SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Quality control of ultrasound for fetal biometry: results from the INTERGROWTH-21(st) Project.

Cavallaro, A; Ash, ST; Napolitano, R; Wanyonyi, S; Ohuma, EO; Molloholli, M; Sande, J; Sarris, I; Ioannou, C; Norris, T; et al. Cavallaro, A; Ash, ST; Napolitano, R; Wanyonyi, S; Ohuma, EO; Molloholli, M; Sande, J; Sarris, I; Ioannou, C; Norris, T; Donadono, V; Carvalho, M; Purwar, M; Barros, FC; Jaffer, YA; Bertino, E; Pang, R; Gravett, MG; Salomon, LJ; Noble, JA; Altman, DG; Papageorghiou, AT (2018) Quality control of ultrasound for fetal biometry: results from the INTERGROWTH-21(st) Project. Ultrasound Obstet Gynecol, 52 (3). pp. 332-339. ISSN 1469-0705 https://doi.org/10.1002/uog.18811
SGUL Authors: Papageorghiou, Aris

[img]
Preview
PDF Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (1MB) | Preview

Abstract

Objective To assess a comprehensive package of ultrasound quality control in the Fetal Growth Longitudinal Study of the INTERGROWTH‐21st Project, a large multicenter study of fetal growth. Methods Quality control (QC) measures were performed for 20 313 ultrasound scan images obtained prospectively from 4321 fetuses at 14–41 weeks' gestation in eight geographical locations. At the time of each ultrasound examination, three fetal biometric variables (head circumference (HC), abdominal circumference (AC) and femur length (FL)) were measured in triplicate on separately generated images. All measurements were taken in a blinded fashion. QC had two elements: (1) qualitative QC: visual assessment by sonographers at each study site of their images based on specific criteria, with 10% of images being re‐assessed at the Oxford‐based Ultrasound Quality Unit (compared using an adjusted kappa statistic); and (2) quantitative QC: assessment of measurement data by comparing the first, second and third measurements (intraobserver variability), remeasurement of caliper replacement in 10% (interobserver variability), both by Bland–Altman plots and plotting frequency histograms of the SD of triplicate measurements and assessing how many were above or below 2 SD of the expected distribution. The system allowed the sonographers' performances to be monitored regularly. Results A high level of agreement between self‐ and external scoring was demonstrated for all measurements (κ = 0.99 (95% CI, 0.98–0.99) for HC, 0.98 (95% CI, 0.97–0.99) for AC and 0.96 (95% CI, 0.95–0.98) for FL). Intraobserver 95% limits of agreement (LoA) of ultrasound measures for HC, AC and FL were ± 3.3%, ± 5.6% and ± 6.2%, respectively; the corresponding values for interobserver LoA were ± 4.4%, ± 6.0% and ± 5.6%. The SD distribution of triplicate measurements for all biometric variables showed excessive variability for three of 31 sonographers, allowing prompt identification and retraining. Conclusions Qualitative and quantitative QC monitoring was feasible and highly reproducible in a large multicenter research study, which facilitated the production of high‐quality ultrasound images. We recommend that the QC system we developed is implemented in future research studies and clinical practice.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Cavallaro, A. , Ash, S. T., Napolitano, R. , Wanyonyi, S. , Ohuma, E. O., Molloholli, M. , Sande, J. , Sarris, I. , Ioannou, C. , Norris, T. , Donadono, V. , Carvalho, M. , Purwar, M. , Barros, F. C., Jaffer, Y. A., Bertino, E. , Pang, R. , Gravett, M. G., Salomon, L. J., Noble, J. A., Altman, D. G. and Papageorghiou, A. T. (2018), Quality control of ultrasound for fetal biometry: results from the INTERGROWTH‐21st Project. Ultrasound Obstet Gynecol, 52: 332-339, which has been published in final form at http://doi.org/10.1002/uog.18811. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Keywords: fetal growth, pregnancy, quality control, reproducibility, variability, Obstetrics & Reproductive Medicine, 1114 Paediatrics And Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
4 September 2018Published
26 July 2018Published Online
5 July 2017Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
UNSPECIFIEDBill and Melinda Gates Foundationhttp://dx.doi.org/10.13039/100000865
PubMed ID: 28718938
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109161
Publisher's version: https://doi.org/10.1002/uog.18811

Actions (login required)

Edit Item Edit Item