KMID : 1207720210130040513
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Clinics in Orthopedic Surgery 2021 Volume.13 No. 4 p.513 ~ p.519
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Detection of Rotator Cuff Tears by Ultrasound: How Many Scans Do Novices Need to Be Competent?
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Kim Dong-Min
Seo Jae-Seong Jeon In-Ho Cho Chang-Ho Koh Kyoung-Hwan
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Abstract
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Background: Ultrasound is commonly used for evaluating rotator cuff tears. However, little training in ultrasound imaging is provided during orthopedic residents¡¯ training period. Therefore, we performed this study to determine how many ultrasound scans are required for orthopedic residents to be competent and self-confident in the diagnosis of supraspinatus tendon tears and to investigate whether senior residents outperformed junior residents.
Methods: We studied two third-year residents who had no previous experience of shoulder ultrasound and evaluated their ability to detect rotator cuff pathologies. Their learning curves were plotted using a cumulative summation analysis with a 20% acceptable failure rate compared to arthroscopic findings. Downward, upward, and horizontal cumulative summation trends indicated incompetence, exceptional competence, and competence, respectively. The diagnostic accuracy of third-year residents was compared with that of second-year residents and the number of cases required to gain self-confidence was evaluated.
Results: Cumulative summation analysis showed that after 26?28 scans, residents achieved the competence to correctly diagnose supraspinatus tears: an upward trend was observed from the beginning for full-thickness tears and a downward trend was observed for partial-thickness tears. Sensitivity and specificity were 0.95 and 0.79, respectively, for third-year residents and 0.91 and 0.58, respectively, for second-year residents. Residents reported self-confidence after 30 ultrasound scans for the detection of rotator cuff tears.
Conclusions: The number of scans that novices needed to be competent for detecting rotator cuff tears was approximately 30 cases, and the diagnostic accuracy of third-year residents was significantly higher than that of second-year residents.
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KEYWORD
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Rotator cuff injuries, Shoulder, Ultrasonography, Diagnosis, Learning curve
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