Hower Kimberly, Young Clipper F, Wagner Alesia, Thorsen Dean, Dugan Joy
J Am Osteopath Assoc. 2019 May 1;119(5):e19-e24. doi: 10.7556/jaoa.2019.056.
The US Preventive Services Task Force (USPSTF) recommends a 1-time ultrasonography (US) screening for abdominal aortic aneurysm (AAA) to reduce AAA-specific mortality in men aged 65 to 75 years who have ever smoked. A 2015 study concluded that less than 50% of at-risk primary care patients are screened for AAA. To increase screening rates, it would be beneficial to train other health care professionals in accurately measuring abdominal aortic dimensions.
To determine whether osteopathic medical students can use handheld US machines to measure abdominal aortic diameters as accurately as an experienced US technologist.
Three osteopathic medical students underwent 8 hours of US training with a board-certified radiologist to measure abdominal aortic dimensions using a handheld US device. After the training, students independently conducted AAA US screenings at a clinic on participants meeting USPSTF AAA screening criteria. Transverse and anteroposterior measurements were taken at 3 sites: celiac axis, inferior to the renal arteries, and superior to the iliac bifurcation. A US technologist then measured the participants' aortic diameters in the radiology department at another facility. The measurements from both reports were then compared using a 2-sample t test.
The aortic diameter was measured in 16 participants with a mean (SD) body mass index of 26.7 (3.6). The mean (SD) difference between novice and expert measurement of the abdominal aorta was -0.15 (0.23) cm. No statistically significant difference was found between the US measurements completed by students and a US technologist (t=-1.38, P=.09). None of the participants met the criteria for AAA (>3.0 cm), with the largest abdominal aorta scanned by experts measuring 2.86 cm.
When properly trained, osteopathic medical students can accurately measure abdominal aortic diameters using a handheld US device. Training more medical students in ultrasonography would offer increased screening opportunities and possibly reduce AAA-related mortality. Further studies are needed to assess the ability of osteopathic medical students to accurately measure AAAs, as no participants in this study met the criteria for AAA.
美国预防服务工作组（USPSTF）建议对65至75岁有吸烟史的男性进行一次腹部主动脉瘤（AAA）超声检查，以降低AAA特异性死亡率。2015年的一项研究得出结论，不到50%的高危初级保健患者接受了AAA筛查。为了提高筛查率，培训其他医疗保健专业人员准确测量腹主动脉尺寸将是有益的。
确定整骨医学学生是否能像经验丰富的超声技师一样，使用手持式超声机器准确测量腹主动脉直径。
三名整骨医学学生与一名获得委员会认证的放射科医生一起接受了8小时的超声培训，使用手持式超声设备测量腹主动脉尺寸。培训后，学生们在诊所对符合USPSTF AAA筛查标准的参与者独立进行AAA超声筛查。在三个部位进行横向和前后径测量：腹腔干、肾动脉下方和髂总动脉分叉上方。然后，一名超声技师在另一家机构的放射科测量参与者的主动脉直径。然后使用双样本t检验比较两份报告中的测量结果。
对16名参与者进行了主动脉直径测量，平均（标准差）体重指数为26.7（3.6）。新手与专家对腹主动脉测量的平均（标准差）差异为-0.15（0.23）cm。学生完成的超声测量与超声技师的测量之间未发现统计学上的显著差异（t=-1.38，P=0.09）。没有参与者符合AAA标准（>3.0 cm），专家扫描的最大腹主动脉为2.86 cm。
经过适当培训后，整骨医学学生可以使用手持式超声设备准确测量腹主动脉直径。培训更多医学生进行超声检查将提供更多的筛查机会，并可能降低与AAA相关的死亡率。由于本研究中没有参与者符合AAA标准，因此需要进一步研究来评估整骨医学学生准确测量AAA的能力。
