Background:
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.

Methods:
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.

Results:
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.

Conclusions:
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.