Use of Artificial Intelligence for Acquisition of Limited Echocardiograms: A Randomized Controlled Trial for Educational Outcomes

Background Point-of-care ultrasound (POCUS) machines may utilize artificial intelligence (AI) to enhance image interpretation and acquisition. This study investigates whether AI-enabled devices improve competency among POCUS novices. Methods We conducted a randomized controlled trial at a single academic institution from 2021-2022. Internal medicine trainees (N=43) with limited POCUS experience were randomized to receive a POCUS device with (Echonous, N=22) or without (Butterfly, N=21) AI-functionality for two weeks while on an inpatient rotation. The AI-device provided automatic labeling of cardiac structures, guidance for optimal probe placement to acquire cardiac views, and ejection fraction estimations. Participants were allowed to use the devices at their discretion for patient-related care. The primary outcome was the time to acquire an apical 4-chamber (A4C) image. Secondary outcomes included A4C image quality using the modified Rapid Assessment for Competency in Echocardiography (RACE) scale, correct identification of pathology, and participant attitudes. Measurements were performed at the time of randomization and at two-week follow-up. All scanning assessments were performed on the same standardized patient. Results Both AI and non-AI groups had similar scan times and image quality scores at baseline. At follow-up, the AI group had faster scan times (72 seconds [IQR 38-85] vs. 85 seconds [IQR 54-166]; p=0.01), higher image quality scores (4.5 [IQR 2-5.5] vs. 2 [IQR 1-3]; p<0.01) and correctly identified reduced systolic function more often (85% vs 50%; p=0.02) compared to the non-AI group. Trust in the AI features did not differ between the groups pre- or post-intervention. The AI group did not report increased confidence in their abilities to obtain or interpret cardiac images. Conclusions POCUS devices with AI features may improve image acquisition and interpretation by novices. Future studies are needed to determine the extent that AI impacts POCUS learning. ### Competing Interest Statement Dr. Kumar reports receiving consultant fees from Vave Health, which is unrelated to this body of work. The other authors do not have any financial interests to disclose. This study was an investigator-initiated study. None of the device manufacturers used in this study oversaw, influenced, or reviewed the data presented prior to submission. The authors vouch for the independent nature by which this investigation was conducted and disseminated, without influence from outside organizations. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Stanford University IRB gave ethical approval for this protocol (ID 42094) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes ll data produced in the present study are available upon reasonable request to the authors