Currently accepted at: JMIR Medical Education
Date Submitted: Oct 29, 2025
Open Peer Review Period: Nov 3, 2025 - Dec 29, 2025
Date Accepted: Jul 1, 2026
(closed for review but you can still tweet)
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/86730
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Development and Validation of an Assessment Test for Abdominal Contrast-enhanced Ultrasound in a Large-Multicenter Cohort
ABSTRACT
Background:
An adequate amount of theoretical knowledge is a prerequisite for developing hands-on competency in contrast-enhanced ultrasound (CEUS), particularly for novices. Despite the increasing adoption CEUS for liver examinations, there is currently no standardized tool to assess the competency of trainees in terms of both theoretical knowledge and practical cognitive skills, which hinders the objective evaluation of training effectiveness.The purpose of this study is to develop and validate a CEUS competency assessment for the liver (CCAL) and address the critical gap in current training paradigms.
Objective:
To develop and validate a CEUS competency assessment for the liver (CCAL) and address the critical gap in current training paradigms.
Methods:
A four-stage process was conducted as follows: ① Item Generation: The initial items were derived from a literature review and clinical guidelines. ② Qualitative Refinement: The items underwent three rounds of Delphi expert consultation (n=21 experts) and cognitive testing (n=10 trainees) for content validity and clarity. ③ Internal Validation: Psychometric properties (reliability: Cronbach’s αand Guttman split-half; validity: exploratory factor analysis and item difficulty/discrimination) were analyzed using responses from trainees (n=100). ④ External Validation: Generalizability was assessed using data from trainees (n=579) across 25 multicenter sites.
Results:
The final CCAL was comprised of 66 items across three domains (demographics, self-evaluations, and objective questions), demonstrating high reliability (Cronbach’s α=0.916) and discriminant validity and revealing significant competency gaps in scanning procedures (65.6% pass rate) and image-guided intervention (38.3% pass rate), with objective questions showing balanced difficulty (63.2% easy and 3.5% difficult) and strong discrimination (61.4% good).
Conclusions:
The CCAL represents the first validated instrument designed for the objective assessment of operator competency in liver CEUS and thereby addresses an essential unmet need in current training paradigms. Furthermore, its implementation holds significant potential to standardize competency-based assessments and improve quality assurance protocols within hepatic imaging programs. Clinical Trial: Chinese Clinical Trial Registry; ChiCTR2000035750.
Citation
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