title: Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study.
abstract: OBJECTIVE
  To evaluate the learning process for acquiring three- and four-dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions at rest, during pelvic floor muscle (PFM) contraction and on Valsalva maneuver, and for analyzing the ultrasound volumes, as well as to perform an interobserver reliability study between two independent ultrasound examiners.
  
  
  METHODS
  This was a prospective study including 22 women. We monitored the learning process of an inexperienced examiner (IE) performing 3D/4D transperineal ultrasonography and analyzing the volumes. The examination included acquiring volumes during three PFM contractions and three Valsalva maneuvers. LH dimensions were determined in the axial plane. The learning process was documented by estimating agreement between the IE and an experienced examiner (E) using the intraclass correlation coefficient. Agreement was calculated in blocks of 10 ultrasound examinations and analyzed volumes. After the learning process was complete the interobserver reliability for the technique was calculated between these two independent examiners.
  
  
  RESULTS
  For offline analysis of the first 10 ultrasound volumes obtained by E, good to very good agreement between E and IE was achieved for all LH measurements except for the left and right levator-urethra gap and pubic arc. For the next 10 analyzed volumes, agreement improved for all LH measurements. Volumes that had been obtained by IE and E were then re-evaluated by IE, and good to very good agreement was found for all LH measurements indicating consistency in volume acquisition. The interobserver reliability study showed excellent ICC values (ICC, 0.81-0.97) for all LH measurements except the pubic arc (ICC = 0.67).
  
  
  CONCLUSIONS
  3D/4D transperineal ultrasound is a reliable technique that can be learned in a short period of time.
authors.affiliation: Department of Obstetrics and Gynaecology, Akershus University Hospital, Lørenskog, Norway. franziska.richter@medisin.uio.no
authors.forename: F
authors.initials: F
authors.lastname: Siafarikas
authors.forename: J
authors.initials: J
authors.lastname: Staer-Jensen
authors.forename: I H
authors.initials: IH
authors.lastname: Braekken
authors.forename: K
authors.initials: K
authors.lastname: Bø
authors.forename: M Ellström
authors.initials: ME
authors.lastname: Engh
mesh_terms: D002983:Clinical Competence; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data*; D007858:Learning; D009119:Muscle Contraction / Q000502:physiology; D015588:Observer Variation; D017773:Pelvic Floor / Q000000981:diagnostic imaging* / Q000502:physiology; D010502:Perineum / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods / Q000706:statistics & numerical data*; D014636:Valsalva Maneuver / Q000502:physiology