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Ultrasound Phantoms in 3-dimensional endovaginal and endoanal pelvic floor imaging: A step forward in teaching hands-on pelvic floor imaging to a large group of participants.

Study design, materials and methods Four ultrasound phantoms were created each with a specific function. The phantoms simulated 1) Anterior, 2) Posterior (Figure 1), 3) Levator ani, and 4) Endoanal compartments. A 40 question internet based interactive test using ultrasound images simulating normal anatomy (Figure 2) from the phantoms was administered to six 3D ultrasound imaging experts (2 UROGYN, 2 radiologists, one sonographer, and one colorectal). For each of four phantoms, the accuracy of the model was calculated by taking the correct answers by all readers and dividing them by total number of questions. For each question >67% (4/6 readers) agreement amongst experts was deemed as successful simulation of normal anatomy. The phantom specific agreement was calculated by dividing the total number of agreements by total number of questions for each phantom. Interclass coefficient was determined to assure consistency amongst readers. A full day structured course was given to 32 course participants. The course involved pelvic anatomy and ultrasound imaging lectures. The participants rotated through 10 stations, four of which were hands-on ultrasound stations utilizing phantoms, four of which were computer stations demonstrating normal 3D ultrasound anatomy in Anterior, Posterior, Levator ani, and Endoanal compartments as shown in the phantoms. The two remaining computer stations demonstrated 3D ultrasound endoanal and endovaginal pathology. A pre and post-test was administered to the participants. The test included 40 questions pertaining to four compartments tested in the phantoms, and 20 additional questions that pertained to endoanal and endovaginal pathology. Student t test was used to compare pre and post test responses. A p of 0.05 was deemed as significant.