To explore the application value of deep learning algorithms in quality control of the 11 standard fetal cardiac views.
Methods
Images of fetal echocardiography were collected from seven hospitals, of which a total of 35331 images were selected from fetuses between 20 and 34 weeks of gestation.Based on the 11 standard fetal cardiac views recommended by fetal echocardiography guidelines, a novel automatic quality control method integrating transformer-based techniques was proposed to assess image quality.Using expert evaluation as the reference standard, the collected images were divided into two datasets: dataset A (24 000 images) for model training, and dataset B (11 331 images) for both deep learning-based prediction and manual quality assessment by two physicians with five years of clinical experience.Average precision (AP) was used as the primary metric to evaluate model performance.
Results
The transformer-based automatic quality control method achieved an AP of 0.885 in recognizing anatomical structures in fetal cardiac views, demonstrating accurate identification of key anatomical features required in standard fetal echocardiography.The deep learning model processed each image in approximately 0.028 seconds, while the two experienced physicians took an average of 3.77 seconds per image.Thus, the deep learning-based approach was 134.6 times faster than manual evaluation.
Conclusion
The application of deep learning models for quality control of fetal echocardiographic views can achieve expert-level performance while significantly reducing the time required for manual quality assessment.
To retrospectively analyze the implementation measures and effectiveness of the provincial and municipal ultrasound professional quality control centers in Jiangxi Province, in accordance with the national and provincial “Action Plan for Comprehensively Improving Medical Quality (2023-2025)”.
Methods
In terms of implementation measures, annual activities were structured in three phases: initial deployment at year-start, including organized study of the action plan; year-round implementation through close collaboration between provincial and municipal ultrasound quality control centers; and year-end summary and experiencesharing sessions.Regarding effectiveness analysis, nonparametric independent samples tests were used to compare 10 key ultrasound quality control indicators from 2023 and 2024 across Jiangxi Province.
Results
The Jiangxi Provincial Ultrasound Quality Control Center formulated 57 sets of rules and regulations, established 7 sets of quality control indicators and standards for same-level and same-type medical institutions in Jiangxi, conducted one annual provincial-level ultrasound medical quality control training program, and organized 11 municipallevel training sessions annually, achieving full coverage of all municipal ultrasound quality control centers across the province.Outcome indicators (2024 vs 2023) are as follows: there were significant improvements in ultrasound diagnostic accuracy rate [90.9(85.0, 95.0)% vs 87.5(86.0, 92.7)%, Z=2.45, P=0.014] and rate of BI-RADS classification application for breast lesion reports [99.3(95.0, 100)% vs 95.0(95.0, 100)%, Z=3.19,P＜0.001]; non-significant improvements (P＞0.05) in positive rate of outpatient/emergency ultrasound reports;significant declines in completion rate of inpatient ultrasound examinations within 48 hours [100(98.5, 100)% vs 100(100, 100)%, Z=-4.80, P＜0.001], detection rate of major lethal fetal malformations in ultrasound screening[0(0, 0)% vs 0(0, 0)%, Z=-7.05, P＜0.001], and ultrasound report documentation compliance [97.0(95.0, 98.2)% vs 98.1(95.0, 100)%, Z=-4.72, P＜0.001]; and non-significant declines (P＞0.05) in 10-minute notification rate for ultrasound critical values, ultrasound equipment quality inspection rate, positive rate of inpatient ultrasound reports, and average monthly workload per ultrasound physician.
Conclusion
The close collaboration between provincial and municipal ultrasound quality control centers in Jiangxi Province during 2024 demonstrates initial improvement in ultrasound medical quality.
To explore the role of promotion of standardized thyroid ultrasound examination and C-TIRADS classification in improving the diagnostic concordance rate of thyroid ultrasound examinations in secondary and primary healthcare institutions in Haidian District, Beijing.
Methods
From July 2023 to June 2024, the Ultrasound Medical Quality Control and Improvement Center of Haidian District, Beijing conducted a one-year program of training and promotion of standardized thyroid ultrasound examination and C-TIRADS classification among secondary and primary healthcare institutions in Haidian District, Beijing.Both at baseline and after training, an online questionnaire survey was used to investigate the usage of C-TIRADS classification and the diagnostic concordance rate of thyroid ultrasound examinations in the involved institutions.The t-test was employed to compare the differences in diagnostic concordance rates between secondary and primary hospitals, as well as before and after training.
Results
A total of 59 valid questionnaires were finally included.At baseline, the usage rate of C-TIRADS classification was 30.5% (18/59); after training, it increased to 66.1% (39/59).At baseline, the overall diagnostic concordance rate of thyroid ultrasound examinations was 80.6%±11.7%.The diagnostic concordance rate in secondary hospitals was significantly higher than that in primary hospitals [(88.8%±9.4%) vs (78.8%±11.5%),t=3.064, P=0.007].After training, the overall diagnostic concordance rate of thyroid ultrasound examinations was 83.5%±7.6%.The diagnostic concordance rate in secondary hospitals remained significantly higher than that in primary hospitals [(88.9%±6.5%) vs (82.2%±7.4%), t=2.987, P=0.009], and the concordance rate in primary hospitals significantly increased compared with the baseline level (t=-2.453, P=0.018).
Conclusion
The Ultrasound Medical Quality Control and Improvement Center of Haidian District, Beijing has successfully increased the usage rate of C-TIRADS classification for thyroid nodules in secondary and primary hospitals in Haidian District, Beijing, significantly improving the diagnostic concordance rate of thyroid nodule ultrasound in primary hospitals.These efforts are beneficial for the establishment of a tiered diagnosis and treatment pattern.
To assess the clinical utility of the Ovarian-Adnexal Reporting and Data System (O-RADS) in ultrasound diagnosis of ovarian tumors and its impact on core quality metrics using the Plan-Do-Study-Act (PDSA) cycle framework.
Methods
We retrospectively analyzed 1790 ovarian tumor cases from Chongqing Maternal and Child Health Hospital (2021-2024), comparing pre-implementation(2021-2022, n=858) and post-implementation (2023-2024, n=932) cohorts following O-RADS adoption.The PDSA intervention addressed three baseline deficiencies: inconsistent terminology (28.79%),missing key imaging planes (27.04%), and diagnostic uncertainty (13.98%), with targets set for ＞95%achievement in standardization, completeness, and diagnostic clarity.Implementation involved O-RADSaligned terminology, standardized imaging protocols, and structured reporting templates.Post-intervention quality metrics were statistically compared using χ2 tests.
Results
Standardized ultrasound diagnosis for ovarian tumors significantly improved quality control metrics, with reporting rates, image completeness,and diagnostic certainty reaching 95.06%, 97.5%, and 95.17%, respectively—all exceeding improvement targets.These values represent statistically significant increases of 23.85%, 24.54%, and 9.15% compared to baseline measurements (χ2=185.66, 220.79, and 44.77, respectively, P＜0.001 for all comparisons).
Conclusion
The systematic application of PDSA cycle management combined with O-RADS classification significantly improves the standardization of ultrasound diagnosis for ovarian tumors, validating the model’s efficacy in single-disease ultrasound quality control.
To explore the application value of the plan-do-check-act (PDCA ) cycle in enhancing the quality of peripheral vascular ultrasound reports (including textual and imaging components)generated by resident physicians in the ultrasound department.
Methods
The PDCA cycle was implemented from January to July 2023.Peripheral vascular ultrasound reports produced by resident physicians were randomly sampled monthly from the Ultrasound Medical Imaging Information System of the Third Central Hospital of Tianjin.These reports were evaluated for textual clarity, image quality, and diagnostic accuracy.We set an improvement target of 95% or more for category A image and text reports and established a continuous quality improvement team to analyze deficiencies and develop corrective measures for substandard reports.After the implementation of the improvement measures from August to December 2023, the image and text scores were rescored.A chi-square test was used to compare the differences in image and text report scores and deficiency items before and after implementation.The improvement results were assessed through ongoing training implementation,discussion within the department, and feedback from resident physicians.
Results
Prior to PDCA implementation,category A images accounted for 66.3% (130/196) of reports, and category A reports constituted 44.9% (88/196).After PDCA intervention, category A images significantly increased to 95.8% (92/96), and category A reports improved to 78.1% (75/96).The enhancements in both image and report quality were statistically significant(χ2=30.797, P＜0.01; χ2=28.849, P＜0.01).After implementing the PDCA cycle, image and report deficiencies were significantly reduced (45 vs 102; 59 vs 164), and the ability of instrument adjustment, disease diagnosis and description, and standardized image storage were improved.
Conclusion
The PDCA cycle effectively improves the quality of peripheral vascular ultrasound reports.
To evaluate the efficacy of the PDCA (Plan-Do-Check-Act) cycle method in improving the quality control indicators of breast ultrasound diagnosis.
Methods
This study was performed at the Ultrasound Department of Xiamen Third Hospital, where the PDCA cycle method was introduced into the breast ultrasound diagnosis quality control system starting in January 2024 to manage quality control.A retrospective analysis was performed on breast ultrasound quality control indicators before (January-December 2023) and after (January-December 2024) implementing the PDCA cycle method.The indicators included: the rate of Breast Imaging Reporting and Data System (BI-RADS) classification in breast lesion ultrasound reports, the diagnostic accuracy rate of breast masses by ultrasound, the qualification rate of breast ultrasound report writing, and the qualification rate of breast ultrasound image sections.The Mann-Whitney U non-parametric test was used to compare the differences in these indicators before and after PDCA implementation.
Results
After implementing the PDCA cycle method, the BIRADS classification rate (85.22% vs 67.01%), the diagnostic accuracy rate of breast masses (80.49% vs 71.79%), and the qualification rate of image sections (80.06% vs 60.12%) all showed significant improvements compared to those of the pre-implementation period (Z=-3.984, P＜0.001; Z=-2.288, P=0.020; and Z=-4.025, P＜0.001, respectively).The qualification rate of report writing increased slightly from 97.92% to 98.51%, but this difference was not statistically significant (P＞0.05).
Conclusion
The PDCA cycle method significantly optimizes core quality indicators for breast ultrasound examinations, demonstrating particularly notable effects in standardizing classification reporting and image acquisition.This method can effectively advance the standardization process in breast ultrasound diagnosis.
To evaluate the value of quality control circle in improving the accuracy of ultrasound diagnosis of uterine fibroids.
Methods
The Department of Ultrasound Imaging of Zhuhai People’s Hospital launched a quality control circle activity in September 2022.After establishing a theme and plan for the activity, physicians were divided into three groups based on their professional titles: junior,intermediate, and senior.Six physicians were randomly selected from each group, totaling 18 physicians.Cases of uterine fibroids diagnosed by these physicians between April 2021 and September 2022 were collected and verified against surgical records and postoperative pathology.Diagnostic accuracy and classification rates were statistically analyzed, while diagnostic errors were categorized and investigated.Countermeasures were formulated, and activity goals were established.From October 2022 to March 2024,continuous quality control circle activity was implemented.Post-intervention diagnostic accuracy rates,target achievement rates, and improvement rates were statistically analyzed.Pre- versus post-intervention diagnostic accuracy rates were compared using the Wilcoxon test.
Results
Following quality control circle activity implementation, diagnostic accuracy rates increased relative to pre-intervention values (43.8%-66.7% vs 46.2%-81.8%), with a target achievement rate of 53.2% and improvement rate of 14.7%.Diagnostic accuracy significantly increased across all professional tiers (junior: 46.2%-58.6% vs 40.0%-50.0%,Z=-2.032, P=0.042; intermediate: 55.3%-72.3% vs 40.0%-53.8%, Z=-2.214, P=0.027; senior: 63.0%-81.8% vs 50.0%-66.7%, Z=-2.023, P=0.043).
Conclusion
Quality control circle activity implementation effectively improves the accuracy of ultrasound diagnosis of uterine fibroids.
This article systematically explores the key aspects of quality control in reproductive andrology ultrasound, integrating the clinical expertise of Peking University Third Hospital with the latest guidelines from the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group.Unlike routine scrotal ultrasound, which primarily evaluates tumors, inflammation, and other pathologies,reproductive andrology ultrasound focuses on diagnosing male infertility, with particular emphasis on anatomical abnormalities and disorders of spermatogenic and sperm transport pathways.This paper elaborates on standardized examination protocols, including equipment parameter settings, probe selection (primarily high-frequency linear array probes), and standardized scanning protocols for the scrotum, penis, and transrectal prostate.Requirements for image documentation using 2D, color Doppler, and spectral Doppler imaging are detailed, covering testicular volume measurement, varicocele assessment, and erectile dysfunction testing.Furthermore, the article proposes standardized image and reporting guidelines, emphasizing the enhancement of diagnostic accuracy through scientific quality control to meet clinical needs in reproductive medicine.This paper provides practical guidance for optimizing reproductive andrology ultrasound workflows and reducing missed diagnoses and misdiagnoses, and holds significant clinical reference value.
To comprehensively compare the efficacy, postoperative quality of life, and psychological status in patients undergoing radiofrequency ablation (RFA) versus surgical treatment for papillary thyroid microcarcinoma (PTMC), with the aim of providing clinicians with evidence for treatment decision-making and improving patients’ postoperative quality of life and psychological health.
Methods
A total of 107 patients who were diagnosed with PTMC and underwent radiofrequency ablation at the First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and March 2023 were selected and subjected to propensity score matching (PSM) with 536 PTMC patients who underwent surgical operation.Matching variables included age, nodule location, and maximum nodule volume.In the radiofrequency ablation group, the changes in nodule volume were measured by ultrasound at 1, 3, and 6 months after the operation.The χ2 test or t-test was used to compare the differences in postoperative complications, recurrence, operation and hospitalization time, changes in thyroid hormone levels, quality of life, psychological anxiety, and depression between the two groups.Additionally,multiple linear regression analysis was performed to identify the influencing factors of postoperative quality of life and psychological status.
Results
After PSM, there were 107 patients in each group.Compared with the surgical operation group, the radiofrequency ablation group had significantly shorter operation time [(30.05±5.95)min vs (57.15±7.01) min, t=-30.48, P＜0.001] and hospitalization time [(3.08±1.06) d vs (6.56±1.27) d, t=-21.79, P＜0.001], and lower hospitalization costs [(10274.92±984.88) yuan vs (14802.46±2409.91) yuan, t=-17.99, P＜0.001].There were no serious complications in either group.Three cases (2.8%) in the radiofrequency ablation group and eight cases (7.5%) in the surgical operation group had minor complications, with no statistically significant difference in the rate of complications between the two groups (P＞0.05).In terms of postoperative recurrence rate, it was 2.8% in the radiofrequency ablation group and 0.9% in the surgical operation group, with no statistically significant difference (P＞0.05).There were no significant changes in thyroid function after the operation in the radiofrequency ablation group, while in the surgical operation group, there was a significant increase in thyroid-stimulating hormone (TSH) and significant decrease in free triiodothyronine (FT3) and free thyroxine (FT4) (P＜0.05).There were significant differences in the nodule volume changes at 1, 3, and 6 months after the operation in the radiofrequency ablation group.The scores of physical health (PCS), mental health (MCS),and overall quality of life in the radiofrequency ablation group were significantly higher than those of the surgical operation group [(83.89±9.25) points vs (78.15±10.93) points, t=4.32, P＜0.001; (79.10±8.39) points vs(74.07±9.28) points, t=3.89, P＜0.001; (81.49±6.46) points vs (76.11±6.82) points, t=5.67, P＜0.001], and the standard scores of the Zung self-rating anxiety scale (SAS) and the Zung self-rating depression scale (SDS) in the radiofrequency ablation group were significantly lower than those of the surgical operation group [(46.75±6.57)points vs (50.34±7.66) points, t=2.22, P=0.027; (54.30±7.18) points vs (56.58±7.77) points, t=2.18, P=0.0.030].Surgical approach and SAS standard score were main factors influencing the patients’ overall postoperative quality of life (β=-7.49 and 0.84, respectively; both P＜0.001).Surgical approach, surgical costs, and PCS and MCS scores were main factors influencing the patients’ postoperative anxiety and depression levels (β=6.17, 0.00, 0.39,and 0.36; P＜0.001, =0.025, ＜0.001, and ＜0.001, respectively).
Conclusion
Ultrasound-guided radiofrequency ablation is an effective treatment for papillary thyroid microcarcinoma with less surgical trauma, reduced costs,and improved postoperative quality of life.Compared to surgical treatment, radiofrequency ablation is a safe and effective alternative, improving patients’ quality of life and psychological well-being.
To evaluate the value of contrast-enhanced ultrasound (CEUS)quantitative parameters in predicting microvascular invasion (MVI) and postoperative recurrence in hepatocellular carcinoma (HCC) patients, in order to provide a basis for clinical decision-making.
Methods
A total of 180 HCC patients admitted to Shanghai Eastern Hepatobiliary Surgery Hospital between August 2022 and August 2023 were included.Patient baseline characteristics and clinical data were collected.Based on postoperative pathology, the patients were divided into either an MVInegative group (M0) or an MVI-positive group (M1 and M2).The postoperative patients were followed until August 1, 2024, and recurrence was recorded.CEUS data including the washout ratio (WoR) of both the lesion and surrounding liver parenchyma were quantitatively analyzed.Logistic regression analysis was performed to identify independent predictors of MVI and 1-year postoperative recurrence.Receiver operating characteristic (ROC) curves were generated to evaluate predictive performance.
Results
Compared to the MVI-negative group (n=92), the MVI-positive group (n=88) exhibited significantly different tumor number (38.60% vs 20.70%; χ2=7.002, P=0.008), total bilirubin [(16.70±6.97) μmol/L vs (13.82±6.63)μmol/L; t=-2.842, P=0.008], prothrombin time [(12.45±1.24) s vs (11.76±1.32) s; t=-3.452, P=0.001],international normalized ratio [(1.04±0.11) vs (0.98±0.12); t=-3.354, P=0.002], lesion WoR [528.10(65.05, 591.82) a.u vs 996.09 (131.63, 1208.03) a.u; Z=-2.424, P=0.031], and liver parenchyma WoR[247.97 (64.5, 375.52) a.u vs 157.19 (26.55, 211.11) a.u; Z=-2.379, P=0.027].Multivariate logistic regression analysis identified tumor number (B=0.877, odds ratio (OR)=2.405, P=0.019), prothrombin time (B=0.362,OR=1.437, P=0.012), and lesion WoR (B=0.000, OR=1.000, P=0.022) as independent predictors of MVI,and their combination had an area under the ROC curve (AUC) of 0.754.Lesion WoR (B=0.000, OR=1.000,P=0.025) and liver parenchyma WoR (B=0.001, OR=1.001, P=0.042) were significantly associated with 1-year recurrence, yielding AUC values of 0.673 (95%CI: 0.568-0.778) and 0.625 (95%CI: 0.526-0.724),respectively.
Conclusion
CEUS quantitative parameters, particularly lesion WoR and liver parenchyma WoR, demonstrate significant clinical value in the preoperative prediction of MVI and postoperative recurrence in HCC patients.These findings provide critical insights for individualized surgical planning and prognostic assessment, highlighting their potential for broad clinical application.
To explore the prenatal ultrasound features and prognosis of twin anemiapolycythemia sequence (TAPS).
Methods
A retrospective analysis was conducted on 26 twins diagnosed with TAPS by prenatal ultrasound at the Women and Children’s Hospital of Chongqing Medical University from July 2017 to December 2024, focusing on their prenatal ultrasound features, treatment methods, and pregnancy outcomes.
Results
All 26 cases were monochorionic twins, and all were diagnosed with primary TAPS.Common prenatal ultrasound features included: (1) peak systolic velocity of the middle cerebral artery (MCA-PSV) > 1.5 multiples of the median (MoM) in the donor twin and < 1.0 MoM in the recipient twin; and (2) “black and white” placenta.Other ultrasound features included: (1) “starry sky” sign in the recipient twin’s liver; (2) enhanced intestinal echogenicity in the donor twin; (3) cardiac abnormalities;(4) abnormal Doppler blood flow indices; (5) fetal hydrops; (6) umbilical cord abnormalities; (7) uneven amniotic fluid volume; and (8) coexisting selective intrauterine growth restriction, twin to twin transfusion syndrome, etc.Among the 26 cases, 13 underwent radiofrequency ablation for fetal reduction (survival rate 92%), 5 underwent fetoscopic coagulation of placental vascular anastomoses (survival rate 100%), 7 received expectant management (survival rate 64%), and 1 underwent induced labor.
Conclusion
In ultrasound examinations of monochorionic twins, special attention should be paid to fetal Doppler blood flow indicators,placental conditions, liver and intestinal tract echoes, etc.The prognosis of TAPS twins without intrauterine treatment is relatively poor.Once TAPS is diagnosed, it is recommended to refer the patient to a tertiary prenatal diagnosis center with intrauterine treatment conditions for diagnosis and treatment.
To retrospectively analyze the ultrasonographic characteristics and outcomes of primary cardiac tumors (PCTs) in children.
Methods
A total of 15 infants or children with PCTs who underwent surgery and pathology examination at Children’s Hospital Affiliated to Xi ’an Jiaotong University from March 2017 to May 2024 were retrospectively included in this study.Gender, clinical symptoms, and echocardiographic results, as well as tumor location, size, pathology, and prognosis, were analyzed.
Results
Among the 15 pediatric patients included, 12 (80.0%) had benign cardiac tumors (rhabdomyoma in 6 cases,fibroma in 2, myxoma in 2, hemangioma in 1, and lipoma in 1), 2 (13.3%) had intermediate-type tumors(inflammatory myofibroblastoma in both), and 1 (6.7%) had malignant cardiac tumor (CIC rearrangement sarcoma).Patients with rhabdomyoma exhibited lower age, body weight, and maximum tumor diameter compared to other pathological subtypes.Tumor distribution analysis showed solitary lesions in 12 cases and multiple lesions in 3.In total, there were 22 lesions, and the locations were as follows: 15 lesions in the left ventricle, 4 in the right ventricle, 1 in the left atrium, 1 in the right atrium, and 1 in the pericardium.Concomitant pericardial effusion was found in 3 cases.Preoperative echocardiography findings were coincident with pathological diagnoses in 9 cases (60.0%), with 4 misdiagnoses (2 solitary rhabdomyomas misdiagnosed as myxomas; 1 pedunculated capillary hemangioma misdiagnosed as myxoma; 1 inflammatory myofibroblastic tumor misdiagnosed as myxoma), and 2 cases remained undiagnosed.Partial tumor resection was performed in 3 cases, and complete resection in 12, with no perioperative mortality.The patient with malignant cardiac tumor died 5 months after operation, and the other 14 cases were alive, with no tumor recurrence or reoperation during 0.5 to 10 years of follow-up.
Conclusion
The majority of PCTs in children are benign, some of them have specific echocardiographic manifestations, and rare types need pathological examination for diagnosis.The prognosis of benign and intermediate PCTs in children undergoing surgical resection is satisfactory.
