# Phantom-based training of ultrasound-guided breast biopsy in medical education: a randomized controlled trial comparing handheld and high-end ultrasound

## TL;DR

This study shows that handheld ultrasound devices are as effective as high-end scanners for teaching medical students how to perform breast biopsies.

## Contribution

Demonstrates that handheld ultrasound devices are comparable to high-end systems for training novices in ultrasound-guided procedures.

## Key findings

- Biopsy success rates were slightly higher with handheld devices (79.7%) compared to high-end systems (68.8%).
- Performance times were similar between the two ultrasound types.
- Operability and perceived workload were rated equally for both devices.

## Abstract

Modern handheld ultrasound devices (HUDs) are attractive for teaching programs in undergraduate medical education due to their miniaturization and portability along at relatively low cost. They offer high-resolution imaging and are easy to use, opening up new possibilities for training of novices in ultrasound (US)-guided percutaneous procedures. The objective of this study was to investigate if guidance by HUD is on par with a cart-based high-end ultrasound scanner (HEUS) regarding performance times and success rates in video- and phantom-based training of novices in US-guided freehand breast biopsy.

32 medical students without any experience in performing US-guided percutaneous biopsies, who had previously completed a standardized diagnostic US training program, were randomized into either a HUD-group (n = 16) or a HEUS-group (n = 16). After a video training lecture participants performed US-guided biopsies of hypoechogenic and hyperechogenic target-lesions in a breast phantom using either a HUD or a HEUS. Performance times and success rates were primary outcomes. Participants were asked to complete a post-study questionnaire (Likert Scale and Raw NASA Workload Task Load Index) for subjective assessment of the operability and individually perceived workload of both US imaging tools and guidance-techniques as secondary outcomes.

Biopsy success rates were slightly higher using the HUD (79.7%) in comparison to the HEUS (68.8%, p = 0.045). Median performance times were similar for the HUD (0.63 min, interquartile range IQR = 0.37–1.08 min) compared to the HEUS (0.60 min, IQR = 0.30–2.09 min, p = 0.751). Operability and the individually perceived workload were rated equal.

Percutaneous biopsy performed by novices using HUDs is feasible, performance times, success rates, operability and the individually perceived workload were on par with HEUS-guidance. HUDs can be used as cost-effective tools for percutaneous biopsy training purposes in medical education.

The online version contains supplementary material available at 10.1186/s12909-025-07163-1.