title: Learning Curve in Monitoring Magnetically Controlled Growing Rod Distractions With Ultrasound.
abstract: METHODS
  Prospective study.
  
  
  OBJECTIVE
  To determine whether a learning curve exists for ultrasound measurement of magnetically controlled growing rod (MCGR) distractions.
  
  
  BACKGROUND
  For patients managed by MCGRs, close monitoring of interval distraction length gains is important to determine whether the distractions are translating into actual spine growth. Radiographs are the criterion standard for measuring length gains, but ultrasound has been shown to be effective in monitoring distraction lengths without radiation exposure. It is, however, an operator-dependent tool and thus the accuracy of ultrasound measurement of distracted length may improve with experience.
  
  
  METHODS
  This is a prospective correlation analysis of patients who underwent MCGR treatment for scoliosis. The study period was inclusive of 19th February 2013 to 31st March 2015. All subjects were consecutively recruited in a prospective manner. Data regarding date of the distraction visit, and the interval radiograph and ultrasound measurements of the distracted lengths were collected. Only those episodes with both radiograph and ultrasound performed were used for analysis. The mean differences in change of radiograph and ultrasound measurements were plotted to determine correlation differences and to observe for a learning curve.
  
  
  RESULTS
  A total of 379 distraction episodes were analyzed. The mean differences between ultrasound and radiograph measurements per distraction episode were -0.3 mm for the right rod and -0.1 mm for the left rod. For learning curve analysis, there were three distinct timepoints in which the difference of correlation became significantly better and were described as clusters. The correlation in the first cluster (19th February 2013 to 15th October 2013) was 0.612 (right rod) and 0.795 (left rod), the second cluster (16th October 2013 to 20th May 2014) was 0.879 (right rod) and 0.918 (left rod), and the third cluster (21st May 2014 to 31st March 2015) was 0.956 (right rod) and 0.932 (left rod). Thus, a plateau was observed at the second cluster, which translated to 97 to 146 rod measurements.
  
  
  CONCLUSIONS
  Correlation between radiograph and ultrasound measurements is reasonable to begin with but improves with time. During initial use, successful distractions should correlate between the clinical feel and ultrasound confirmation. Although the absolute value may not be accurate and may require radiographs to confirm, with time and experience, ultrasound measurements can then be more reliable.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China.
authors.forename: Jason P Y
authors.initials: JPY
authors.lastname: Cheung
authors.forename: Karen K L
authors.initials: KKL
authors.lastname: Yiu
authors.forename: Cora
authors.initials: C
authors.lastname: Bow
authors.forename: Prudence W H
authors.initials: PWH
authors.lastname: Cheung
authors.forename: Dino
authors.initials: D
authors.lastname: Samartzis
authors.forename: Kenneth M C
authors.initials: KMC
authors.lastname: Cheung
mesh_terms: D006801:Humans; D059032:Learning Curve; D059346:Magnets; D019857:Osteogenesis, Distraction / Q000379:methods*; D011446:Prospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography / Q000379:methods*