Ultrasound simulators: experience with the SonoTrainer and comparative review of other training systems

Ultrasound has become indispensable in prenatal diagnosis. Ultrasound training, however, still lacks proper quality assessment and control. Moreover, most fetal anomalies which must be diagnosed during pregnancy are extremely rare. Ultrasound simulators could provide an opportunity to overcome this dilemma. This review summarizes the potential benefits of simulator‐based ultrasound training, briefly describes the properties of a variety of ultrasound simulators that have been developed for various applications including prenatal diagnosis, and presents the SonoTrainer sonography simulation system which makes it possible to run a real‐time simulation of a complete prenatal ultrasound examination. We evaluated the system for the training of first‐ and second‐trimester screening for both normal and pathological findings and found that physicians who received theoretical training and were additionally trained with the simulator (T + S) significantly improved their skills in measurements of nuchal translucency thickness (NT) and crown–rump length (CRL) as compared with colleagues who only underwent theoretical instruction (T) [mean ± SD NT deviation: 0.31 ± 0.1 mm (T + S) vs. 0.62 ± 0.2 mm (T), P < 0.05; mean ± SD CRL deviation: 1.48 ± 2.0 mm (T + S) vs. 3.27 ± 2.5 (T), P < 0.05]. Simulator‐based training enabled physicians to diagnose rare fetal anomalies in the second trimester with a sensitivity of 86% and a specificity of 100%. In a study in which second‐trimester scans including fetal anomalies were presented to physicians, 96% of the participants subjectively estimated their training effect as being good. We therefore conclude that simulator‐based training would provide an ideal educational tool to test, improve and monitor a physician's or technician's ultrasound skills in detecting fetal anomalies. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

[1]  P. Defoort,et al.  End‐result of routine ultrasound screening for congenital anomalies: The Belgian Multicentric Study 1984–92 , 1995, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[2]  T. Selden,et al.  How would mental health parity affect the marginal price of care? , 2001, Health services research.

[3]  M M Knudson,et al.  Training residents using simulation technology: experience with ultrasound for trauma. , 2000, The Journal of trauma.

[4]  C Kaufmann,et al.  Trauma training: virtual reality applications. , 2001, Studies in health technology and informatics.

[5]  Joni K. Evans,et al.  A randomized trial of prenatal ultrasonographic screening: impact on the detection, management, and outcome of anomalous fetuses. The RADIUS Study Group. , 1994, American journal of obstetrics and gynecology.

[6]  J Stallkamp,et al.  UltraTrainer--a training system for medical ultrasound examination. , 1998, Studies in health technology and informatics.

[7]  S. Cnattingius,et al.  Second trimester ultrasound screening performed by midwives; sensitivity for detection of fetal anomalies , 1999, Acta obstetricia et gynecologica Scandinavica.

[8]  C. Sohn,et al.  DIE DREIDIMENSIONALE ULTRASCHALLDIAGNOSTIK IN GYNAKOLOGIE UND GEBURTSHILFE , 1991 .

[9]  Michael L. LeFevre,et al.  Effect of Prenatal Ultrasound Screening on Perinatal Outcome , 1993, The New England journal of medicine.

[10]  P M Bossuyt,et al.  Intra‐ and interoperator repeatability of the nuchal translucency measurement , 2000, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[11]  J. Bofill,et al.  Obstetric sonography. Who to scan, when to scan, and by whom. , 1998, Obstetrics and gynecology clinics of North America.

[12]  H Reindell,et al.  Simulation of abdomen sonography. Evaluation of a new ultrasound simulator. , 2003, Ultraschall in der Medizin.

[13]  P. Ylöstalo,et al.  Ultrasound Screening and Perinatal Mortality: Controlled Trial of Systematic One-stage Screening in Pregnancy The Helsinki Ultrasound Trial , 1991 .

[14]  O. Heinonen,et al.  Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy , 1990, The Lancet.

[15]  Effect of prenatal ultrasound screening on perinatal outcome. RADIUS Study Group. , 1993, The New England journal of medicine.

[16]  B. Thilaganathan,et al.  Nuchal translucency thickness measurement: repeatability using a virtual ultrasound scanner , 2003, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[17]  J Troccaz,et al.  Virtual echography. The simulation of ultrasonographic examination. , 1996, Studies in health technology and informatics.

[18]  H. Schwid,et al.  Evaluation of Anesthesia Residents Using Mannequin-based Simulation: A Multiinstitutional Study , 2002, Anesthesiology.

[19]  Christoph Wick,et al.  Augmented Reality Simulator for Training in Two-Dimensional Echocardiography , 2000, Comput. Biomed. Res..

[20]  D. Altman,et al.  Repeatability of measurement of fetal nuchal translucency thickness , 1995, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[21]  A. Rule,et al.  Nurse anesthesia students' perceptions of the anesthesia patient simulator: a qualitative study. , 2002, AANA journal.

[22]  C Wick,et al.  [Augmented reality in echocardiography. A new method of computer-assisted training and image processing using virtual and real three-dimensional data sets]. , 2000, Zeitschrift fur Kardiologie.

[23]  H H Ehricke SONOSim3D: a multimedia system for sonography simulation and education with an extensible case database. , 1998, European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology.

[24]  J F Smith,et al.  A SIMPLE MODEL FOR LEARNING STEREOTACTIC SKILLS IN ULTRASOUND‐GUIDED AMNIOCENTESIS , 1998, Obstetrics and gynecology.

[25]  C Sohn,et al.  [New ultrasound simulation system: a method for training and improved quality management in ultrasound examination]. , 2001, Zeitschrift fur Geburtshilfe und Neonatologie.

[26]  M. Weidenbach,et al.  Augmented Reality in der Echokardiograpie – Eine neue Methode der computergestützten Ausbildung und Bildbearbeitung durch virtuelle und reale dreidimensionale Datensätze , 2000, Zeitschrift für Kardiologie.

[27]  D. K. Kim,et al.  Effectiveness of prenatal ultrasonography in detecting fetal anomalies and perinatal outcome of anomalous fetuses. , 1998, Yonsei medical journal.

[28]  T. Fox,et al.  Szenische Enablingsysteme - Trainingsumgebungen in der Echokardiographie , 1995 .

[29]  G Meller,et al.  The tradeoffs of successful simulation. , 1997, Studies in health technology and informatics.