
使用简化的美国超声心动图协会 CIMT 方案对一名住院医师（R1）进行培训。使用便携式超声系统，在 60 名受试者中比较 R1 与专家扫描仪的 CIMT 和斑块评估结果。在第一阶段研究结果分析后，对第二名住院医师（R2）进行 CIMT 方案培训，重点关注斑块可视化，然后在另外 10 名受试者中与专家进行比较。
在第一阶段研究中，共有 106 个图像（94%可解释）可用于 R1 和专家进行 CIMT 和斑块评估。在超声分辨率的限制内，CIMT 测量值具有生物等效性，一致性为 88%。斑块存在的变异性很高，一致性仅为 53%。R2 和专家分别对 10 名新受试者进行了两次扫描，共获得 40 个可解释的图像。R2 显示 CIMT 一致性（93%）与第一阶段观察到的一致，但斑块一致性（100%）大大提高。在第二阶段，R2 和专家的观察者内变异性均极低。
与专家相比，住院医师可以快速接受 CIMT 测量和斑块可视化培训，以检测亚临床动脉粥样硬化。
