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Real-time quality control of nuchal translucency measurements using the exponentially weighted moving average chart. Taiwan J Obstet Gynecol 2021; 60:84-89. [PMID: 33495014 DOI: 10.1016/j.tjog.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The establishment of ongoing audits for first-trimester nuchal translucency (NT) measurements is of paramount importance. The exponentially weighted moving average (EWMA) chart has been published as an efficient tool for NT quality control with the advantages of being suitable for real-time long-term monitoring. This study aimed to assess the efficacy of real-time NT quality control using EWMA charts. MATERIALS AND METHODS This was an ongoing prospective study conducted from January 2011 to December 2017 at the Centre for Fetal Medicine Gennet in Prague. The quality of NT measurements was assessed using the NT retrospective distribution parameters and EWMA charts, and the results were presented to the sonographers during collective meetings. RESULTS Overall, 28,928 NT measurements obtained from six sonographers were eligible for the study. Looking at individual EWMA charts, we observed four main outcomes. First, there was a clear improvement in the performance of sonographers with initially poor performances. Second, the performance of sonographers with an initially satisfactory quality was maintained. Third, there was an observed deterioration of the performance without the audits. Last, the sonographers appreciated an unequivocal and straightforward graphical presentation of EWMA curves. CONCLUSION EWMA proved to be an efficient and suitable tool for real-time monitoring of NT quality and led to an overall improvement of the sonographers' performance.
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Badal B, Ballesteros A, Crespo M, Morell-Garcia D, Bauçà JM, Pastor M, Ruiz de Gopegui R, Martín I. Quality control of ultrasonography markers for Down's syndrome screening: a retrospective study by the laboratory. Diagnosis (Berl) 2021; 0:dx-2021-0007. [PMID: 34090321 DOI: 10.1515/dx-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Quality control of ultrasonography markers is necessary to ensure greater efficacy of prenatal aneuploidy screening. The aim of this study was to assess the quality of the crown-rump length (CRL) and nuchal translucence (NT) measurement accuracy by the laboratory according to quality indicators. METHODS Retrospective observational study on 4,908 single-foetus pregnant women who underwent prenatal aneuploidy screening in the first trimester of pregnancy. Euploid foetuses with CRL between 45 and 84 mm were included, while those with NT≥3.5 mm were excluded. CRL measurement was considered to be accurate if the median multiples of the median (MoM) for pregnancy-associated plasma protein A (PAPP-A) was between 0.90 and 1.10. Fifteen sonographers participated in the study, six of whom comprised the control group. Systematic error for a sonographer was considered when CRL measurement was greater than ±2 mm with respect to the control group. Quality for NT was assured by means of the WHIRI method and each sonographer cumulative sum control chart (CUSUM). RESULTS For CRL accuracy, five sonographers underestimated the measurements, while another four overestimated them, with no statistical differences. For smaller sized foetuses, all sonographers met the established specifications. Regarding NT control, three sonographers did not meet the quality criteria for the median MoM. All sonographers met the specifications for the logarithmic standard deviation of the NT MoM levels. Thirteen sonographers met the CUSUM specifications. CONCLUSIONS Evaluation of a quality control of ultrasonography parameters by laboratory professionals is necessary to avoid under- or overestimation tendencies for CRL and NT measurements. CUSUM is a useful tool for the immediate correction of errors in NT measurements.
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Affiliation(s)
- Blanca Badal
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antonieta Ballesteros
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Miriam Crespo
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Morell-Garcia
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Josep Miquel Bauçà
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Maria Pastor
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Rosa Ruiz de Gopegui
- Gynecology and Obstetrics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Inmaculada Martín
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Ramirez-Abarca TG, Gallardo-Gaona JM, Lumbreras-Marquez MI, Seifert SM, Rodriguez-Sibaja MJ, Velazquez-Torres B, Ramirez-Calvo JA, Acevedo-Gallegos S. Amniocentesis learning curve using a low-cost simulation model to teach maternal-fetal medicine fellows. Int J Gynaecol Obstet 2020; 153:95-99. [PMID: 33040369 DOI: 10.1002/ijgo.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/31/2020] [Accepted: 10/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the learning curve for amniocentesis among Maternal-Fetal Medicine (MFM) fellows using a low-cost simulation model in Mexico. METHODS Fourteen first- and second-year MFM fellows with no previous experience in amniocentesis participated in this single-center prospective study from March to June of 2019. The study was approved by the Institutional Review Board at the Instituto Nacional de Perinatologia and written informed consent was obtained from all participants. After an introductory course based on a standardized technique for amniocentesis, each fellow performed this procedure using a low-cost simulation model; experienced operators supervised the procedures. Learning curves were then created using cumulative sum analysis. Thresholds for acceptable and unacceptable failure rates were defined as 10% and 25%, respectively. RESULTS Experienced MFM specialists evaluated 3675 procedures. On average, MFM fellows performed 263 ± 53 procedures. The mean number to achieve competence was 255 ± 53. The overall failure rate among the trainees was 16%. CONCLUSION We describe individual learning curves for amniocentesis among MFM fellows using a low-cost simulation model. This approach allows direct assessment of proficiency in amniocentesis before clinical practice.
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Affiliation(s)
- Tania G Ramirez-Abarca
- Department of Maternal and Fetal Medicine, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Juan M Gallardo-Gaona
- Department of Maternal and Fetal Medicine, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Mario I Lumbreras-Marquez
- Department of Obstetric Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara M Seifert
- Department of Obstetric Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria J Rodriguez-Sibaja
- Department of Maternal and Fetal Medicine, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | | | - Jose A Ramirez-Calvo
- Department of Maternal and Fetal Medicine, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Sandra Acevedo-Gallegos
- Department of Maternal and Fetal Medicine, Instituto Nacional de Perinatologia, Mexico City, Mexico
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Torrent A, Manrique G, Gómez-Castelló T, Baldrich E, Cahuana M, Manresa JM, Borrell A. Sonologist's characteristics related to a higher quality in fetal nuchal translucency measured in primary antenatal care centers. Prenat Diagn 2019; 39:934-939. [PMID: 31237971 DOI: 10.1002/pd.5512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the quality of nuchal translucency (NT) measurements in primary care and the sonologist's characteristics related with a higher quality. METHODS The median NT expressed in multiples of the median (MoM) was calculated for each sonologist of 14 participating antenatal primary care centers of the Catalan Institute of Health. A survey to the sonologists was used to establish variables related to higher-quality measurements. RESULTS The median NT MoM obtained in 16 448 NT measurements, performed by 102 sonologists, was 0.94 MoM. NT underestimation was observed in 46% of the sonologists. Underestimation were less frequent among professionals who performed more than 230 ultrasounds per year (26% vs 53%;p = .022), those who completed the online Fetal Medicine Foundation (FMF) course (22% vs 54%; p = .021), and those who were subject to periodic audits (24% vs 56%; p = .021). Underestimation rate decreased from 60%, to 33% and 14% with the increase of the years of experience from less than 5 years, to 6 to 15 years and more than 15 years of experience, respectively (p = .029). CONCLUSIONS Higher-quality measurements were demonstrated in sonologists who performed more ultrasounds per year, those with more years of scanning experience, those who completed the online FMF course, and those periodically audited.
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Affiliation(s)
- Anna Torrent
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mollet, Institut Catala De La Salut, Barcelona, Spain.,GRASSIR Emerging Consolidated Research Group on Sexual and Reproductive Health, Institut de Recerca en Atencio Primaria Jordi Gol
| | - Gemma Manrique
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mollet, Institut Catala De La Salut, Barcelona, Spain
| | - Teresa Gómez-Castelló
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mataró, Institut Catala De La Salut, Barcelona, Spain
| | - Elisabeth Baldrich
- Obstetrics and Gynecology Primary Care Center (ASSIR) Sabadell, Institut Catala De La Salut, Barcelona, Spain
| | - Marc Cahuana
- GRASSIR Emerging Consolidated Research Group on Sexual and Reproductive Health, Institut de Recerca en Atencio Primaria Jordi Gol.,Obstetrics and Gynecology Primary Care Center (ASSIR) Sabadell, Institut Catala De La Salut, Barcelona, Spain
| | - Josep M Manresa
- Unitat Suport Recerca Metropolitana Nord, Institut de Recerca en Atencio Primaria IDIAPJGol, Sabadell, Spain.,Departament d'Infermeria, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Antoni Borrell
- Department of Maternal-Fetal Medicine Barcelona, Institute Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
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Filce C, Hyett J, Sahota D, Wilson K, McLennan A. Developing a quality assurance program for transvaginal cervical length measurement at 18-21 weeks' gestation. Aust N Z J Obstet Gynaecol 2019; 60:55-62. [PMID: 31141167 DOI: 10.1111/ajo.12984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/21/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Preterm birth is the leading cause of death in children under the age of five years. Transvaginal cervical length (TVCL) assessment can be used to predict preterm delivery risk at the mid-trimester scan. To optimise the screening tool, developing and maintaining quality standards is important. AIMS To develop an Australian reference range for TVCL at 18.0-21.0 weeks' gestation, quality standards for measurement and audit mechanisms for ultrasound operators. MATERIALS AND METHODS A retrospective audit was performed of consecutive patients scanned at 18.0-21.0 weeks' gestation. Each TVCL measurement ultrasound image was reviewed, and exclusions were made based on a defined set of quality criteria. Fractional polynomial Bayesian methodology was used to establish a reference range. Central tendency, dispersion plots and cumulative sum charts for operators in the original reference range cohort were created. These plots were then applied to a second validation cohort of operators to establish the efficacy of this quality assurance audit tool. RESULTS Median TVCL from 1031 participants was 36.0 mm (interquartile range 32.7-40.0 mm), which was independent of gestational age. The quality audit tool was applied to 15 operators from the reference cohort with a mean cervix length multiple of the median of 1.01 and a mean SD log10 cervix length multiple of the median of 0.06. Of the 22 operators in the validation cohort, 20 (90.9%) demonstrated ideal or acceptable central tendency results, and 19 (86.4%) remained in the appropriate cumulative sum zone. CONCLUSION An Australian cervix length measurement reference range at 18.0-21.0 weeks' gestation has been developed along with a validated quality assurance audit tool for ultrasound operators.
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Affiliation(s)
- Casey Filce
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Jon Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Daljit Sahota
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Kate Wilson
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Fries N, Salomon LJ, Muller F, Dreux S, Houfflin-Debarge V, Coquel P, Kleinfinger P, Dommergues M. Impact of a shift in nuchal translucency measurements on the detection rate of first-trimester Down syndrome screening: A population-based study. Prenat Diagn 2018; 38:106-109. [PMID: 29231978 DOI: 10.1002/pd.5193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the distribution of nuchal translucency (NT) measurements following a national policy without credentialing and its impact on first-trimester Down syndrome screening (DSS) detection rate. METHOD All first-trimester DSS data recorded in France (2010-2014) were collected by the laboratories in charge via an Internet database (https://www.bionuqual.org/echo.php). There was no minimal requirement for image quality to allow sonographers to enter the screening process. A subgroup of DSS with complete DS follow-up corresponded to 1614 sonographers. Based on the distribution of maternal age, DS detection rate was calculated and split as a function of the distribution of NT multiple of the median (MoM). RESULTS Four thousand nine hundred forty-three sonographers performed 2,337,372 NT measurements. Median NT expressed in MoM was 0.83. Screenings with complete follow-up consisted of 197,417 screenings, in which DSS detection rates were respectively 70.4%, 70.9%, 79.4%, 87.7%, and 79.5% for the following median NT MoM ranges: <0.7, 0.70 to 0.79, 0.80 to 0.89, 0.90 to 0.99, and >0.99 (trend χ = 12.21; P = .0158). CONCLUSION In France, following a policy of quality assessment without standardized credentialing, the distribution of NT measurements did not fit the expected distribution. Down syndrome detection rate was 10% lower in screenings by sonographers with a median NT < 0.80 MoM.
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Affiliation(s)
- Nicolas Fries
- Collège Français d'Echographie Foetale (CFEF), Montpellier, France
| | - Laurent J Salomon
- Maternité, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Descartes, Paris, France.,Collège d'Evaluation des Pratiques Professionnelles en Imagerie Médicale (CEPPIM), Paris, France
| | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France.,Association des Biologistes Agréés (ABA), Paris, France
| | - Sophie Dreux
- Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France.,Association des Biologistes Agréés (ABA), Paris, France
| | - Véronique Houfflin-Debarge
- Département d'Obstétrique, CHU Lille, Lille, France.,Collège National des Gynécologues Obstétriciens Français (CNGOF), Paris, France
| | - Philippe Coquel
- Collège d'Evaluation des Pratiques Professionnelles en Imagerie Médicale (CEPPIM), Paris, France
| | | | - Marc Dommergues
- Gynécologie-Obstétrique, Hôpital Pitié-Salpétrière AP-HP, Paris, France.,Université Pierre et Marie Curie Paris 6, Paris, France
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Sabria J, Guirado L, Miró I, Gómez-Roig MD, Borrell A. Crown-rump length audit plots with the use of operator-specific PAPP-A andβ-hCG median MoM. Prenat Diagn 2017; 37:229-234. [DOI: 10.1002/pd.4996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/10/2016] [Accepted: 12/15/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Joan Sabria
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
- RETICS funded by the PN I + D + I 2008-2011 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Ref. RD12/0026.; Spain
| | - Laura Guirado
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
| | - Isabel Miró
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
| | - Maria Dolors Gómez-Roig
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
- RETICS funded by the PN I + D + I 2008-2011 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Ref. RD12/0026.; Spain
| | - Antoni Borrell
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
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Análisis de resultados «falsos negativos» para trisomía 21 en los programas de cribado combinado de primer trimestre: una herramienta para la mejora de la calidad. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ridding G, Hyett JA, Sahota D, McLennan AC. Assessing quality standards in measurement of uterine artery pulsatility index at 11 to 13 + 6 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:299-305. [PMID: 25412757 DOI: 10.1002/uog.14732] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/13/2014] [Accepted: 11/13/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the effect of audit and feedback on the performance of first-trimester uterine artery pulsatility index (UtA-PI) measurement, to determine whether operator experience affects performance and whether an operator's measurement profile affects the screen-positive rate for early-onset pre-eclampsia (PE). METHODS This was a prospective cohort study in which UtA-PI measurements were collected between 11 to 13 + 6 weeks' gestation by 12 operators and were entered into individualized calculators to convert them to multiples of a locally-derived median (MoM). Individual sonographer cumulative sum (CUSUM) and target charts were generated to assess central tendency and dispersion to identify systematic measurement errors and deviation from expected measurement performance. Six of the operators received regular feedback whilst the remaining six received no feedback. Each group consisted of four experienced operators and two relatively inexperienced operators. The average MoM for each operator was compared with their respective screen-positive rates for early-onset PE. RESULTS The group that received feedback performed better than that which received none, with results more closely matching the expected measurement distribution. UtA-PI measurements were comparable between the experienced and inexperienced sonographers (mean log10 lowest PI MoM, -0.0089 vs 0.0124, respectively); however the inexperienced sonographers had a higher overall screen-positive rate for early-onset PE (10.0% vs 2.7%, respectively). There was a significant positive correlation between the mean MoM for each operator and the screen-positive rate (r = 0.63). CONCLUSIONS CUSUM and target graphs are an effective method of audit for first-trimester UtA-PI measurement. Feedback to operators resulted in improved measurement performance, which will ultimately result in improved screening accuracy for PE.
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Affiliation(s)
- G Ridding
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - J A Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, Australia
| | - D Sahota
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong, China
| | - A C McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
- Sydney Ultrasound For Women, Sydney, Australia
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Lu B, Smallwood AM, Sellers TA, Drukteinis JS, Heine JJ, Fowler EEE. Calibrated breast density methods for full field digital mammography: a system for serial quality control and inter-system generalization. Med Phys 2015; 42:623-36. [PMID: 25652480 DOI: 10.1118/1.4903299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The authors are developing a system for calibrated breast density measurements using full field digital mammography (FFDM). Breast tissue equivalent (BTE) phantom images are used to establish baseline (BL) calibration curves at time zero. For a given FFDM unit, the full BL dataset is comprised of approximately 160 phantom images, acquired prior to calibrating prospective patient mammograms. BL curves are monitored serially to ensure they produce accurate calibration and require updating when calibration accuracy degrades beyond an acceptable tolerance, rather than acquiring full BL datasets repeatedly. BL updating is a special case of generalizing calibration datasets across FFDM units, referred to as cross-calibration. Serial monitoring, BL updating, and cross-calibration techniques were developed and evaluated. METHODS BL curves were established for three Hologic Selenia FFDM units at time zero. In addition, one set of serial phantom images, comprised of equal proportions of adipose and fibroglandular BTE materials (50/50 compositions) of a fixed height, was acquired biweekly and monitored with the cumulative sum (Cusum) technique. These 50/50 composition images were used to update the BL curves when the calibration accuracy degraded beyond a preset tolerance of ±4 standardized units. A second set of serial images, comprised of a wide-range of BTE compositions, was acquired biweekly to evaluate serial monitoring, BL updating, and cross-calibration techniques. RESULTS Calibration accuracy can degrade serially and is a function of acquisition technique and phantom height. The authors demonstrated that all heights could be monitored simultaneously while acquiring images of a 50/50 phantom with a fixed height for each acquisition technique biweekly, translating into approximately 16 image acquisitions biweekly per FFDM unit. The same serial images are sufficient for serial monitoring, BL updating, and cross-calibration. Serial calibration accuracy was maintained within ±4 standardized unit variation from the ideal when applying BL updating. BL updating is a special case of cross-calibration; the BL dataset of unit 1 can be converted to the BL dataset for another similar unit (i.e., unit 2) at any given time point using the 16 serial monitoring 50/50 phantom images of unit 2 (or vice versa) acquired near this time point while maintaining the ±4 standardized unit tolerance. CONCLUSIONS A methodology for monitoring and maintaining serial calibration accuracy for breast density measurements was evaluated. Calibration datasets for a given unit can be translated forward in time with minimal phantom imaging effort. Similarly, cross-calibration is a method for generalizing calibration datasets across similar units without additional phantom imaging. This methodology will require further evaluation with mammograms for complete validation.
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Affiliation(s)
- B Lu
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center, Tampa, Florida 33612
| | - A M Smallwood
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center, Tampa, Florida 33612
| | - T A Sellers
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center, Tampa, Florida 33612
| | - J S Drukteinis
- Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center, Tampa, Florida 33612
| | - J J Heine
- Department of Cancer Imaging and Metabolism, Division of Basic Science, H. Lee Moffitt Cancer Center, Tampa, Florida 33612
| | - E E E Fowler
- Department of Cancer Epidemiology, Division of Population Science, H. Lee Moffitt Cancer Center, Tampa, Florida 33612
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Hynek M, Smetanová D, Stejskal D, Zvárová J. Exponentially weighted moving average chart as a suitable tool for nuchal translucency quality review. Prenat Diagn 2014; 34:367-76. [DOI: 10.1002/pd.4314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/30/2013] [Accepted: 12/31/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Martin Hynek
- Gennet, Centre for Fetal Medicine and Reproductive Genetics; Prague Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine; Charles University; Prague Czech Republic
- Department of Gynecology and Obstetrics; Thomayer Hospital; Prague Czech Republic
| | - Dagmar Smetanová
- Gennet, Centre for Fetal Medicine and Reproductive Genetics; Prague Czech Republic
| | - David Stejskal
- Gennet, Centre for Fetal Medicine and Reproductive Genetics; Prague Czech Republic
| | - Jana Zvárová
- European Centre for Medical Informatics, Statistics and Epidemiology; Institute of Computer Science AS CR; Prague Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine; Charles University; Prague Czech Republic
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Sabria J, Comas C, Barceló-Vidal C, Illa M, Echevarria M, Gomez-Roig MD, Borrell A. Cumulative sum plots and retrospective parameters in first-trimester ductus venosus quality assurance. Prenat Diagn 2013; 33:384-90. [PMID: 23494871 DOI: 10.1002/pd.4079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the application of two quality assurance methods to the ductus venosus pulsatility index (DVPI), as a first-trimester aneuploidy marker, including retrospective assessment of distribution parameters and cumulative sum (CUSUM) plots. METHODS The DVPI was measured in 14 444 singleton fetuses at 11+0 to 13+6 weeks in two Fetal Medicine centers during a 4-year period. Sonologist-specific quality assurance distribution parameters, previously described for nuchal translucency, were assessed: the median multiples of the median (MoM), the logarithmic standard deviation of DVPI MoMs and the weekly DVPI percent decrease. Quality assurance results were compared between median MoMs and MoM-based CUSUM plots. RESULTS When sonologist-specific DVPI distribution parameters were retrospectively applied for quality assurance, a 1.0 median MoM, a 0.1 median logarithmic standard deviation and a 3.4 median weekly DVPI drop percentage were observed. CUSUM plots showed good agreement with 0.9-1.1 MoMs range for median MoM, in the assessment of sonologist-specific performances. CONCLUSION Retrospective and prospective DVPI quality assurance methods appear to be applicable to DVPI at 11+0 to 13+6 weeks. Its use should be encouraged if DVPI is to be added to first-trimester Down syndrome or cardiac defects screening.
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Affiliation(s)
- Joan Sabria
- Ultrasound Unit, Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
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Cuckle H, Maymon R. Role of second-trimester ultrasound in screening for Down syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:241-244. [PMID: 23460191 DOI: 10.1002/uog.12397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- H Cuckle
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA.
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Gabriel CC, Echevarria M, Rodríguez I, Serra B. Analysis of quality of nuchal translucency measurements: its role in prenatal diagnosis. ScientificWorldJournal 2011; 2012:482832. [PMID: 22649294 PMCID: PMC3353280 DOI: 10.1100/2012/482832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. Quantitative analysis of the quality of nuchal translucency (NT) measurements. Methods. First-trimester combined screening for Down syndrome was performed to all pregnant women attended in our Department from October 2003 to November 2009. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians. The performance of NT measurements was retrospectively analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown rump length (CRL) values, and FMF certification was statistically tested. Results. A total of 14978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0,98. (2) Mean percentage of cases >95th and <5th centiles were 5,0% and 4,2%, respectively. (3) Logarithmic mean and SD of the NT MoM values were 0,00 and 0,13, respectively. (4) The DR for trisomy 21 at screening time was 90,7% for a FPR of 6,7% for standard screening strategy. (5) According to Cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Conclusion. Overall, quality standards show optimal NT measurements in our unit. Operator experience, a dedicated profile to fetal medicine, CRL over 60 mm, and FMF certification have a significant positive impact on the quality standards.
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Affiliation(s)
- Carmen Comas Gabriel
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Gran Vía Carles III 71-75, 08028 Barcelona, Spain.
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Singh Sahota D, Leung WC, Kee To W, Pan Chan W, Lau TK, Yeung Leung T. Quality assurance of nuchal translucency for prenatal fetal Down syndrome screening. J Matern Fetal Neonatal Med 2011; 25:1039-43. [DOI: 10.3109/14767058.2011.614658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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