Impact of clinical training on supra‐aortic duplex and transcranial doppler examination concordance

Sonographic tests are observer‐dependent. With 1,527 consecutive patients, 22 trainees were assessed at baseline and after a hands‐on 1:1 program, with a pre‐examination median of 76 studies/trainee. We evaluated the required number of supervised examinations to reach a 0.80 kappa index (ki). Statistics included linear and exponential generalized estimating equation models. In the exponential model, 76 studies for carotid‐duplex and >102 for vertebral‐duplex and transcranial Doppler were needed for a 0.80 ki. “Relevant‐categories” after‐training ki was 0.80 in carotid‐duplex and transcranial Doppler but 0.60 in vertebral‐duplex. A fixed training does not guarantee a high ki. Measuring the acquired skills of every trainee would improve quality. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44 :571–579, 2016