Diagnostic image quality in gynaecological ultrasound: Who should measure it, what should we measure and how?

Abstract

Assessment of diagnostic image quality in gynaecological ultrasound is an important aspect of imaging department quality assurance. This may be addressed through audit, but who should undertake the audit, what should be measured and how, remains contentious. The aim of this study was to identify whether peer audit is a suitable method of assessing the diagnostic quality of gynaecological ultrasound images. Nineteen gynaecological ultrasound studies were independently assessed by six sonographers utilising a pilot version of an audit tool. Outcome measures were levels of inter-rater agreement using different data collection methods (binary scores, Likert scale, continuous scale), effect of ultrasound study difficulty on study score and whether systematic differences were present between reviewers of different clinical grades and length of experience. Inter-rater agreement ranged from moderate to good depending on the data collection method. A continuous scale gave the highest level of inter-rater agreement with an intra-class correlation coefficient of 0.73. A strong correlation (r ¼ 0.89) between study difficulty and study score was yielded. Length of clinical experience between reviewers had no effect on the audit scores, but individuals of a higher clinical grade gave significantly lower scores than those of a lower grade (p ¼ 0.04). Peer audit is a promising tool in the assessment of ultrasound image quality. Continuous scales seem to be the best method of data collection implying a strong element of heuristically driven decision making by reviewing ultrasound practitioners.

Peer review audit (PRA) in ultrasound practice: A paper based on established UK sonography PRA models which are generalizable to other jurisdictions

“…20 The full process can be time consuming and there may be short-term negative financial effect, through reducing patient throughput to support PRA. 21 However the long-term financial benefit through improving practice and improving practitioner confidence and therefore reducing mortality and medico-legal action far outweigh this small activity detriment. 14 Meetings can be difficult to co-ordinate cross-sites, or in departments heavily staffed with agency workers, 25 however this is becoming easier with improved connectivity.…”

“…4,5 6 | THE PROCESS OF PRA PRA involves professional colleagues assessing each other's work using specified criteria; one professional will make a judgement on their peer's work, as to whether they would have made similar conclusions, given the information at hand, and if the work was to an accepted standard. 21 In sonography, the process may also compare sonographic findings with findings from other imaging modalities. For example, a Computed Tomography examination may discover a lesion in a liver however, the ultrasound examination performed 4 weeks prior was normal.…”

“…However, these questions could be adapted to represent different settings and local practices. Bespoke PRA tools may also be designed for specific areas of sonographic practice such as gynaecology or third trimester abdominal circumference measurements 12,21 . PRA tools could be developed into electronic versions, making data collection and recording easier, however this may introduce additional financial burden 24 …”

“…Examinations can be accessed from a secure computer drive for review. The British Medical Ultrasound Society (BMUS) 21 PRA tool assesses the quality of the ultrasound images, quality of the report and the quality of the referral (Table 2). Image quality assessment is made based on equipment utilisation, the standard of acquired/stored images and if images have been acquired as per scan protocols.…”

Image Analysis for Ultrasound Quality Assurance

“…Common QA methods include visual checks and more sophisticated phantom methods. 2,5,22 -24 As the part of this study, WAD-QC was used to assess in-air reverberation patterns obtained from ultrasound transducers. The analysis of the obtained image and the calculation of uniformity parameters were used to perform Quality Control of the transducers.…”