评估河南省妇科超声检查的开展现状及质量控制水平，分析妇科超声检查的技术推广、操作规范性及资源分配。探讨开展妇科超声检查中存在的问题，提出整改意见及建议，为优化资源配置提供依据。

采用横断面调查设计，河南省超声医学质量控制中心于2024年5月下发《对河南省妇科超声检查现状开展基线调研的通知》，调查对象为河南省已开展妇科超声检查的各级各类医疗机构。资料提交时间为2024年5月25日到6月25日。调查内容分为线上填写调查问卷和提交超声影像资料。调查问卷内容包括开展妇科超声检查的医疗机构基本信息、仪器与设备、从业人员的基本情况、妇科相关超声开展情况、2023年全年科室各种妇科超声检查工作量等。超声影像资料要求提交3例正常经腹妇科超声（TAS）检查及3例正常经阴道妇科超声（TVS）图像，每份TAS+TVS共需提交11张不同切面图像。由2名高年资妇科超声医师进行质量控制评分，内容包括提交病例是否完整、图像具体评分等。采用Kruskal-Wallis H检验比较不同级别、不同类别医院间妇科超声检查图像缺失率及图像评分的差异，差异有统计学意义的变量则进行Mann-Whitney U检验进行两两比较。采用组内相关系数（ICC）评价2名医师的组内和组间一致性。

本次调查共收到河南省256家医疗机构的调查问卷，157家医疗机构的超声影像资料（其中综合医院112家，妇幼专科医院31家，其他专科医院14家；三级甲等医院40家，三级乙等医院45家，二级甲等医院44家，二级乙等医院27家，一级医院1家）。不同级别医院之间的图像缺失率比较，差异无统计学意义（P>0.05）。对于11张正常子宫图像中，不同级别医院的经阴道子宫正中矢状切面图像质量评分比较，差异具有统计学意义（H=10.58，P=0.032），其中三级甲等医院的图像质量评分[19.00（18.00，20.00）分]明显高于二级乙等医院[18.00（16.00，20.00）分]、二级甲等医院[18.00（17.00，20.00）分]和三级乙等医院[18.00（17.00，20.00）分]，差异具有统计学意义（Z=6.91，P=0.009；Z=7.23，P=0.007；Z=4.04，P=0.044）；其他切面图像质量评分不同级别医院间差异均无统计学意义（P均>0.05）。不同类别医院间经腹左卵巢最大长轴切面图像评分比较，差异具有统计学意义（H=6.35，P=0.042），其中妇幼专科医院的图像质量评分[18.00（17.50，20.00）分]优于综合性医院[18.00（16.00，18.75）分]和其他专科医院[18.00（16.00，18.00）分]，差异具有统计学意义（Z=4.04，P=0.045；Z=4.91，P=0.027）；不同类别医院间盆底正中矢状切面图像评分比较，差异具有统计学意义（H=7.15，P=0.028），其中综合性医院的图像质量评分[18.00（14.00，19.00）分]高于其他专科医院[14.00（0.00，18.00）分]，差异具有统计学意义（Z=7.06，P=0.008）。评分者内部及之间一致性均良好（ICC>0.75）。

妇科超声检查在河南省各级医院已较为全面开展，但仍存在留存图像不完整、部分图像不标准等相关医疗质量问题。需加强基层医院技术培训和质量控制标准的落实，对部分超声检查切面进一步关注和强调。

To evaluate the current status and quality control level of gynecological ultrasound examinations in Henan Province, in order to analyze the technical promotion, operational standardization, and resource allocation of gynecological ultrasound examination; and to explore the problems existing in the implementation of gynecological ultrasound examinations and propose rectification suggestions and opinions, in order to provide a basis for optimizing resource allocation.

A cross-sectional survey design was used in this study. "Notice on Conducting a Baseline Research on the Current Situation of Gynecological Ultrasound Examination in Henan Province" was issued by Henan Province Ultrasound Medical Quality Control Center in May 2024. The survey subjects were all levels and kinds of medical institutions in Henan Province that have carried out gynecological ultrasound examinations. The survey period was from May 25 to June 25, 2024. The survey content included online questionnaire completion and submission of ultrasound image data. The survey questionnaire encompassed the following aspects: basic information about medical institutions offering gynecological ultrasound services, the equipment and instruments used, demographic and professional details of the practitioners, the scope of gynecological ultrasound examinations performed, and the annual workload statistics of various gynecological ultrasound procedures in 2023. Three cases of normal transabdominal gynecological ultrasound images and 3 cases of normal transvaginal gynecological ultrasound image data were required to be submitted. Quality control was conducted by two senior gynecological ultrasound doctors, including checking the completeness of submitted cases and image scoring. The Kruskal-Wallis H test was used to compare differences in image missing rates and quality scores among hospitals of different levels and types. For statistically significant differences, the Mann-Whitney U test was applied for further pairwise comparisons. Intra-class correlation coefficient (ICC) analysis was performed to assess intra- and inter-rater reliability between the two physicians.

A total of 256 medical institutions in Henan Province were surveyed, and ultrasound image data from 157 medical institutions (among them, there were 112 general hospitals, 31 maternal and child specialty hospitals, and 14 other speciality hospitals; there were 40 grade III-A hospitals, 45 grade III-B hospitals, 44 grade II-A hospitals, 27 grade II-B hospitals, and 1 primary hospital) were collected. There was no significant difference in the rate of missing images among different levels of hospitals (H=8.61, P=0.072). Among the 11 normal uterine images evaluated, the comparison of image quality scores for the transvaginal mid-sagittal view revealed a statistically significant difference across hospital grades (H=10.58, P =0.032). Grade III-A hospitals demonstrated significantly superior image quality compared to Grade II-B hospitals [19.00 (18.00, 20.00) vs 18.00 (16.00, 20.00), Z=6.91, P=0.009], Grade II-A hospitals [18.00 (17.00, 20.00), Z=7.23, P=0.007], and Grade III-B hospitals [18.00 (17.00, 20.00), Z=4.04, P=0.044]. No statistically significant differences were noted in the scores of other imaging planes across different hospital grades (P>0.05). A statistically significant difference was found in the image quality scores for the transabdominal long-axis view of the left ovary among different hospital categories (H=6.35, P=0.042). Maternal and child specialty hospitals achieved higher image quality scores compared to general hospitals [18.00 (17.50, 20.00) vs 18.00 (16.00, 18.75), Z=4.04, P=0.045] and other specialty hospitals [18.00 (16.00, 18.00), Z=4.91, P=0.027]. Significant differences were observed in the image quality scores for the mid-sagittal view of the pelvic floor among different hospital categories (H=7.15, P=0.028). General hospitals outperformed other specialty hospitals in image quality [18.00 (14.00, 19.00) vs 14.00 (0.00, 18.00), Z=7.06, P=0.008]. Both intra- and inter-rater consistency proved excellent (ICC>0.75).

Gynecological ultrasound examination is now widely implemented across hospitals of all levels in Henan Province. Nevertheless, persistent medical quality issues remain, such as incomplete image archiving and non-standardized imaging acquisition. Enhancing technical training in primary healthcare institutions and rigorously enforcing quality control standards are critical. Particular attention should be paid to standardizing specific ultrasound sectional views.