Boelig Rupsa C, Feltovich Helen, Spitz Jean Lea, Toland Gregory, Berghella Vincenzo, Iams Jay D
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the Division of Maternal-Fetal Medicine, Obstetrics & Gynecology, Intermountain Healthcare, Utah Valley Hospital, Provo, Utah; the Perinatal Quality Foundation, Oklahoma City, Oklahoma; and the Ohio Perinatal Quality Collaborative, Columbus, Ohio.
Obstet Gynecol. 2017 Mar;129(3):536-541. doi: 10.1097/AOG.0000000000001820.
To use data from the Cervical Length Education and Review program to evaluate the quality of transvaginal cervical length ultrasonography by trained imagers (ie, ultrasonographers, radiologists, perinatologists).
This is a retrospective observational study of data from the Cervical Length Education and Review program. Candidates underwent an online lecture series, examination, and submitted a batch of images for review. For a candidate's batch of images to pass, all images must meet at least seven of the nine criteria assessed, the overall batch score needs to be 80% or greater, correct caliper placement must be met for all images, and the same criterion cannot be consistently missed. We also examined a subset of these criteria-appropriate image acquisitions, defined as an image that demonstrated both internal and external os and visualization of the entire endocervical canal. Primary outcome was the overall initial candidate pass rate; secondary outcomes included distribution of criteria missed in images and percentage of images that was inadequately acquired.
Six hundred eighty-seven candidates submitted 3,748 images between June 10, 2012, and August 18, 2016. Eighty-five percent of candidates were ultrasonographers. Of the 687 initial batches submitted, 105 (15%) did not pass. Eight hundred thirty-seven images (22%) of all images failed at least one criterion; the most common image deficiencies were in "anterior width of cervix equals the posterior width" (33%), "failure to visualize" the internal or external os (29%), "cervix occupies 75% of image and bladder area visible" (33%), and incorrect caliper placement (24%). Two hundred fifty-six (7%) of all images failed to meet our criteria for adequate image acquisition.
Fifteen percent of trained imagers failed to obtain appropriate cervical length imaging. This highlights the importance of a standardized cervical length training and certification program.
利用宫颈长度教育与评估项目的数据，评估经过培训的成像人员（即超声检查医师、放射科医师、围产医学专家）经阴道测量宫颈长度超声检查的质量。
这是一项对宫颈长度教育与评估项目数据的回顾性观察研究。参与者参加了在线讲座系列、考试，并提交一批图像以供评估。要使参与者的一批图像通过评估，所有图像必须至少符合所评估的九条标准中的七条，整批图像的总得分需达到80%或更高，所有图像的卡尺放置必须正确，且不能总是遗漏同一标准。我们还检查了这些标准中的一个子集——合适的图像采集，定义为一张显示宫颈内口和外口以及整个宫颈管可视化的图像。主要结果是参与者的总体初始通过率；次要结果包括图像中未达标准的分布情况以及采集不充分的图像百分比。
2012年6月10日至2016年8月18日期间，687名参与者提交了3748张图像。85%的参与者是超声检查医师。在提交的687批初始图像中，105批（15%）未通过。所有图像中有837张（22%）至少有一项标准未达标；最常见的图像缺陷是“宫颈前宽度等于后宽度方面”（33%）、“未能显示”宫颈内口或外口（29%）、“宫颈占据图像的75%且膀胱区域可见”（33%）以及卡尺放置不正确（24%）。所有图像中有256张（7%）未达到我们关于合适图像采集的标准。
15%经过培训的成像人员未能获得合适的宫颈长度成像。这凸显了标准化宫颈长度培训和认证项目的重要性。
