AB1557 ULTRASOUND LEARNING CURVE IN INTERSTITIAL LUNG DISEASE OF AUTOIMMUNE RHEUMATIC DISORDERS: A DISEASE ORIENTED TRAINING PROGRAM

Abstract

Background: Ultrasound (US) has elicited considerable interest among rheumatologists because of its usefulness in clinical practice. Recently, it has been demonstrated its ability to assess interstitial lung disease (ILD) in rheumatic patients. While a solid and still growing body of evidence supports its use in daily rheumatologic practice, operator dependency and the long learning curve represent the main limitations. Objectives: To describe the learning curve of rheumatologists with limited experience using US attending an intensive disease-oriented training program focusing on the skills required to obtain and interpret US signs of ILD in patients with autoimmune rheumatic diseases. Methods: A total of 5 investigators participated in a seven-day training program involving 15 patients with autoimmune rheumatic diseases. The expert sonographer was a Rheumatologist with >15 years of US experience, whose assessments were used as the gold standard to evaluate the US findings obtained by the remaining 4 investigators. Two beginner sonographers were fellows in rheumatology with 5 months of global US experience, whereas the other 2 beginner sonographers were fellows in rehabilitation and rheumatology with a very basic knowledge of musculoskeletal US (<3 months) and no direct US experience in ILD. The training program lasted for 7 days (at least 5 hours per day) following specific aims and activities for each day during the training program. The agreement between the expert and beginners was calculated in 4 sessions involving 15 patients (13 females and 2 males; 4 rheumatoid arthritis, 6 systemic sclerosis, 3 Sjogren syndrome, 2 dermatomyositis). The US assessment was performed according the previously proposed 14-intercostal spaces (IS) scanning protocol using the following semiquantitative scale [0 = normal (≤5 B-lines); 1 = slight (≥6 and ≤15 B-lines); 2 = moderate, (≤16 and ≥30 B-lines); 3 = severe (≥30 B-lines)] [1]. Additionally the pleural irregularity in each IS was dichotomously recorded. Results: A total of 210 lung IS were studied. Kappa values and overall agreement percentages of qualitative and dichotomist assessments of US ILD findings (B-lines and pleural irregularity) at the end of the exercise showed moderate to excellent agreement (between 0.769 and 0.895), while in the first session they showed poor/fair agreement (between 0.325 and 0.435). The comparison between the expert (gold standard) and beginners' examinations at the fourth and final session, including the kappa values, sensitivity, specificity, and negative and positive predictive value were also improved. Conclusion: After 1 week of the disease-oriented training program, physicians with limited experience in US were satisfactorily able to detect and interpret the main US signs indicative of ILD in patients with autoimmune rheumatic diseases.