To make a preliminary survey on department of ultrasound in various hospitals and probe into the major problems faced by ultrasonic quality management.

For ultrasound departments of various types at various levels, the Ultrasonic Medical Quality Control Center of Liaoning Province has issued ultrasonic quality baseline survey forms in March 2021. The investigation period was from January 1 to December 31, 2020. The contents included general information of sonographers, examining items conducted, the average number of ultrasound examinations per year, the ratio of the number of sonographers to the number of diagnostic equipment, ultrasound appointment time for an inpatient examination, the number of critical value report, the positive rate of ultrasonic report, the coincidence rate of ultrasound diagnosis, etc. The ultrasonic quality control indicators in hospitals of different levels were compared by chi-square test or one-way ANOVA.

The questionnaires were returned from 141 hospitals in 14 prefecture-level cities in Liaoning Province, including 48 tertiary grade A hospitals, 20 tertiary grade B hospitals, 42 secondary grade A hospitals, 5 secondary grade B hospitals, and 26 other hospitals. There existed a significant difference in the average number of sonographers and their age (＞45 years old), titles (senior and junior titles), and education background in hospitals at different levels (P＜0.05). The differences in the ultrasound examination number of outpatients, emergency room visits, physical examinations, and inpatient numbers at various levels of hospitals were statistically significant (P＜0.05). The number of examinations performed is highest in tertiary grade A hospitals and lowest in secondary grade B hospitals. Besides, hospitals at all levels showed a significant differences in the average ultrasound appointment time for inpatients (P＜0.05). Among the quality control indicators of ultrasound examination, the difference in the positive rate of ultrasound reports in hospitals at various levels was statistically significant (P＜0.05), with the positive rate of ultrasound reports in tertiary grade A hospitals being the highest [(78.3±23.6)%]; in terms of the coincidence rate of ultrasound diagnosis among hospitals at various levels, the difference was statistically significant (P＜0.05). The coincidence rate of ultrasound diagnosis in secondary grade B hospitals [(65.6±11.2)%] was significantly lower than those of other hospitals.

There are obvious differences in many quality control indicators in the ultrasound department of hospitals at various levels in Liaoning Province. The Ultrasonic Medical Quality Control Center should formulate relevant quality control policies and carry out relevant quality control work based on the baseline survey results, so as to facilitate the normalization, standardization, and homogenization of ultrasound diagnosis and treatment in Liaoning Province.

To investigate and analyze the present situation and possible problems of ultrasonic quality control in tertiary hospitals of traditional Chinese medicine (TCM) in Anhui Province, China.

Anhui Ultrasonic Medical Quality Control Center issued the 2019 quality questionnaire to 48 public tertiary hospitals in Anhui Province, China, including 10 TCM hospitals and 38 general hospitals. Seven ultrasonic quality control indicators from the 2018 Ultrasonic Medical Professional Quality Management Control Target Expert Consensus, and the development of ultrasonic subgroups in the hospital were compared between the two groups.

The average numbers of daily ultrasound examinations and annual critical value report cases in TCM hospitals were less than those in the same level general hospitals (210.9 person-time/day vs 482.5 person-time/day; 12 cases vs 44 cases). In terms of the development of ultrasonic subgroups including interventional ultrasound subgroup and musculoskeletal subgroup, there was also a significant difference between TCM hospitals and general hospitals (30.0% vs 89.4%; 10.0% vs 63.2%).

There is a difference in the development of ultrasonic subgroups groups and ultrasound new technology between TCM hospitals and general hospitals in Anhui Province, China. Developing suitable new ultrasound technology and improving the ultrasound medical education in TCM universities may promote the improvement of ultrasound quality control in TCM hospitals.

To explore the quality control effect of the Deming cycle method by comparing the core ultrasound quality control indicators of Beijing sentinel hospitals in 2017 and 2019.

We developed quality control indicators at the structure, process, and result levels, and conducted Deming cycle management through quality control training, single disease quality control, and on-site quality control guidance. Structure and process quality control indicators in 71 hospitals in Beijing were compared between 2017 and 2019 by the rank sum test. Result quality control indicators were compared by paired sample t test.

Based on the Deming cycle management, Beijing had an average of 1.18 (0.92, 1.58) sonographers per 10,000 patients in 2019, which had a 11.94% decrease compared with that in 2017 [1.34(1.01, 2.31) persons/10,000 person-times]. In 2019, the average daily workload of sonographers in Beijing was 33.85 (25.59, 43.36) person-times, which exhibited an increase of 13.36% compared with that in 2017 [29.86 (17.86, 39.65) person-times]. The average positive rate of ultrasound in 2019 was (0.72±0.19), which was significantly higher than that in 2017 (0.56±0.23, t=-4.021, P＜0.001). In 2019, the average coincidence rate of ultrasound diagnosis was (0.84±0.09), which had an increase of 3.70% compared with that in 2017 (0.81±0.14).

The implementation of the Deming cycle improves the core quality control indicators, such as the coincidence rate of ultrasound diagnosis, though ultrasound workload increases.

To explore the main problems in ultrasound departments of secondary and tertiary hospitals in Dongguan according to their basic situations and quality control indexes.

Basic situations and quality control indexes of ultrasound departments were surveyed and analyzed in 21 secondary hospitals and 31 tertiary hospitals in Dongguan, China from January 1, 2020 to December 31, 2020. The differences of basic situations (staff of ultrasound departments, age of ultrasonic doctors, professional title of ultrasonic doctors, and educational qualification of ultrasonic doctors) were compared between secondary hospitals and tertiary hospitals by using by chi-square test. The rank sum test was used to compare the differences of quality control indexes (structural quality indexes, process quality indexes, and result quality indexes) between secondary hospitals and tertiary hospitals.

Regarding basic situations, there were statistically significant differences in the staff of ultrasound departments, age of ultrasonic doctors, and educational qualification of ultrasonic doctors between secondary hospitals and tertiary hospitals (χ²=15.499, 8.418, and 95.375, P=0.001, =0.038, and ＜0.001, respectively). However, the professional title of ultrasonic doctors had no statistically significant difference (χ²=3.674, P＞0.05). With regard to quality control indexes between secondary hospitals and tertiary hospitals, structure quality indexes including the average daily ultrasound examination amount in outpatients, emergency cases, cases of physical examination, cases of in-hospital ultrasound examination, and the ratio between the number of ultrasonic doctors and patients [183.94 (107.14, 266.11) patients/day vs 383.85 (174.19, 557.50) patients/day; 19.02(6.03, 25.37) patients/day vs 24.72 (5.32, 36.51) patients/day; 27.66 (8.76, 36.90) patients/day vs 50.94 (30.29, 115.29) patients/day; 49.55 (32.96, 69.94) patients/day vs 84.80 (43.76, 303.47) patients/day; 1.24 (0.96, 1.64) per ten thousand patients vs 0.89 (0.79, 1.18) per ten thousand patients] exhibited statistically significant differences (U=176.000, 141.00, 141.000, 196.000, and 203.000, P=0.005, 0.002, 0.002, 0.016, and 0.022, respectively), while the ratio between the number of ultrasonic doctors and diagnostic instruments had no statistically significant difference (U=265.000, P＞0.05). For process quality indexes, neither the average inpatient ultrasound appointment time nor the cases with ultrasound critical value report showed a statistically significant difference (U=313.000 and 239.500, respectively, P＞0.05). Regarding result quality indexes, the compliance rate of ultrasound diagnosis [90.00% (78.50%, 92.10%) vs 90.85% (88.00%, 95.00%)] had a statistically significant difference (U=150.000, P=0.038), but the positive rate of ultrasound reports had no statistically significant difference (U=301.000, P＞0.05).

In order to solve the main problems that ultrasonic doctors are urgently needed in tertiary hospitals and poorly educated in secondary hospitals in Dongguan, the ultrasound departments should recruit new staff and reeducate them after graduation. In the future, the government should formulate policies to improve the quality of ultrasound departments based on their own characteristics.

To explore the application of PDSA cycle in the quality control of ultrasonic detection of fetal middle cerebral artery (MCA) blood flow spectrum.

(Plan) Three hundred images of fetal MCA blood flow spectrum obtained in Chongqing Health Center for Women and Children from July 2019 to December 2019 were evaluated according to the quality control standard. The percentage of grade A images ＞95% was the goal of quality improvement. The formulation of improvement measures was based on the existing problems. (Do) The improvement measures were implemented from January to June 2020. (Study) Five hundred MCA blood flow spectrum images of the same period were evaluated. The image scores before and after quality control were analyzed. The proportions of grade A standard images before and after PDSA cycle were analyzed by chi-square test. (Action) Continuous improvement and follow-up feedback were used to determine the stage improvement results.

MCA bloodstream spectrum grade A images accounted for 81.0% (243/300) before and 96.8% (484/500) after the implementation of PDSA cycle. The image quality was significantly improved after the implementation of PDSA cycle (χ2=24.793, P＜0.01). Before improvement, the image deficiency items mainly included the angle between the acoustic beam and blood flow (19.35%), the absence of diastolic blood flow (18.75%), and the position of the sampling frame (14.29%). The main defects of the improved images were the angle between the acoustic beam and blood flow (22.83%), images of the Willis arterial ring (16.30%), and the size of the sampling volume (15.22%). The results showed that the training on the adjustment of the parameters of diastolic low speed blood flow measurement was effective, but the examinees did not pay attention to the blood flow image, measurement angle and sampling volume when the spectrum waveform was normal.

The application of PDSA cycle effectively improves the image quality of MCA blood flow spectrum, which is worthy of being used as a quality control tool in the process of establishing the quality control system of ultrasonic detection of single diseases.

To investigate the effect of quality control circle (QCC) activity in improving the image quality control of the nuchal translucency (NT) ultrasound in women at 11-13⁺⁶ weeks of pregnancy.

The QCC activity was carried out from August 2020 to April 2021 at Department of Ultrasound, Guangdong Women and Children Hospital. The theme of the selected activity was determined to be"improving the image quality control of the NT ultrasound in the 11-13⁺⁶ weeks of pregnancy". Afterwards, a plan was developed to grasp the current situation. The ultrasound image quality of 14 992 patients who had undergone NT ultrasound examination at 11~13⁺⁶ weeks of pregnancy were collected and retrospectively analyzed from August 2019 to April 2020. The ultrasound examination at 11-13⁺⁶ weeks of pregnancy by the same ultrasound physician was scored by three deputy chief or above physicians to assess whether the ultrasonic images met the standard. Then, the activity goal was set, and the countermeasures were proposed. Based on the data, the goal and measures were determined, confirmed, and implemented continuously from August to September 2020. The image quality control of the NT ultrasound at 11-13⁺⁶weeks of pregnancy before the implementation of the measures (from August to April 2018) was compared with that after the implementation of the measures (from October to April 2019) by χ² test.

After the implementation of QCC activity, statistical analysis showed that 92.1% (10 576/11 482) of cases had NT ultrasound images that met the standard, which was significantly higher than that before the implementation of QCC activity (84.9%, χ²=0.000, P<0.001).

QCC activity can effectively improve NT ultrasound images at 11-13⁺⁶ weeks of pregnancy and the professional quality management ability of ultrasonic medicine.

To explore the application of the Model for Improvement (MFI) in the procedure of preoperative diagnosis of breast ultrasound.

Consecutive patients with breast lesions who had a preoperative diagnosis by breast ultrasound were divided into either a study group (50 patients, from July to October 2019) or a control group (50 patients, from January to April 2019). In the study group, MFI was developed and used, which involved a series of actions such as on-site review by specialized doctors, training enhancement of specialized doctors, improvement of appointment procedures, etc. In the control group, no intervention was performed. The diagnostic accuracy rate, rate of undetermined diagnosis, appointment time, and number of hospital visits were compared between two groups.

The diagnostic accuracy rates of the study and control groups were 91.7% and 70.5%, and the rates of undetermined diagnosis were 4.0% and 12.0%, respectively, with significantly statistical differences between the two groups (P＜0.05). The appointment time of the study and control group was (0.58±0.99) days and (5.76±2.35) days, and the number of hospital visits was 1.38±0.63 and 2.52±0.67, respectively, with significantly statistical differences between the two groups (P＜0.05).

MFI can optimize the procedure of preoperative diagnosis of breast ultrasound, make full use of the limited medical resources, and benefit more patients.

To investigate the current situation of quality control management of ultrasonic medicine in Sichuan Province, China, and to establish a basis for exploring more efficient management strategies.

The basic data of ultrasonic quality control (qualification of ultrasound doctors, proportion of ultrasound equipment, operation capacity, and total score of quality control management) of 708 medical institutions in Sichuan Province, China were collected from January 1 to December 31, 2018. The χ² test was used to compare the differences of academic qualifications, professional title, age distribution, and qualification of ultrasound personnel among different levels of hospitals. The rank sum test was used to compare the differences of various indexes of inter-hospital workload (staff-patient ratio, daily average numbers of outpatients, inpatients, and emergency examinations, and daily average number and positive rate of ultrasonic reports). ANOVA was used to compare the differences of quality control management comprehensive scores among cities and different levels of hospitals.

The survey included 65 third-grade class-A hospitals, 95 third-grade class-B hospitals, 182 second-grade class-A hospitals, 94 second-grade class-B hospitals, and 271 medical institutions of other levels. The differences in the ratio of educational background (χ²=1631.46, P＜0.001), the composition of professional titles (χ²=797.622, P＜0.001), age composition (χ²=113.161, P＜0.001), and the holding rate of doctors' certificate (χ²=11.813, P=0.027) were statistically significant among different levels of hospitals. With the decrease of hospital grade, the proportion of imported equipment decreased gradually, and the proportion of domestic equipment and equipment under 10 years increased gradually. The difference in staff/patient ratio was not statistically significant (third-grade class-A 1.38 (1.04, 2.06), third-grade class-B 1.49 (1.15, 1.90), second-grade class-A 2.00 (1.49, 2.80), second-grade class-B 2.88 (1.90, 5.39), and others 3.99 (2.331, 8.42), H=1.775, P=0.132), though there was an upward trend with the decrease of hospital grade. There were statistically significant differences in the daily average numbers of outpatients, inpatients, and emergency examinations, as well as daily average number of examinations among different hospital grades (H=50.429, 45.232, 34.956, and 73.633, respectively, P＜0.001); the results showed that with the decrease of hospital grade, the trend was downward. The total score of quality control management among different cities and states of medical treatment were statistically significant (F=5.187, P＜0.001). The total score of quality control management among different grades of medical institutions was also statistically significant (F=98.189, P＜0.001).

Because there are differences in quality control management of ultrasonic medicine specialty among different levels of medical institutions in Sichuan Province, the evaluation system based on the hospital level is conducive to carrying out efficient quality control management.

By analyzing the learning curve of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules that was conducted by six doctors at the ultrasound department, we aimed to obtain the number of cases that beginners need to perform to achieve the average and stable level of US-FNAB, so as to effectively control the quality of US-FNAB of thyroid nodules.

A total of 6147 thyroid nodules that underwent US-FNAB (performed by 6 doctors; Dr1 and Dr6 were experienced doctors, and Dr2-Dr5 were inexperienced doctors) were retrospectively studied between March 2011 and November 2014 at West China Hospital, Sichuan University. To evaluate the operator's diagnostic inadequacy over time, the procedures were chronologically subdivided into several consecutive groups of 100 cases each. Yields of US-FNAB were divided into two levels according to the classification standard of the Bethesda system: adequacy and inadequacy. The learning curve was plotted based on the inadequate diagnostic rate of US-FNAB according to every group data of each doctor. The average rate of diagnostic inadequacy for the 6147 thyroid nodules was analyzed. Then, the inadequate diagnostic rates for the first 100 (F100) and second 100 cases (S100) for each doctor from Dr2 to Dr5 was analyzed, respectively. Pearson Chi-Square test was used to compare the inadequate diagnostic rate between the average rate of diagnostic inadequacy for the 6147 thyroid nodules and the F100 and S100 of four doctors (Dr2-Dr5), respectively.

The rates of non-diagnostic procedures for each group from Dr1 to Dr6 were: Dr1 (17 groups): 25%, 23%, 17%, 17%, 14%, 15%, 24%, 14%, 12%, 7%, 8%, 9%, 6%, 10%, 11%, 16%, and 8%; Dr2 (5 groups): 40%, 27%, 24%, 21%, and 13%; Dr3 (10 groups): 22%, 9%, 20%, 23%, 13%, 17%, 14%, 11%, 10%, and 15%; Dr4 (15 groups): 21%, 22%, 28%, 26%, 22%, 29%, 24%, 19%, 14%, 20%, 8%, 11%, 11%, 9%, and 4%; Dr5 (8 groups): 39%, 24%, 13%, 21%, 12%, 13%, 8%, and 9%; Dr6 (4 groups): 13%, 15%, 5%, and 9%. The average rate of diagnostic inadequacy for the 6147 thyroid nodules was 16.04%. The inadequate diagnostic rates of the F100 cases and the S100 cases for each doctor from Dr2 to Dr5 were: Dr2: 40% and 27%; Dr3: 22% and 9%; Dr4: 21% and 22%; Dr5: 39% and 24%. The inadequacy rate of the F100 cases in Dr2 and Dr5 was significantly higher than the average rate of diagnostic inadequacy for the 6147 thyroid nodules (Dr2: χ²=14.286, P<0.001; Dr5: χ²=13.266, P<0.001). There was no difference in inadequate diagnostic rates between the S100 cases in each doctor from Dr2 to Dr5 and the average rate of diagnostic inadequacy for the 6147 thyroid nodules (P>0.05).

The learning curve of US-FNAB of thyroid nodules for beginners has been drawn and observed. According to the training amount that beginners require to achieve the average and stable level of US-FNAB, we can determine the time accurately when beginners could perform US-FNAB of thyroid nodules independently. In this way, we can get an effective method to manage the quality of US-FNAB of thyroid nodules.

To analyze the current status of quality control of ultrasound medicine in Ningbo.

The Ningbo Ultrasound Basic Situation Questionnaire was issued by e-mail to investigate the current situation of Ultrasound Department in Ningbo medical institutions at all levels. The status of ultrasound medical quality before and after the establishment of quality control in Ningbo was analyzed, including personnel, equipment, business, training, and quality control.

Most hospitals faced a shortage of personnel both before and after quality control, but the qualifications of ultrasound doctors were significantly higher than those before quality control. Some hospitals faced the problem of an insufficient number of machines both before and after quality control, but the use of machines by operators was greatly improved. The number of grants obtained after quality control was significantly increased compared with that before quality control. After the establishment of quality control, two rounds of ultrasound quality control training were conducted by Ningbo Ultrasound Quality Control Center each year; each county and city has set up their own quality control centers, and most of the tertiary hospitals had booking functions.

Ningbo Ultrasound Quality Control Center, based on the current status of ultrasound quality in Ningbo, accurately grasps the development direction of ultrasound medicine to facilitate the healthy development of ultrasound medicine to the maximum extent.

To evaluate the feasibility and validity of teaching training for ultrasound rapid diagnosis of common trauma in primary health care institutions.

A total of 89 trainees from primary health care institutions received a 4-day intensive training, of whom 81 (91.0%) had little or no prior ultrasound training experience. The theory teachers were ultrasound experts with a professional title above deputy senior level, and the skill teachers were ultrasound residents who were skilled in ultrasound rapid diagnosis technology. The teaching was mainly based on theory teaching and practical hand-in-hand teaching with the purpose of letting the trainees learn to diagnose common emergency and trauma by ultrasound. After the training, all trainees took theoretical knowledge written exam (centesimal system) and skill operation test, and the assessment results were analyzed.

The participation rate of 89 trainees was 100%. After the training, the mean score of 81 trainees without ultrasound experience was (93.7±5.0), and that of 8 trainees with ultrasound basis was (95.5±3.0). The difference between the two groups was not statistically significant (t=1.55, P>0.05). The results showed that there was no difference in the mastery of the theoretical knowledge of ultrasound rapid diagnostic techniques for common trauma, even if the trainees had little or no prior ultrasound training experience. Among the 81 trainees without ultrasound experience, the rate of excellence in practical operation test was 76.5% (62/81), and the rate of goodness was 23.5% (19/81). Among the 8 trainees with ultrasound basic, the rate of excellence in practical operation test was 75.0% (6/8), and the rate of goodness was 25.0% (2/8). The difference between the two groups was not statistically significant (χ²=0.01, P>0.05). It showed that through training, trainees without ultrasound knowledge can basically master the operation essentials of ultrasound rapid diagnostic techniques for common trauma as well as those with basic ultrasound knowledge.

Through the training, the trainees of primary health care institutions can quickly master the theoretical knowledge and the practical skills of ultrasound rapid diagnostic techniques for common trauma.