Prospective randomized evaluation of the sustained impact of assistive artificial intelligence on anesthetists’ ultrasound scanning for regional anesthesia

• Published in: BMJ surgery, interventions, & health technologies interventions, & health technologies, 2024-10, Vol.6 (1), p.e000264
• Main Authors: Kowa, Chao-Ying, Morecroft, Megan, Macfarlane, Alan J R, Burckett-St Laurent, David, Pawa, Amit, West, Simeon, Margetts, Steve, Haslam, Nat, Ashken, Toby, Sebastian, Maria Paz, Thottungal, Athmaja, Womack, Jono, Noble, Julia Alison, Higham, Helen, Bowness, James S
• Format: Article
• Language: English
• Subjects: Artificial intelligence; Brachial plexus; Confidence; Device Evaluation; Devices; Original research; Regional anesthesia; Technology; Ultrasonic imaging
• ISSN: 2631-4940; 2631-4940
• DOI: 10.1136/bmjsit-2024-000264

ObjectivesUltrasound-guided regional anesthesia (UGRA) relies on acquiring and interpreting an appropriate view of sonoanatomy. Artificial intelligence (AI) has the potential to aid this by applying a color overlay to key sonoanatomical structures.The primary aim was to determine whether an AI-generated color overlay was associated with a difference in participants’ ability to identify an appropriate block view over a 2-month period after a standardized teaching session (as judged by a blinded assessor). Secondary outcomes included the ability to identify an appropriate block view (unblinded assessor), global rating score and participant confidence scores.DesignRandomized, partially blinded, prospective cross-over study.SettingSimulation scans on healthy volunteers. Initial assessments on 29 November 2022 and 30 November 2022, with follow-up on 25 January 2023 – 27 January 2023.Participants57 junior anesthetists undertook initial assessments and 51 (89.47%) returned at 2 months.InterventionParticipants performed ultrasound scans for six peripheral nerve blocks, with AI assistance randomized to half of the blocks. Cross-over assignment was employed for 2 months.Main outcome measuresBlinded experts assessed whether the block view acquired was acceptable (yes/no). Unblinded experts also assessed this parameter and provided a global performance rating (0–100). Participants reported scan confidence (0–100).ResultsAI assistance was associated with a higher rate of appropriate block view acquisition in both blinded and unblinded assessments (p=0.02 and