VP05.17: Learning curve for the ultrasound detection of uterosacral ligaments and torus uterinus deep endometriosis: repeatability and reproducibility study

The study objective is to evaluate how many scans are necessary for trainees with intermediate sonography experience to be proficient in diagnosing endometriosis of the uterosacral ligaments (USL), torus uterinus (TU) and pouch of Douglas (POD) obliteration with transvaginal scan following the IDEA consensus protocol (aTVS). It consists of a prospective observational study involving all women with symptoms suggestive of endometriosis, with the indication for aTVS at a specialised tertiary centre. The trainees were exposed to a protocol lecture and observed at least ten aTVS before the beginning of the study. The aTVS was performed by an experienced sonologist who has performed more than 20,000 scans, following the IDEA consensus. The same woman was scanned by one of two trainees with different levels of experience (but both competent in performing basic transvaginal scans), focusing on the sonographic identification of the uterosacral ligament as an anatomical structure and the presence of DE nodules and the SS (POD obliteration or not). The final agreement rate will be calculated via the learning curve's cumulative summation test (LC—CUSUM). Preliminary data analysis showed that identification of the USLs and similar conclusions regarding the SS was achieved immediately from the first five scans for both trainees. However, the detection of DE nodules has not reached acceptable levels. Recruitment is ongoing, and final results will be presented when the study is complete. Identification of the USLs and TU anatomical position and structures and the SS's evaluation are essential components of the IDEA protocol. Regarding the posterior compartment analysis, it can be achieved rapidly after basic TVS training background, protocol theory exposure and observation of live scans. The final number of necessary scans to achieve competency in identifying deep endometriosis will be calculated and possibly not extensive.