Healthcare E-Learning Ecosystem for the Use of Ultrasound in Interventional Procedures: Sharing the Keynotes on a Real Experience

Introduction

Medical imaging is not only a useful tool in diagnostics and interventional procedures, in fact it has become a disruptive element in Medicine. From all the kinds of imaging techniques, ultrasound (US) has a lot of advantages when it is compared to other techniques like basic radiography (X-rays), Computed Tomography (CT), Magnetic Resonance Imaging (MRI). Thus, in US imaging patients have no need for radiation exposure, US is convenient, inexpensive, and repeatable. Moreover, as it can provide dynamic and comparative images in real time, it now has a primary role in the diagnostic protocol for a wide spectrum of diseases at physical medicine and rehabilitation tasks (Özçakar et al., 2012). Ultrasound is used at a face-to-face and interactive (in situ) exploration, which allows the practitioner to use high-resolution images of human soft tissues in real time way. It can be easily performed by physicians and is readily accepted by patients as it does not cause any injuries. Another US important advantage in clinical practice comes from the fact that it is suitable for guiding diagnostic and therapeutic interventions. US could be used to aid needle positioning and to facilitate invasive procedures such as fluid aspiration, abscess drainage, tissue biopsy and local injection of therapeutic agents. Ultrasound-guided interventional procedures are especially useful when fluid concentrations are very small or when the needle trajectory can be very close to vital structures (e.g., nerves and arteries) that could be severely damaged during the procedure.

Its main limitation comes from the fact that it is highly operator dependent (Romero-Morales et al., 2020). Therefore, experience, within a typically complex training procedure, is mandatory before being able to reliably perform an imaging assessment of various pathologies or an interventional procedure. However, due to certain barriers, such as a real US device availability in most clinics and the lack of training at real health facilities, have limited its use. Originally, ultrasound scanners were expensive, difficult to move and only available to specialized medical centers. Thanks to technological advances in the electronic device miniaturization, portable scanners (Rykkje et al., 2019) have recently become available, with reduced cost and sufficient image quality. As a result, their use is spreading to all specialties, which has a particular impact on the need for training (Bhagra et al., 2016).

One of the most effective and safer strategies for medical training for the necessary skills acquisition for interventional US is given by simulation resources (Blum et al., 2009; García-Esteban et al., 2019). First, training and learning through simulators avoids causing injuries to patients when they are due to lack of experience. Other advantages are that it enables unlimited training, so it allows the construction of a wide variety of case studies where the most interesting characteristics (Moreno-Guerrero et al., 2020; Zhang et al., 2021) appear.

At the same time, for a continuous actualization, specialized training at advanced techniques and daily work must be compatible (Aljawarneh, 2020). In this way, for the last decades, distance learning has been revealed as an important tool to the knowledge transmission (Moreno-Guerrero et al., 2020) for people that cannot leave the work and aspects like high accessibility, availability, and autonomy (Ashwin & Guddeti, 2020) are significant. Supported by Web technologies, considering actual LMS (Learning Management System), the e-learning makes it possible to acquire it, in addition to self-training, a greater student participation (V. Moreno et al., 2019) at the educational process both in synchronous and asynchronous activities.