Bromley Bryann, Spitz Jean, Fuchs Karin, Thornburg Loralei L
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts USA (B.B.); Departments of Obstetrics and Gynecology and Radiology, Brigham and Women's Hospital, Boston, Massachusetts USA (B.B.); Nuchal Translucency Quality Review Program, Perinatal Quality Foundation, Oklahoma City, Oklahoma USA (J.S.); Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, New York USA (K.F.); and Division of Maternal-Fetal Medicine, University of Rochester, Rochester, New York USA (L.L.T.).
J Ultrasound Med. 2014 Jul;33(7):1209-14. doi: 10.7863/ultra.33.7.1209.
The purpose of this study was to evaluate compliance with the ALARA (as low as reasonably achievable) principle by practitioners seeking credentialing for nuchal translucency (NT) measurement between 11 and 14 weeks' gestation.
Nuchal Translucency Quality Review Program credentialing requires quantitative scoring of 5 NT measurements from 5 different fetuses. Images submitted by 100 consecutive practitioners were retrospectively evaluated for the output display standard (ODS). The thermal index (TI) type (bone [TIb] or soft tissue [TIs]) and numeric value of the index were recorded. The TIb was considered the correct index for this study. Compliance with the numeric value was evaluated in several ways. Collectively, a TIb lower than 0.5 was considered optimal, lower than 0.7 compliant, and 1.0 or lower satisfactory.
An ODS was present in at least 1 image submitted by 77 practitioners. The TIb was used exclusively by 15 (19.5%), the TIs by 37 (48.1%), and 25 used a combination of the TIb and TIs. Only 4 of 77 providers (5%) used the correct TI type (TIb) at lower than 0.5 for all submitted images, 5 of 77 (6%) at lower than 0.7, and 9 of 77 (12%) at 1.0 or lower. A TI (TIb or TIs) higher than 1.0 was used by 15 of 77 providers (19.5%). Proficiency in NT measurement and educational background (physician or sonographer) did not influence compliance with ALARA.
Clinicians seeking credentialing in NT do not demonstrate compliance with the recommended use of the TIb in monitoring acoustic output.
本研究旨在评估寻求孕11至14周颈项透明层（NT）测量资质认证的从业者对“尽可能低合理可达”（ALARA）原则的遵循情况。
颈项透明层质量审查计划的资质认证要求对来自5个不同胎儿的5次NT测量进行定量评分。对100名连续从业者提交的图像进行回顾性评估，以确定输出显示标准（ODS）。记录热指数（TI）类型（骨骼[TIb]或软组织[TIs]）及其数值。本研究将TIb视为正确的指数。通过多种方式评估数值的合规性。总体而言，TIb低于0.5被视为最佳，低于0.7为合规，1.0及以下为满意。
77名从业者提交的至少1张图像中存在ODS。仅15名（19.5%）仅使用TIb，37名（48.1%）仅使用TIs，25名同时使用TIb和TIs。77名提供者中只有4名（5%）在所有提交图像中使用正确的TI类型（TIb）且低于0.5，77名中有5名（6%）低于0.7，77名中有9名（12%）为1.0及以下。77名提供者中有15名（19.5%）使用高于1.0的TI（TIb或TIs）。NT测量的熟练程度和教育背景（医生或超声检查技师）不影响对ALARA原则的遵循情况。
寻求NT测量资质认证的临床医生在监测声输出时未遵循推荐使用TIb的要求。
