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Trial registered on ANZCTR

Trial ID
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
Visuospatial ability and brachial plexus sonography performance
Scientific title
In novices without prior ultrasonography experience, does the degree of innate visuospatial ability confer an advantage in successful performance of brachial plexus sonography
Secondary ID [1] 285047 0
Universal Trial Number (UTN)
Trial acronym
not applicable
Linked study record

Health condition
Health condition(s) or problem(s) studied:
visuospatial ability 292565 0
ultrasound imaging of the brachial plexus 292566 0
Condition category
Condition code
Anaesthesiology 292872 292872 0 0
Other anaesthesiology

Study type
Patient registry
Target follow-up duration
Target follow-up type
Description of intervention(s) / exposure
This is a prospective observational study of adult novices with no prior exposure to ultrasonography training or teaching. Baseline testing of novices' innate visuospatial ability will be performed using validated assessment tools of visuospatial performance, including components of the Weschler Adult Intelligence Scale-IV, the Vanderberg and Kuse Mental Rotations Test, and the Thurston and Jeffrey Flexibility of Closure Test. All of these tests are desktop paper and pencil, or manipulation of wooden blocks to construct shapes, and administered by a trained neuropsychologist.
After watching a short didactic instruction 15 minute video, novices are next taken to a human volunteer and asked to perform non-invasive ultrasonography of the brachial plexus from neck to axilla. Image quality, smoothness of ultrasound scanning, and ability to obtain standardised images will be assessed using an objective scoring form by Assessors, who are experts in sonography.
The assessment of visuospatial ability and scoring of performance will take a weekend.
Intervention code [1] 289883 0
Not applicable
Comparator / control treatment
Experts in ultrasonography of the brachial plexus (those performing at least 50 cases per year) will also be administered the visuospatial assessment tools, and be asked to perform the same sonography task on the same human volunteer. Experts' performance on the task will be assessed using the same objective scoring form by the same Assessors.
Control group

Primary outcome [1] 292742 0
Sonographic performance between novices and experts, based on objective assessment scores. This assessment form has been designed specifically for this study
Timepoint [1] 292742 0
At end of brief training in sonography
Primary outcome [2] 292743 0
Sonographic performance between novices with low and high visuospatial ability, when stratified using tests of visuospatial skill on specific domains (Weschler Adult Intelligence Scale-IV, Vanderberg and Kuse Mental Rotations, and Thurston and Jeffrey Flexibility of Closure tests)
Timepoint [2] 292743 0
at end of brief training in sonography
Secondary outcome [1] 309588 0
Timepoint [1] 309588 0

Key inclusion criteria
adult volunteers enrolled in health sciences degree in a tertiary educational institution (nursing, medicine, occupational therapy, physiotherapy, medical science)
Normal or corrected to normal visual acuity
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Prior experience, exposure to ultrasound teaching or training
Prior musculoskeletal ultrasound of the neck or shoulder, due to potential bias arising from viewing the technique
Radiology students, due to potential bias from learning from other imaging modalities
Previous cognitive or psychological testing in the past 12 months, due to potential contamination from performing similar psychometric tests of visuospatial ability

Study design
Defined population
Statistical methods / analysis
Endpoints are individual scores in the visuospatial tests of the different domains. Performance in the sonography task is recorded as a time taken to complete, individual item scores on the objective assessment tool, and a composite performance score. Linear mixed models will be used to model each sonographic outcome. Variables in these models include expertise and the visuospatial baseline measurements. Based on the mixed models, we will compare the sonographic performance between novices and experts , and between higher and lower visuospatial ability.
No previous study has been conducted in anaesthesia or radiology examining the visuospatial ability in ultrasound imaging. However, based on other studies in surgical laparoscopic skills and gastroenterlological endoscopy skills, novices were strongly discriminated in ability based on small sample sizes <30 participants. It is thought that in early uptake of new hand-eye coordination skills, visuospatial ability is dominant in learning. A sample size of 30 was chosen for this observational study for reasons of feasibility.

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 2766 0
Liverpool Hospital - Liverpool
Recruitment postcode(s) [1] 8464 0
2170 - Liverpool

Funding & Sponsors
Funding source category [1] 289653 0
Name [1] 289653 0
Department of Anaesthesia, Liverpool Hospital
Address [1] 289653 0
c/ Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
Country [1] 289653 0
Primary sponsor type
Department of Anaesthesia, Liverpool Hospital
Department of Anaesthesia
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
Secondary sponsor category [1] 288380 0
Name [1] 288380 0
Address [1] 288380 0
Country [1] 288380 0

Ethics approval
Ethics application status
Ethics committee name [1] 291389 0
South Western Sydney Local Health District HREC
Ethics committee address [1] 291389 0
Research and Ethics Office
Locked Bag 7103
Ethics committee country [1] 291389 0
Date submitted for ethics approval [1] 291389 0
Approval date [1] 291389 0
Ethics approval number [1] 291389 0

Brief summary
Ultrasound-guided regional anaesthesia (UGRA) is a complex procedural task that anaesthetists must learn. UGRA has been shown to have greater efficacy and safety than other nerve block localisation techniques and is thus the standard of care for performing peripheral nerve blockade.
Task deconstruction reveals that bimanual dexterity, hand-eye coordination and sonographic interpretation are some of the skills necessary for performance of UGRA. There is likely to be a correlation with visuospatial aptitude (defined as the ability to generate, retain and manipulate abstract visual images) and superior performance in UGRA in novices.
This study aims to evaluate the importance of visuospatial aptitude on the performance of UGRA in both novices and experts and which domains of visual perception are most closely linked to UGRA performance.
We will recruit novices to UGRA and administer a series of psychometric tests on visuospatial ability, to identify individuals with higher and lower skills. All novices will be asked to perform non-invasive, ultrasound scanning of the neck and shoulder of healthy human volunteers and their performance on several metrics (image quality, time, stability, and ability to obtain standard images) will be recorded. Experts in UGRA will tested as well, and they provide a control group against whom the novices will be compared to.
Trial website
Trial related presentations / publications
submitted to journal
Public notes

Principal investigator
Name 50178 0
Dr Alwin Chuan
Address 50178 0
Department of Anaesthesia
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
Country 50178 0
Phone 50178 0
+61 2 9828 3173
Fax 50178 0
Email 50178 0
Contact person for public queries
Name 50179 0
Dr Alwin Chuan
Address 50179 0
Department of Anaesthesia
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
Country 50179 0
Phone 50179 0
+61 2 9828 3173
Fax 50179 0
Email 50179 0
Contact person for scientific queries
Name 50180 0
Dr Alwin Chuan
Address 50180 0
Department of Anaesthesia
Liverpool Hospital
Elizabeth Street
Liverpool NSW 2170
Country 50180 0
Phone 50180 0
+61 2 9828 3173
Fax 50180 0
Email 50180 0