Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH.
Am J Obstet Gynecol. 2013 Oct;209(4):365.e1-5. doi: 10.1016/j.ajog.2013.07.032. Epub 2013 Aug 16.
Adherence to published criteria for transvaginal imaging and measurement of cervical length is uncertain. We sought to assess adherence by evaluating images submitted to certify research sonographers for participation in a clinical trial.
We reviewed qualifying test results of sonographers seeking certification to image and measure cervical length in a clinical trial. Participating sonographers were required to access training materials and submit 15 images, 3 each from 5 pregnant women not enrolled in the trial. One of 2 sonologists reviewed all qualifying images. We recorded the proportion of images that did not meet standard criteria (excess compression, landmarks not seen, improper image size, or full maternal bladder) and the proportion in which the cervical length was measured incorrectly. Failure for a given patient was defined as >1 unacceptable image, or >2 acceptable images with incorrect caliper placement or erroneous choice of the "shortest best" cervical length. Certification required satisfactory images and cervical length measurement from ≥4 patients.
A total of 327 sonographers submitted 4905 images. A total of 271 sonographers (83%) were certified on the first, 41 (13%) on the second, and 2 (0.6%) on the third submission. Thirteen never achieved certification. Of 314 who passed, 196 submitted 15 acceptable images that were appropriately measured for all 5 women. There were 1277 deficient images: 493 were acceptable but incorrectly measured images from sonographers who passed certification because mismeasurement occurred no more than twice. Of 784 deficient images submitted by sonographers who failed the certification, 471 were rejected because of improper measurement (caliper placement and/or failure to identify the shortest best image), and 313 because of failure to obtain a satisfactory image (excessive compression, required landmarks not visible, incorrect image size, brief examination, and/or full maternal bladder).
Although 83% of sonographers were certified on their first submission, >1 in 4 ultrasound images submitted did not meet published quality criteria. Increased attention to standardized education and credentials is warranted for persons who perform ultrasound examinations of the cervix in pregnancy.
阴道超声成像和宫颈长度测量的发表标准的遵循情况尚不确定。我们试图通过评估提交的图像来评估研究超声医师的遵循情况，这些图像用于参加临床试验的认证。
我们回顾了寻求认证以在临床试验中进行宫颈成像和测量的超声医师的合格测试结果。参加超声医师需要访问培训材料并提交 15 张图像，每张图像来自 5 名未参加试验的孕妇。2 位超声科医生中的 1 位审核了所有合格图像。我们记录了不符合标准标准（过度压缩、未见到标志、图像尺寸不当或完整的母体膀胱）的图像比例，以及宫颈长度测量不正确的图像比例。对于给定的患者，定义为> 1 个不可接受的图像，或> 2 个可接受的图像，但卡尺放置不正确或错误选择“最短最佳”宫颈长度。认证需要从≥ 4 名患者获得满意的图像和宫颈长度测量。
共有 327 名超声医师提交了 4905 张图像。共有 271 名超声医师（83％）在第一次提交时获得认证，41 名（13％）在第二次提交时获得认证，2 名（0.6％）在第三次提交时获得认证。有 13 名从未获得认证。在通过认证的 314 名中，有 196 名提交了 15 张可接受的图像，这些图像适用于所有 5 名女性。共有 1277 张图像存在缺陷：493 张是可接受的，但测量不正确的图像来自通过认证的超声医师，因为测量错误不超过两次。在未能通过认证的 784 张图像中，有 471 张因测量不当（卡尺放置和/或未能识别最短最佳图像）而被拒绝，313 张因未能获得满意的图像（过度压缩、需要的标志不可见、图像尺寸不正确、检查时间短和/或完整的母体膀胱）而被拒绝。
尽管 83％的超声医师在第一次提交时获得了认证，但提交的超过 1/4 的超声图像不符合已发表的质量标准。对于在妊娠期间进行宫颈超声检查的人员，需要更加关注标准化教育和证书。
