Combs C Andrew, Amara Sushma, Kline Carolyn, Ashimi Balogun Olaide, Bowman Zachary S
The Pediatrix Center for Research, Education, Quality & Safety, Sunrise, FL 33323, USA.
Obstetrix of California, Campbell, CA 95008, USA.
J Clin Med. 2024 Aug 17;13(16):4860. doi: 10.3390/jcm13164860.
: To evaluate the quality of an ultrasound practice, both large-scale and focused audits are recommended by professional organizations, but such audits can be time-consuming, inefficient, and expensive. Our objective was to develop a time-efficient, quantitative, objective, large-scale method to evaluate fetal biometry measurements for an entire practice, combined with a process for focused image review for personnel whose measurements are outliers. : Ultrasound exam data for a full year are exported from commercial ultrasound reporting software to a statistical package. Fetal biometry measurements are converted to z-scores to standardize across gestational ages. For a large-scale audit, sonographer mean z-scores are compared using analysis of variance (ANOVA) with Scheffe multiple comparisons test. A focused image review is performed on a random sample of exams for sonographers whose mean z-scores differ significantly from the practice mean. A similar large-scale audit is performed, comparing physician mean z-scores. : Using fetal abdominal circumference measurements as an example, significant differences between sonographer mean z-scores are readily identified by the ANOVA and Scheffe test. A method is described for the blinded image audit of sonographers with outlier mean z-scores. Examples are also given for the identification and interpretation of several types of systematic errors that are unlikely to be detectable by image review, including z-scores with large or small standard deviations and physicians with outlier mean z-scores. : The large-scale quantitative analysis provides an overview of the biometry measurements of all the sonographers and physicians in a practice, so that image audits can be focused on those whose measurements are outliers. The analysis takes little time to perform after initial development and avoids the time, complexity, and expense of auditing providers whose measurements fall within the expected range. We encourage commercial software developers to include tools in their ultrasound reporting software to facilitate such quantitative reviews.
为评估超声检查业务的质量，专业组织推荐进行大规模和针对性的审核，但此类审核可能耗时、低效且成本高昂。我们的目标是开发一种省时、定量、客观的大规模方法，用于评估整个业务中胎儿生物测量值，并结合针对测量值为异常值的人员进行针对性图像审查的流程。
全年的超声检查数据从商业超声报告软件导出到统计软件包。胎儿生物测量值转换为z分数，以便在不同孕周进行标准化。对于大规模审核，使用方差分析（ANOVA）和谢费多重比较检验比较超声技师的平均z分数。对平均z分数与业务平均值有显著差异的超声技师的检查进行随机抽样，进行针对性图像审查。对医生的平均z分数进行类似的大规模审核。
以胎儿腹围测量为例，通过方差分析和谢费检验很容易识别超声技师平均z分数之间的显著差异。描述了一种对平均z分数为异常值的超声技师进行盲法图像审核的方法。还给出了识别和解释几种图像审查不太可能检测到的系统误差的示例，包括标准差大或小的z分数以及平均z分数为异常值的医生。
大规模定量分析提供了一个业务中所有超声技师和医生生物测量值的概述，以便图像审核可以集中在测量值为异常值的人员身上。该分析在初步开发后执行所需时间很少，避免了对测量值在预期范围内的提供者进行审核所花费的时间、复杂性和成本。我们鼓励商业软件开发人员在其超声报告软件中纳入工具，以促进此类定量审查。
