A Systematic Approach to Orbital CT Scans: Integrating the BALPINE Method into Ophthalmology Curriculum

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