P050 A training programme for ultrasonography for the diagnosis of giant cell arteritis

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Abstract Background/Aims Ultrasonography (US) has become the modality of choice for the diagnosis of giant cell arteritis (GCA). There is no formal training for this skill and it is not on the rheumatology training curriculum. The fleeting exposure at the few available courses is not sufficient to allow one to become a service provider. We share the results of an intensive training package developed in our centre. Methods The training package consists of the following stages - 1. Pre-clinical training consisting of surface anatomy, ergonomics of US, understanding of settings and being able to setup the machine without use of presets; 2. Supervised scanning using a directly observed procedure (DOPs) checklist with 17 items; 3. Independent scanning of minimum 10 hot cases. At each scan, the trainee records intima-media thickness in 3 segments of each superficial temporal (STA) and axillary artery (AX), interprets it to be a halo/no halo, concludes whether it is GCA or not GCA. Each patient is then rescanned by a validated sonographer (CBM). The intima-media thickness (IMT) at the 12 segments is compared using the Wilcoxon Signed Rank Test. The halo/no halo decisions are compared using kappa. The GCA/no GCA decisions were compared. Progress through training was only possible with successful completion of previous stage. We used the GE Logiq e and GE Logiq P9 machines with a 10-22 MHz linear probe OR 4-12 MHz linear probe. Results 4 trainees have completed the package (2 higher specialty trainees, 1 specialist nurse and 1 rheumatology consultant). No patient was scanned by more than 1 trainee. We were not routinely recording IMT for trainee 1. 360 individual IMTs were recorded by trainee and trainer. The trainees median IMTs (IQR) were 0.18 (0.07) mm and 0.61 (0.35) mm for the STA and AX respectively. The trainers median IMTs (IQR) were 0.18 (0.08) mm and 0.59 (0.38) mm for the STA and AX respectively (p = 0.687, and p = 0.315 respectively - Wilcoxon Signed Rank Test). Of the 504 halo/no halo assessments, there was agreement on 93 halos and 398 no halos. The kappa was 0.92 (95% CI 0.88, 0.96). There was 100% agreement on GCA/no GCA decisions - 14 had GCA and 28 did not. No trainee had an individual kappa <0.89 when compared to the trainer. Conclusion We present the first training package which has strong components of education, supervision and validation. The multi-faceted validation proves the value of the package. Each trainee is competent to work without presets, has an understanding of the clinical aspects of GCA, the physics of US and has an excellent outcome when their results are compared to the trainer. The training package provides confidence from getting the diagnosis right down to the individual IMT measurement. Disclosure C.B. Mukhtyar: None. F.L. Coath: None. G. Ducker: None. H. Naeem: None. S. Fordham: None.