{"paper_id":"448002b2-e518-4faf-a797-15b0839ea485","body_text":"Importância do treinamento e capacitação de radiologistas no mapeamento de endometriose por RM com protocolo específico e melhora do desempenho com uso de gel vaginal e retal\nArquivos\nData\nTipo\nTítulo da Revista\nISSN da Revista\nTítulo de Volume\nResumo\nObjetivos: Avaliar o desempenho de radiologistas após o treinamento com cinco mil exames de ressonância magnética de pelve com preparo intestinal (RM-PI) ao longo de 12 meses para a especialização em diagnóstico por imagem da endometriose. Investigar a acurácia do uso de gel vaginal e retal na RM-PI no diagnóstico da endometriose, analisando se esse protocolo facilita o mapeamento.\nMétodos: Estudo educacional, multicêntrico, utilizando modelo de treinamento baseado em metodologia ativa com cenários práticos de casos clínicos reais. A equipe foi composta por três trainees e dois especialistas japoneses, que receberam um léxico explicativo para padronizar os achados. Foram selecionados 29 casos de RM-PI com e sem protocolo com gel vaginal e retal, com confirmação por laparoscopia. A média de idade das pacientes foi de 35,6 ± 6,9 anos e a média do intervalo entre a realização das RM-PI foi de 21,8 ± 28,7 dias. Todos os casos foram anonimizados, codificados, randomizados e disponibilizados para visualização no repositório institucional. Os trainees realizaram três leituras de modo cego: uma antes do início do treinamento (avaliação pré-teste), a segunda no final do treinamento (protocolo sem gel), e a terceira, seis meses após o treinamento (avaliação pós-teste), repetiu os mesmos casos da primeira (protocolo com gel). Os especialistas japoneses realizaram duas leituras de modo cego em único momento (protocolo com e sem gel). Foram avaliadas a acurácia e a precisão das leituras pré-teste e pós-teste e das leituras dos protocolos com e sem gel retal e vaginal.\nResultados: Os sítios de endometriose mais frequentes foram os ligamentos uterossacros (89,7%), espaço retrocervical (86,2%) e espaço paracervical (82,8%). A maior taxa de melhora no desempenho dos trainees foi na avaliação do intestino, no segmento retossigmoide (35.5%, 37.3%, p<0.001). A utilização do gel retal e vaginal melhorou o mapeamento dos espaços retrocervical (16.4%, p=0.013) e retrovaginal (26.1%, p<0.001), endometriomas (18.7%, p=0.001) e intestinos reto (12.4%, p=0.037) e sigmoide (16.6%, p=0.008) para os trainees, e melhorou o mapeamento da bexiga (21.5%, p=0.009), espaço paracervical (18.9%, p=0.042) e serosa de útero (23.1%, p=0.011) para os especialistas japoneses. O protocolo com utilização de contraste retal e vaginal melhorou a acurácia e a precisão das leituras dos trainees e dos seniores. Na avaliação do treinamento, a taxa de melhora na acurácia das leituras pós-teste foi de 27.0%, 11.1% e 15.1% para os trainees 1, 2 e 3, respectivamente, e a taxa de melhora na precisão das leituras pós-teste foi de 60.7%, 24.0% e 26.2%.\nConclusão: Houve melhora no desempenho dos radiologistas após o treinamento com cinco mil exames de RM-PI ao longo de 12 meses, com taxa de até 15% para radiologistas especialistas em medicina interna e 27% para radiologista recém-formado. O uso do protocolo de RM-PI com administração de gel vaginal e retal facilita o mapeamento da endometriose, em particular, nos sítios paracervicais, retrocervical, retrovaginal.\nObjectives: To assess radiologists’ diagnostic performance following training with five thousand pelvic magnetic resonance imaging with bowel preparation (MRI-BP) exams over 12 months for specialization in imaging-based endometriosis diagnosis. Additionally, to examine the diagnostic accuracy of vaginal and rectal gel application in MRI-BP for detecting endometriotic lesions and evaluate whether this protocol enhances lesion mapping. Methods: This educational, multicenter study employed an active learning model with real-case clinical scenarios. The team included three trainees and two experienced Japanese specialists, each provided with a lexicon for standardized reporting of imaging findings. Twenty-nine MRI-BP cases, with and without the vaginal and rectal gel protocol and laparoscopic confirmation, were selected. Patients had a mean age of 35.6 ± 6.9 years, and the average interval between MRI-BP exams was 21.8 ± 28.7 days. Cases were anonymized, coded, randomized, and stored in an institutional repository for blinded review. Trainees conducted three blind readings: a baseline assessment (pre-test), a second at training completion (protocol without gel), and a third six months post-training (post-test), re-evaluating initial cases (protocol with gel). Japanese specialists completed two blinded readings in a single session (protocol with and without gel). Pre- and post-test accuracy and precision, as well as readings for protocols with and without rectal and vaginal gel, were analyzed. Results: The most frequently identified endometriotic sites were the uterosacral ligaments (89.7%), retrocervical space (86.2%), and paracervical space (82.8%). The largest improvement in trainees’ diagnostic accuracy occurred in bowel evaluation, particularly in the rectosigmoid segment (35.5%, 37.3%, p<0.001). The use of vaginal and rectal gel improved mapping in the retrocervical (16.4%, p=0.013) and retrovaginal spaces (26.1%, p<0.001), endometriomas (18.7%, p=0.001), and the rectum (12.4%, p=0.037) and sigmoid colon (16.6%, p=0.008) for trainees, as well as mapping of the bladder (21.5%, p=0.009), paracervical space (18.9%, p=0.042), and uterine serosa (23.1%, p=0.011) for specialists. The protocol incorporating vaginal and rectal gel enhanced both diagnostic accuracy and precision for trainees and specialists. Post-test reading accuracy improved by 27.0%, 11.1%, and 15.1% for trainees 1, 2, and 3, respectively, with precision gains of 60.7%, 24.0%, and 26.2%. Conclusion: Radiologists’ diagnostic accuracy improved significantly following training with five thousand MRI-BP exams over 12 months, with gains of up to 15% for experienced radiologists and 27% for recent graduates. The MRI-BP protocol with vaginal and rectal gel enhances lesion mapping for endometriosis, particularly in the paracervical, retrocervical, and retrovaginal spaces, bowel (rectum and sigmoid colon), bladder, posterior uterine wall, and endometriomas.\nObjectives: To assess radiologists’ diagnostic performance following training with five thousand pelvic magnetic resonance imaging with bowel preparation (MRI-BP) exams over 12 months for specialization in imaging-based endometriosis diagnosis. Additionally, to examine the diagnostic accuracy of vaginal and rectal gel application in MRI-BP for detecting endometriotic lesions and evaluate whether this protocol enhances lesion mapping. Methods: This educational, multicenter study employed an active learning model with real-case clinical scenarios. The team included three trainees and two experienced Japanese specialists, each provided with a lexicon for standardized reporting of imaging findings. Twenty-nine MRI-BP cases, with and without the vaginal and rectal gel protocol and laparoscopic confirmation, were selected. Patients had a mean age of 35.6 ± 6.9 years, and the average interval between MRI-BP exams was 21.8 ± 28.7 days. Cases were anonymized, coded, randomized, and stored in an institutional repository for blinded review. Trainees conducted three blind readings: a baseline assessment (pre-test), a second at training completion (protocol without gel), and a third six months post-training (post-test), re-evaluating initial cases (protocol with gel). Japanese specialists completed two blinded readings in a single session (protocol with and without gel). Pre- and post-test accuracy and precision, as well as readings for protocols with and without rectal and vaginal gel, were analyzed. Results: The most frequently identified endometriotic sites were the uterosacral ligaments (89.7%), retrocervical space (86.2%), and paracervical space (82.8%). The largest improvement in trainees’ diagnostic accuracy occurred in bowel evaluation, particularly in the rectosigmoid segment (35.5%, 37.3%, p<0.001). The use of vaginal and rectal gel improved mapping in the retrocervical (16.4%, p=0.013) and retrovaginal spaces (26.1%, p<0.001), endometriomas (18.7%, p=0.001), and the rectum (12.4%, p=0.037) and sigmoid colon (16.6%, p=0.008) for trainees, as well as mapping of the bladder (21.5%, p=0.009), paracervical space (18.9%, p=0.042), and uterine serosa (23.1%, p=0.011) for specialists. The protocol incorporating vaginal and rectal gel enhanced both diagnostic accuracy and precision for trainees and specialists. Post-test reading accuracy improved by 27.0%, 11.1%, and 15.1% for trainees 1, 2, and 3, respectively, with precision gains of 60.7%, 24.0%, and 26.2%. Conclusion: Radiologists’ diagnostic accuracy improved significantly following training with five thousand MRI-BP exams over 12 months, with gains of up to 15% for experienced radiologists and 27% for recent graduates. The MRI-BP protocol with vaginal and rectal gel enhances lesion mapping for endometriosis, particularly in the paracervical, retrocervical, and retrovaginal spaces, bowel (rectum and sigmoid colon), bladder, posterior uterine wall, and endometriomas.\nDescrição\nCitação\nPAIVA, Lara Sá de. Importância do treinamento e capacitação de radiologistas no mapeamento de endometriose por RM com protocolo específico e melhora do desempenho com uso de gel vaginal e retal. 2024. 52 f. Tese (Doutorado em Radiologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo. 2024.","source_license":"CC0","license_restricted":false}