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Introduction: Dysfunction of the diaphragm may ultimately lead to respiratory insufficiency and compromise patient outcome. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been the gold standard to measure diaphragmatic excursion. Ultrasonography can visualize diaphragm excursion and holds many advantages such as no radiation exposure, increased portability and accessibility. However, correlation between fluoroscopy and ultrasonography has never been studied. We aimed to compare fluoroscopic and ultrasound measures of diaphragm excursion to determine if ultrasonography can replace fluoroscopy. Methods: We performed ultrasound and fluoroscopy simultaneously during sniff inspiration and at total inspiratory capacity in patients with chronic obstructive pulmonary disease, heart failure and in healthy volunteers. Cranio-caudal excursion was measured by fluoroscopy and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasonography. Results: Forty-two participants were included. The Pearson correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76–1.04) in a regression analysis. Using the Bland–Altman method, the bias was − 0.39 cm (95% CI − 1.04–0.26), p = 0.24. The Pearson correlation between fluoroscopy and B-mode and area change ultrasonography was high; low for thickness and fraction. All correlations were lower during sniff inspiration compared with inspiratory capacity breathing. Conclusion: Ultrasonography has an acceptable correlation and bias compared to fluoroscopy and can thus be used as the primary tool to evaluate diaphragm excursion. [ABSTRACT FROM AUTHOR]

Introduction: As ultrasound becomes more accessible, the use of point-of-care ultrasound examinations performed by clinicians has increased. Sufficient theoretical and practical skills are prerequisites to integrate thoracic ultrasound into a clinical setting and to use it as supplement in the clinical decision-making. Recommendations on how to educate and train clinicians for these ultrasound examinations are debated, and simulation-based training may improve clinical performance. Objectives: The aim of this study was to explore the effect of simulation-based training in thoracic ultrasound compared to training on healthy volunteers. Method: A total of 66 physicians with no previous experience in thoracic ultrasound completed a training program and assessment of competences from November 2018 to May 2019. After a theoretical session in ultrasound physics, sonoanatomy, and thoracic ultrasound, the physicians were randomized into one of three groups for practical training: (1) simulation-based training, (2) training on a healthy volunteer, or (3) no training (control group). Primary outcome was difference in the clinical performance score after the training period. Results: Using a multiple comparison, ANOVA with Bonferroni correction for multiplicity, there was no statistical significant difference between the two trained groups' performance score: 45.1 points versus 41.9 points (minimum 17 points, maximum 68 points; p = 0.38). The simulation-based training group scored significantly higher than the control group without hands-on training, 36.7 points (p = 0.009). Conclusions: The use of simulation-based training in thoracic ultrasound does not improve the clinical performance score compared to conventional training on healthy volunteers. As focused, thoracic ultrasound is a relatively uncomplicated practical procedure when taught; focus should mainly be on the theoretical part and the supervised clinical training in a curriculum. However, simulation can be used instead or as an add-on to training on simulated patients. [ABSTRACT FROM AUTHOR]

Rationale: Point-of-care lung ultrasound imaging has substantial diagnostic value and is widely used in respiratory, emergency, and critical care medicine. Like other ultrasound examinations, lung ultrasound is operator dependent. The current recommendations for competence in lung ultrasound set a fixed number of ultrasound procedures to be performed without considering different learning rates. Recommendations do not consider different uses of lung ultrasound across specialties.Objectives: To create a reliable, valid, and feasible instrument to assess lung ultrasound competence that includes the diverse use of lung ultrasound among medical specialties.Methods: A Delphi consensus survey was undertaken with participation of 11 experts from four different specialties to design an objective and structured assessment ultrasound tool. The construct validity of the assessment tool was examined by scoring 23 ultrasound operators of different competence levels. Examination time was measured and skill level rated by experienced observers using the assessment tool. Interrater agreement was examined by two observers in nine lung ultrasound examinations.Results: Consensus was obtained within three Delphi rounds. Five elements were excluded. Two new elements were proposed, and one gained consensus. Two elements were rephrased. We found that the lung ultrasound competence evaluation tool could differentiate between levels of competence (P < 0.001). Examination time differed significantly between experts and intermediate operators (P = 0.005), but not between novices and intermediate operators (P = 0.06). The assessment tool had good interrater agreement (Pearson's r = 0.85; P < 0.005).Conclusions: This assessment tool provides a relevant, valid, and feasible method for evaluation of operator competence in point-of-care lung ultrasound across multiple specialties. This allows for a more individualized assessment of competence than current recommendations. [ABSTRACT FROM AUTHOR]

Background: Ultrasound can be used to assess diaphragm movement. Existing methods focus on movement at a single point at the hemidiaphragm and may not consider the anatomic and functional complexity. We aimed to develop an ultrasound method, the Area method, to assess movement of the entire hemidiaphragm dome and to compare it with existing methods to evaluate accuracy, inter-rater agreement, and feasibility.Methods: Movement of the diaphragm was evaluated by ultrasonography in 19 healthy subjects and correlated with simultaneously performed spirometry. Two existing methods, the M-mode excursion at the posterior part of diaphragm and the B-mode at the top of the diaphragm, were compared with the Area method. Two independent raters reviewed film clips to analyze inter-rater agreement. Feasibility was tested by novice ultrasound operators.Results: Correlation with expired lung volume was higher with the Area method, 0.88 (95% CI 0.81-0.95), p < 0.001, and with the M-mode measurement, 0.84 (95% CI 0.75-0.92), p < 0.001, than with the B-mode measurement, 0.71 (95% CI 0.59-0.83), p < 0.001. Inter-rater agreement was highest with the Area method, 0.9, p < 0.001, and M-mode measurement 0.9, p < 0.001, and lower with the B-mode measurement, 0.8, p < 0.001. The M-mode measurement could be done in only 20% at the left side. The Area method could be performed in all participants at both hemidiaphragms, and novice operators found it easy to perform.Conclusion: A new method to evaluate diaphragm movement is introduced. Accuracy and inter-rater agreement are high. The Area method is equally feasible at both hemidiaphragms in contrast to existing methods. However, additional studies should include more participants, different types of pulmonary diseases, and investigate the role of patient position to validate the Area method fully. [ABSTRACT FROM AUTHOR]