Four Chamber Normative Data for Computed Tomography Angiography in the Axial Plane

Background: Computed Tomography Angiography (CTA) is a new and promising type of imaging to evaluate cardiac structure and function. Although it does require injection of contrast material and some radiation exposure, it is much less invasive than conventional catheter based on angiography. It has been already shown to correlate well with echocardiography images, but normative values have yet to be established. Objectives: To publish the first known data on CTA measurements for all four chambers of the heart. Methods: We conducted a retrospective chart review study of around 3000 patients over a three-year period (2006-2008) from a private cardiology practice in Phoenix, Arizona. Patients were screened for any preexisting conditions that might contribute to abnormal cardiac structures. A “normal” population of 226 patients’ CTA’s was reviewed and 29 different measurements were taken cardiac anatomy. Patients were then categorized based on sex and BMI and the cardiac measurements were compared. Results: The values obtained were similar to already established normal measurement values from echocardiography. There was good correlation between body mass index (BMI) and the sexes. Conclusion: This study serves to establish normative data for cardiac CTA while also proves to show good correlation with already established normative values for echocardiography and justifies these CTA measurements as an alternative means of cardiac evaluation. Further study regarding the variations between data for specific measurements will be addressed in future studies.

Simulation training in contemporary obstetrics education

AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year(PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard's simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort's mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to thebaseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7(SD = 3.14) vs 7.9(SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6(SD = 5.5, 95%CI: 2.21-7.07), 4.4(SD = 5.2, 95%CI: 2.13-6.70), and 5.6(SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5(SD = 2.27, 95%CI: 2.13-5.00), 7.25(SD = 6.70, 95%CI: 1.50-13.00), 10.75(SD = 1.5, 95%CI: 9.50-12.00), 12.17(SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75(SD = 1.49, 95%CI: 12.75-14.63), 10.25(SD = 0.24, 95%CI: 4.25-14.00), 15.00(SD = 1.16, 95%CI: 14.00-16.00), 15.17(SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.