Search pattern training for evaluation of central venous catheter positioning on chest radiographs

Abstract

The goal of this research was to examine whether search pattern training for central line positioning on chest radiographs (CXRs) improves the ability of healthcare trainees and practitioners to identify malpositioned central venous catheters. Two sets of CXRs with central catheters were shown; half of the images contained catheters that were appropriately positioned, half that were malpositioned. Subjects were asked to: mark the tip of the catheter using the simulated radiology workstations, indicate their confidence in tip localization, and state whether the catheter was appropriately positioned or malpositioned. Subjects were also given a survey assessing their thoughts about the usefulness of search pattern training and the simulated radiology workstation. There was a significant improvement in subjects' ability to classify a catheter as malpositioned after training, [Formula: see text]-value = 0.03. There was no significant difference in localization of the catheter tips or in the confidence for tip localization. Subjects' responses to the questionnaire were significantly positive for all statements, indicating that they felt search pattern training using a simulated radiology workstation had a positive impact on their education. These results suggest that our knowledge of medical image perception may be useful for developing rational educational tools for image interpretation, and that simulated radiology workstations may be a helpful means of deploying these tools.

Keywords: education; imaging; perception; radiology; training.

Fig. 1

Search pattern used to improve nodule identification. This lung search pattern instructs the observer to sweep their eyes over each intercostal space, thereby ensuring that the entire lungs were evaluated by the observer’s central field-of-view.

Fig. 2

Experimental design using counterbalancing. CS, case set; intervention, experimental intervention, which is either: SPT, search pattern training for CVC positioning, or Attn Ctrl, attentional control.

Fig. 3

Suggested search pattern for CVC evaluation (dashed white arrow). This case shows a patient with a left chest port. Suggested search pattern: (1) Identify peripheral most aspect of catheter. (2) Follow catheter course and confirm it corresponds to normal venous anatomy. (3) Confirm the catheter tip is in an acceptable position.

Fig. 4

Histograms of responses to questionnaire. Q# designates questionnaire statement #. Responses requested in the form of a five-point Likert response format—1 = strongly disagree to 5 = strongly agree, and a response of 3 is neutral.