Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
The learning curve for coronary Intra Vascular Ultrasound has not been previously analysed. This study aimed to evaluate the learning curve for intravascular ultrasound (IVUS) among multidisciplinary cardiac catheterization laboratory staff.
Dates: Oct 2024 - April 2025
Implementation sites: Ipswich Hospital
Partnerships: Ipswich Heart Foundation - sponsored for the study
Aim
To evaluate the learning curve for coronary intravascular ultrasound (IVUS) among multidisciplinary cardiac catheterisation laboratory staffs.
Outcomes
Regular application of IVUS accelerated the learning process among the staffs. IVUS catheter setup time reduced from an average of 7.9 minutes during the first 10 cases to 3.9 minutes during the last 10, indicating improved procedural efficiency. Interpretation skills improved in interventional cardiologists and cardiac physiologists after approximately 15 cases, while nurses’ confidence in IVUS setup improved after about 10 cases. Staff attitudes toward IVUS became more positive over the study period. At the end of study, most reported no discouragement from IVUS use.
Background
Despite international guidelines giving intravascular imaging (IVI) a Class I recommendation, its global uptake remains suboptimal due to lack of formal training, confidence, and standardized education frameworks. This challenge is also compounded by the dynamic nature of catheterization laboratory procedures, which require quick online and real-time interpretations. On the other side intravascular imaging becoming mandatory in complex lesions, for optimal stent results. The learning curve for coronary IVI has not been previously analysed. Understanding this learning curve could inform staff training policies and protocols.
Methods
We conducted a prospective study to assess learning curve in our Cath lab involving four interventional cardiologists, seven nurses, six radiographers, and three cardiac physiologists. Fifty consecutive patients undergoing percutaneous coronary intervention (PCI) or left main assessment between October 2024 and April 2025 were recruited. Patients who declined consent forms and anatomy not suitable for IVUS were excluded from the study.
The procedure details, IVUS set up time were recorded for all the cases. Staff completed structured surveys assessing knowledge, confidence, and attitudes toward IVUS at baseline, mid-study (after 25 cases), and at study completion. The results were analysed to assess staff performance improvement and change in perception towards IVUS.
Discussion
Among the 50 cases, pre-procedural IVUS was performed in 30%, post-procedure in 37%, and both pre- and post-procedure in 29%. Diagnostic-only IVUS occurred in 4% of cases, and 48% of PCI performed for acute coronary syndrome.
Procedural efficiency: IVUS catheter setup time reduced from an average of 7.9 minutes during the first 10 cases
to 3.9 minutes during the last 10, indicating improved procedural efficiency (Figure 1A). The mean IVUS Catheter set up time was 5.2 +/-2.5 mins.
Confidence: Interpretation skills improved in interventional cardiologists and cardiac physiologists after approximately
15 cases, while nurses’ confidence in IVUS setup improved after about 10 cases.
Knowledge: Overall staff knowledge improved significantly from baseline to mid-study (p = 0.022) and baseline to final survey (p = 0.032).
Attitudes: Staff attitudes toward IVUS became more positive over the study period. At the end of study, most reported no discouragement from IVUS use. The expected additional time for PCI with IVUS use was perceived as 10–20 minutes. The strong barrier for IVUS was reported as lack of knowledge which leads to increased procedural time. We also observed while comparing mid to final survey results, the results were plateaued after 25 cases.
Limitations: This single-centre study involved tertiary-level staff in a government-funded hospital; results
may not generalize globally. The small sample size, lack of core laboratory validation, and distributed operator experience may have diluted learning effects.
Conclusion: There is evidence of learning curve that the regular application of intravascular ultrasound (IVUS) significantly accelerates procedural efficiency among multidisciplinary catheterization laboratory personnel. To optimize accurate interpretation a structured IVUS training curriculum or central core lab support would be recommended.
References
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MD, PhD p, Ajay J. Kirtane, MD, SMq, r Factors Contributing to Low Utilization of Intracoronary Imaging in Clinical Practice: A White Paper
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Key contact
Dr Yohan Chacko
Interventional Cardiologist
Ipswich Hospital