A preceptorship programme to learn ultrasonography for diagnosis of giant cell arteritis

Ultrasonography has been proposed as the initial diagnostic modality in suspected giant cell arteritis. Proposed quality standards advocate for a certified sonographer. Currently, there are no formal training programmes, and single educational events do not suffice as certification. We developed a preceptorship programme for diagnostic ultrasonography. Here, we describe its contents and test its efficacy.

The programme comprises three stages. The preclinical stage includes machine setting and surface anatomy. Second stage includes supervised assessment, passed via a directly observed procedure form. In the final validation stage, the trainee and trainer perform an ultrasonography examination in succession, with a comparison of the results. For this programme, a scan included all three segments of the superficial temporal artery and all three parts of the axillary arteries. Comparison of the intima-media thickness (IMT) and categorical judgements for the halo sign and final diagnosis were made.

Six trainees have been through this programme so far. A median of 16 ultrasonography examinations was required to reach the validation stage. The mean ± SD IMT in 360 segments, as measured by the trainee and trainer, was 0.45 ± 0.34 and 0.46 ± 0.35, respectively (p = 0.26). The agreement between trainee and trainer for the presence or absence of halo was excellent in 403 segments (κ = 0.91, 95% confidence interval 0.86, 0.96). There was 100% agreement on the final diagnosis.

The integration of technical knowledge with practical skills results in a robust training programme, validating trainees to continue scanning independently.