Abstract
Objective While multiple approaches to the evaluation of orbital computed tomography (CT) imaging
have been proposed in both ophthalmology and radiology literature, there remains a
paucity of standardized approaches to orbital CT interpretation education for the
ophthalmologist in training. To address this, the bones, anterior chamber, lens, posterior
globe, intraconal orbit, neurovascular structures, and extraocular muscles (BALPINE)
method was selected and its utilization tested as an education tool to improve resident
competency in the proper assessment of orbital CT imaging.
Methods The BALPINE method is an established systematic approach to reading orbital CT scans.
This approach was selected as a standardized education tool after a systematic review
of orbital CT evaluation methods in the ophthalmology and radiology literature. A
15-item test, comprised of frequently diagnosed orbital pathologies developed in conjunction
with a radiologist, was designed to test a group of ophthalmologists in training across
multiple residency programs. The in-training ophthalmologists were first given this
test prior to being taught the BALPINE standardized method to assess orbital CT imaging.
The study participants were then administered a lecture describing the BALPINE method
approach to orbital CT imaging. The same study participants were then administered
the same test to assess improvement. The lecture was developed and administered by
a board-certified Oculoplastic surgeon. The lecturer was blinded to the images included
in the examination during lecture development. The radiologist was blinded to the
lecture and the BALPINE method; thus, the images selected were not specific to the
method being taught.
Results Overall, 27 residents, interns, and medical students completed the prelecture test,
BALPINE method curriculum lecture, and postlecture test. There was an average of a
2.3-point (15%) significant improvement per test score (p < 0.0001). Each level of training demonstrated improvement pre- and posttest and
overall scores improved with each additional year of training, indicating the test
was an appropriate measurement of ability and understanding.
Conclusion Teaching a systematic approach to the evaluation of orbital CT scans improves an
ophthalmologist in training's ability to diagnose orbital pathology efficiently and
effectively. Widespread residency curriculum adoption of the BALPINE method would
enhance the training ophthalmologist's diagnostic capability.
Keywords
ophthalmology - radiology - computed tomography - resident education - orbit
