External quality assurance for image grading in the Scottish Diabetic Retinopathy Screening Programme

Goatman, Keith A; Philip, Sam; Fleming, Alan; Harvey, R. Donald; Swa, Ken; Styles, Caroline; Black, M.; Sell, G.; Lee, N.; Sharp, P.; Olson, John A.

doi:10.1111/j.1464-5491.2011.03504.x

Cited by 20 publications

(20 citation statements)

References 10 publications

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“…All images were graded and annotated by a quality assured grader (94.3% sensitivity, 95.7% specificity, for referable retinopathy/maculopathy, 20125) prior to reviewing the OCT data. Borderline images were referred to a senior ophthalmologist.…”

Section: Methodsmentioning

confidence: 99%

Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study

et al. 2014

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Section: Methodsmentioning

confidence: 99%

Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study

et al. 2014

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“…The wide range of performance across the groups was larger than that observed in the first Scottish EQA in 2008. [4] It is expected that this will be reduced and overall performance be improved over repeated EQAs, as happened in Scotland.…”

Section: Discussionmentioning

confidence: 99%

“…Longitudinal analysis of screener performance has shown that it significantly improves performance for all grades of screener. [4] It has enabled the service to assess individual screeners and sites, to identify strengths and weaknesses, and to improve quality.…”

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confidence: 99%

Quality assurance in diabetic retinal screening in South Africa

et al. 2014

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Background. Diabetic retinopathy (DR) is an important biomarker for microvascular disease and blindness. Digital fundus photography is a cost-effective way of screening for DR. Access to DR screening is difficult for many South Africans with diabetes. Objective. To perform external quality assurance (EQA) on graders registered in the Ophthalmological Society of South Africa DR screening programme. Methods. Graders registered on the South African (SA) Diabetic Register website were invited to participate in the study. The Scottish EQA software system was used to enable on-line grading of 100 retinal photographs. Expert National Health Service graders provided the consensus expert grading for the image set. Results. Two hundred and sixty-one participants completed the EQA process, including nine ophthalmologists, 243 optometrists, and nine other graders. A wide range of outcomes were demonstrated, with a mean sensitivity of 0.905 (range 0.286 -1.000) and mean specificity of 0.507 (0.000 -0.935). The mean diagnostic odds ratio was calculated to be 12.3 (range 0.147 -148.2). Conclusions. This is the first quality assurance study conducted with SA healthcare professionals. The outcomes are of interest to all stakeholders dealing with the diabetes epidemic. The disparity in grader performance indicates room for improvement. The results demonstrate a high referral rate to ophthalmology, suggesting that on average graders are performing safely, but with a high number of inappropriate referrals.

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confidence: 99%

“…A high standard of quality controlled grading is essential for any screening programme. We embrace this, and have published data documenting our quality assurance results [3], as cited in our paper [1], and all screening centres in Scotland continue to undertake rigorous quality assurance within the programme.…”

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confidence: 99%

Risk stratification for diabetic eye screening. Reply to Stratton I. M. and Aldington S. J. [letter]

et al. 2013

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We fully acknowledge as stated in our discussion that apparent regression of retinopathy can result from a variety of causes including true regression of disease, changes in the retina that are not captured in retinal photographs and inaccuracy of the actual grading. However, as also noted in our discussion, when we constrained models to allow only misclassification and no actual regression, the model fit was not as good as when the model allowed for both misclassification and regression, so we do not think the regression noted in the paper is principally a result of issues with grading.As stated in our paper [1], the Scottish Diabetic Retinopathy Screening (DRS) programme has a centralised quality controlled grading system. This is comprised of grading centres all working to a single grading scheme with robust internal and external quality assurance. A high standard of quality controlled grading is essential for any screening programme. We embrace this, and have published data documenting our quality assurance results [3], as cited in our

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External quality assurance for image grading in the Scottish Diabetic Retinopathy Screening Programme

Abstract: A useful educational tool has been developed for image grading external quality assurance.

Cited by 20 publications

References 10 publications

Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study

Improving the cost-effectiveness of photographic screening for diabetic macular oedema: a prospective, multi-centre, UK study

Quality assurance in diabetic retinal screening in South Africa

Risk stratification for diabetic eye screening. Reply to Stratton I. M. and Aldington S. J. [letter]

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