To analyze the causes and countermeasures of missed diagnosis and misdiagnosis of pancreatic space-occupying lesions by ultrasound.

A retrospective analysis was performed on the preoperative conventional ultrasound reports of patients with pancreatic space-occupying lesions who underwent surgery or puncture biopsy at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to December 2021. Using the pathological results as the gold standard, the patients were divided into three groups: qualified group (including cases whose ultrasound diagnosis was completely consistent with the pathological results, and those whose ultrasound only suggested "space-occupying lesions" or "further examination"), missed diagnosis group (no pancreatic space-occupying lesions were found by ultrasound, and they were diagnosed by other imaging examinations and underwent puncture biopsy or surgery), and misdiagnosis group (pancreatic space-occupying lesions diagnosed by ultrasound, but it was not in accordance with the pathological diagnosis). The general clinical data and imaging data of the three groups were collected. The t test or chi-square test was used to compare the differences in age, gender, maximum diameter of the lesion, lesion location, seniority of ultrasound doctors, and pathological nature (benign or malignant) between the three groups. The accuary of ultrasound diagnosis was improved by theory and operation training for ultrasound doctors and the establishment of a consultation system. The coincidence rate of ultrasound diagnosis to the pathological results from January to December 2021 was analyzed. The chi-square test was used to compare the difference in the coincidence rate of ultrasound diagnosis to the pathological diagnosis between before and after the implementation (the first half vs second half of 2021) of the measures.

A total of 489 patients with pancreatic space-occupying lesions (benign/malignant: 99/390, male/female: 259/230) were enrolled. There were 428 cases in the qualified group, 26 in the missed diagnosis group, and 35 in the misdiagnosis group. Compared to the qualified group, the age of patients in the missed diagnosis group was significantly older [(65.62±7.52) years vs (60.49±12.70) years, t=-2.033, P=0.043], the maximum diameter of the lesions was significantly smaller [(2.69±1.03) cm vs (3.49±1.74) cm, t=2.316, P=0.021], and the proportion of senior doctors was significantly lower (15/26 vs 342/428, χ²=7.199, P=0.007). There was no significant difference in gender, lesion location or pathological nature (benign or malignant) between the missed diagnosis group and the qualified group (P>0.05 for all). In the missed diagnosis group, 18 lesions were located in the head of the pancreas (11 in the uncinate process), and 8 were located in the body and tail of the pancreas (6 in the tail). In 5 cases, the lesions were not clearly displayed due to the interference of abdominal gas. There was no significant difference in age, gender, lesion location, maximum diameter, pathological nature (benign or malignant), or seniority of doctors between the misdiagnosis group and the qualified group (P>0.05 for all). From January to December 2021, the coincidence rates of ultrasound diagnosis of pancreatic space-occupying lesions to the pathological diagnosis were 86.54%, 86.96%, 94.59%, 88.89%, 85.71%, 68.42%, 83.93%, 92.86%, 86.84%, 94.12%, 92.86%, and 93.02%, respectively. The coincidence rate in the second half of 2021 was higher than that in the first half (89.87% vs 85.50%), but the difference was not statistically significant (P>0.05).

Conventional ultrasound has limitations in the diagnosis of pancreatic space-occupying lesions. Age of patients, lesion size and location, and seniority of doctors may lead to missed diagnosis and misdiagnosis. It is necessary to strengthen the training of doctors, establish the consultation system, and apply other combined examinations to improve the diagnostic coincidence rate.

To explore the impact of artificial intelligence (AI) ultrasound and quality control circle (QCC) activity on junior sonographers' ability to accurately estimate the risk of thyroid nodules.

From January to October 2019, 119 two-dimensional ultrasonographic images of thyroid nodules with surgical pathology outcomes were collected in our hospital. AI ultrasound in conjunction with QCC activity was used to continually enhance two junior physicians' (doctors 1 and 2) ability to assess thyroid nodule risk. The gold standard for diagnosing benign and malignant thyroid nodules was surgical pathology. The signs of thyroid nodules recognized by two senior physicians were used as the gold standard. Two junior sonographers used the 2017 American College of Radiology Thyroid Imaging Reporting and Data System Thyroid Nodules (ACR TI-RADS) to assess thyroid nodules both before and after the activity. Then, both before and after the activity, whether thyroid ultrasound examination procedures were standard, the qualified rate of image storage, and patients' trust in younger physicians were examined. Receiver operating characteristic (ROC) curves for benign and malignant thyroid nodules were plotted before and after the activity, and the DeLong test was used to compare the difference in diagnostic efficiency between the two junior sonographers. The McNemar test was used to compare the recognition accuracy of the two junior sonographers (doctor 1 and doctor 2) for thyroid nodule ultrasound signs before and after the activity.

The two young doctors' ability to identify the echo of thyroid nodules was increased by the use of AI ultrasound (doctor 1: 47.90% vs 53.78%, P=0.031; doctor 2: 45.38% vs 53.78%, P=0.004). Doctor 2's ability to recognize thyroid nodules' component (69.75% vs 80.67%, P=0.004), shape (58.82% vs 63.87%, P=0.021), and punctate hyperechogenicity (52.10% vs 56.30%, P=0.031) was similarly enhanced at the same time. The AUC values of the two junior doctors for diagnosing thyroid nodules were significantly higher after QCC activity than before (doctor 1: 0.878 vs 0.921, P=0.036; doctor 2: 0.824 vs 0.883, P=0.001). The qualified rate of image storage grew from 50% to 90%, the qualified rate of thyroid ultrasound examination by junior physicians improved from 60% to 95%, and the patients' trust in junior physicians increased from 70% to 90% as a result of QCC activity.

AI ultrasound combined with QCC activity can improve the ability of junior sonographers to assess the malignant risk of thyroid nodules in an all-round and multi-dimensional way, and improve the quality of medical services.

To obtain the true status of quality control for transthoracic echocardiography image archiving and reports in medical institutions of all levels in various regions of China, in order to provide guidance for quality control work.

The "Cardiac Ultrasound Quality Control Working Group" conducted a nationwide survey questionnaire on the quality control of transthoracic echocardiography image archiving and reports.

The two-dimensional views with an image archiving rate of over 80% in conventional transthoracic echocardiography included apical four chamber view (A4C; 98.97%), parasternal long-axis view of the left ventricle (PLAX-LV; 98.65%), parasternal short-axis view of the aortic valve (PSAX-AV; 96.66%), parasternal long-axis view of the pulmonary artery (PLAX-PA; 87.96%), apical five chamber view (A5C; 87.19%), and parasternal short-axis view of the mitral valve (PSAX-MV; 83.63%). The Doppler sections with an image archiving rate of over 80% included the flow and spectrum of A4C-MV (94.45%), A4C-TR (92.55%), A5C-AV (89.50%), A4C-MR (87.77%), PV (86.26%), A5C-AR (85.36%), PSAX-AV (85.07%), and PLAX-LV (83.63%), which can meet the basic requirements for displaying the structure of heart cavities and evaluating the hemodynamics of each valve. The image archiving rates of tissue Doppler imaging for the septal wall of the mitral annulus, the lateral wall of the mitral annulus, and the right ventricular free wall of the tricuspid annulus were 84.40%, 64.75%, and 25.91%, respectively, reflecting that some ultrasound physicians did not pay enough attention to the evaluation of left and right ventricular systolic function. The most common suggestions for image archiving and reporting of transthoracic echocardiography were the lack of standards for image archiving and reporting of transthoracic echocardiography for different cardiovascular diseases, as well as the need for standardized training.

This large scale research provides an important basis for the implementation of quality control work. The "Cardiac Ultrasound Quality Control Working Group" will carry out work from multiple aspects such as hardware equipment development, clinical training, cardiac single disease ultrasound quality control, and structured report templates simultaneously.

To reveal the dynamic changing trends and characteristics of key ultrasound medical quality control indicators in Sichuan Province from 2020 to 2022.

Based on the Sichuan Provincial Medical Quality Control Data Reporting Platform, we collected and analyzed data on ultrasound quality management control indicators in 21 cities or prefectures in Sichuan Province from 2020 to 2022. The basic situation of ultrasonographers in Sichuan Province as well as the structure, process, and outcome quality analysis indicators was analysed using analysis of variance (ANOVA) or non-parametric tests.

From 2020 to 2022, the average monthly workload of ultrasound physicians and the accuracy rate of ultrasound diagnosis in tertiary specialized hospitals in all cities and prefectures increased year by year, and the doctor-patient ratio in ultrasound departments decreased year by year, with the differences being statistically significant [1.75±0.93 vs 1.59±0.55 vs 1.49±0.56, F=4.11, P=0.020; 770.42±258.30 vs 965.73±323.52 vs 974.75±335.51, F=3.74, P=0.040; (0.79±0.20)% vs (0.95±0.04)% vs (0.96±0.03)%, F=7.39, P<0.001]; in contrast, there was no statistically significant difference in the above indicators in tertiary general hospitals, secondary general hospitals, and secondary specialized hospitals (P>0.05). The completion rate of ultrasound examinations within 48 hours of admission in tertiary general hospitals of all cities and prefectures increased significantly [1.00(0.98, 1.00)% vs 1.00(0.99, 1.00)% vs 1.00(0.97, 1.00)%, H=6.73, P=0.035], but there was no statistically significant difference in tertiary specialized hospitals, secondary general hospitals, and secondary specialized hospitals (P>0.05). When comparing 13 ultrasound quality control indicators in hospitals from 21 cities and prefectures in Sichuan Province in 2020, there were statistically significant differences in four ultrasound quality control indicators: doctor-patient ratio, average monthly workload of ultrasound physicians, positive rate of outpatient and emergency ultrasound reports, and ultrasound diagnostic coincidence rate (P<0.05 for all). In 2021, there were statistically significant differences in three ultrasound quality control indicators: doctor-patient ratio, positive rate of outpatient and emergency ultrasound reports, and ultrasound diagnostic accuracy (P<0.05 for all). However, in 2022, only one ultrasound quality control indicator, ultrasound diagnostic coincidence rate, had a statistically significant difference (P<0.05).

In recent years, the quality control indicators of ultrasound medicine in different cities and prefectures in Sichuan Province have been converging, and the key indicators have been continuously upgraded and improved.

To investigate the the of qualified sections and the rate of cases with qualified sections in prenatal ultrasound screening in Anhui Province, in order to promote the standardization and homogenization of prenatal ultrasound screening and prenatal diagnostic services.

The ultrasound medicine departments of all prenatal screening and/or prenatal diagnosis medical institutions in Anhui Province uploaded the cases screened in March 2023 to the prenatal ultrasound artificial intelligence assistant cloud platform in April 2024 (including at least 2 cases in the first trimester and 5 cases in the second trimester). According to the Practice guidelines for performance of prenatal ultrasound screening (2022) and Chinese expert consensus on assessment standards of obstetric ultrasound training program (2022 edition), intelligent quality control was conducted on the images uploaded by 66 hospitals. The quality control contents included the rate of qualified sections, the rate of cases with qualified sections, single section scores, and sections with lower scores.

A total of 185 cases of prenatal screening in the first trimester were encompassed. The number of cases with non-qualified sections was 91, with an average score of 80.38. The rate of qualified sections and the rate of cases with qualified sections were 40.7% and 50.8%, respectively. The sections obtaining higher scores were the transventricular section (63.8%, 118/185) and the view of nuchal translucency (58.9%, 109/185), while the sections obtaining lower scores were the transverse section of the cord insertion into the fetal abdomen (27.0%, 50/185) and the midsagittal view of the fetus (13.0%, 24/185). The section most often missed was the transverse section of the cord insertion into the fetal abdomen (71.9%, 133/185). A total of 373 cases of prenatal screening in the second trimester were encompassed. The number of cases with non-qualified sections was 265, with an average score of 85.38. The rate of qualified sections and the rate of cases with qualified sections were 54.6% and 29.0%, respectively. The sections obtaining higher scores were the longitudinal cross-section of the tibia and fibula (85.8%, 320/373) and the coronal section of the upper lip (84.2%, 314/373), while the sections obtaining lower scores were the three vessels and trachea view (66.2%, 247/373) and the longitudinal axial section of the humerus (65.4%, 244/373). The section most often missed was the transverse section of the kidneys (16.1%, 60/373).

The low standard rate and integrity rate of ultrasound prenatal screening section in Anhui Province are the common problems faced by hospitals in Anhui province. It is necessary to conduct standardized training for prenatal ultrasound doctors and strengthen quality control before and after the examination.

To analyze the current situation and regional differences of ultrasound medical quality control in Hebei Province by collecting and sorting out the quality control data of hospitals based on a quality control network platform, in order to find the problems and propose solutions.

In 2022, a total of 402 medical institutions with ultrasound medicine specialty in Hebei Province participated in reporting the data to a quality control network platform. The reported data included 12 ultrasound quality control indicators mentioned in the Expert Consensus on the Quality Management and Control Indicators of Ultrasound Medicine ( 2022 Edition): ultrasound physician per capita workload, ultrasonic instrument quality inspection rate, completion rate of ultrasound examination within 48 hours of admission, completion rate of ultrasound critical value report within 10 minutes, qualified rate of ultrasound report writing, classification rate of breast imaging reporting and data system (BI-RADS) for ultrasound report of breast lesions, positive rate of ultrasound report, detection rate of fetal major lethal malformations in ultrasound screening, coincidence rate of ultrasound diagnosis, accuracy of ultrasound diagnosis of breast lesions, coincidence rate of ultrasound diagnosis of carotid stenosis (≥50%), and incidence of major complications related to ultrasound intervention. These data were compared and analyzed.

The average number of daily ultrasound examinations in the whole province was lower than the national average level (23.50 vs 29.99). Among cities in the province, Tangshan had the highest average number of daily ultrasound examinations (30.11 person-times), Handan had the lowest number (17.98 person-times), and 8 cities had a number below the average. The average quality inspection rate of ultrasonic instruments in the whole province was close to the national average level (97.13% vs 97.14%). This rate reached 100% in Cangzhou, Hengshui, and Qinhuangdao, 3 cities had a rate lower than the average, and Tangshan City had the lowest rate at 87.04%. The average completion rate of ultrasound examination within 48 hours of admission in the whole province was slightly higher than the national average level (93.22 % vs 93.07 %). Hengshui had the highest completion rate at 99.93 %, Zhangjiakou had the lowest rate at 79.19%, and three cities had a rate lower than the average. The completion rate of ultrasound critical value report within 10 minutes in the whole province was lower than the national average level (96.87% vs 97.33%). Hengshui and Qinhuangdao had the highest completion rate at 100%, and Cangzhou had the lowest completion rate at 87.63%. The average qualified rate of ultrasound report writing in the whole province was slightly higher than the national average (99.37% vs 99.11%). Qinhuangdao had the highest rate at 99.91%, Chengde had the lowest rate at 95.75%, and 4 cities had a rate below the average. The classification rate of BI-RADS in the ultrasound report of breast lesions in the overall province was lower than the national average level (75.34 % vs 83.95%). Qinhuangdao had the highest classification rate at 98.59%, Shijiazhuang had the lowest rate at 57.03%, and 5 cities had a rate below the average. The positive rate of ultrasound in medical institutions in the province was slightly higher than the national average level (75.37% vs 74.42%). Qinhuangdao had the highest positive rate at 87.83%, Xingtai had the lowest rate at 68.60%, and 6 cities had a rate below the average. The detection rate of fetal major lethal malformations in ultrasound screening in medical institutions in the province was slightly lower than the national average level (0.04% vs 0.06%). Langfang had the highest positive rate at 0.09%, Xingtai had the lowest positive rate at 0.01%, and 5 cities had a rate below the average. The coincidence rate of ultrasound diagnosis in medical institutions in the province was lower than the national average level (86.75 % vs 87.78 %). Chengde had the highest coincidence rate at 94.40%, Handan had the lowest rate at 71.59%, and 4 cities had a rate lower than the average. The accuracy of ultrasound diagnosis of breast masses in medical institutions in the province was higher than the national average level (85.96% vs 82.49%). Chengde had the highest accuracy at 91.98%, Handan had the lowest accuracy at 81.95%, and 5 cities had an accuracy below the average. The accuracy of ultrasound diagnosis of carotid artery stenosis (≥50%) in medical institutions in the province was higher than the national average level (91.84% vs 83.76%). Handan had the highest accuracy at 97.75%, Langfang had the lowest accuracy at 85.39%, and 7 cities had an accuracy below the average. The incidence of major complications related to medical ultrasound intervention in the province was lower than the national average level (0.20% vs 0.41%). Chengde had the highest incidence at 1.15%, Qinhuangdao had the lowest incidence at 0.03%, and 6 cities had an incidence higher than the average.

Based on the data of a quality control network platform, we summarize the current situation and regional differences in ultrasonic medical quality control in Hebei Province, so that we can find problems in time and solve problems to further improve the professional level of ultrasound in the province.

To investigate the current status of quality control indicators and medical service quality in ultrasound medical departments of secondary and tertiary hospitals in Hainan Province, in order to provide reference for the continuous improvement and enhancement of ultrasound diagnostic quality.

The Hainan Ultrasound Medical Quality Control Center collected data on ultrasound diagnostic quality control indicators from 46 secondary and tertiary hospitals in Hainan Province (including 21 secondary hospitals and 25 tertiary hospitals) from January 1, 2024 to December 31, 2023. The indicators investigated included structural quality analysis indicators (monthly average workload of ultrasound physicians, ultrasound instrument quality inspection rate, ultrasound doctor-patient ratio, and ratio of ultrasound physicians to diagnostic instruments), process quality analysis indicators (completion rate of inpatient ultrasound examination within 48 hours, completion rate of ultrasound critical value report within 10 minutes, qualification rate of ultrasound report writing, and classification rate of breast imaging reporting and data system (BI-RADS) for ultrasound report of breast lesions), and result quality analysis indicators (positive rate of outpatient ultrasound reports, positive rate of inpatient ultrasound reports, detection rate of major fatal fetal malformations in ultrasound screening, ultrasound diagnostic compliance rate, and accuracy rate of breast mass ultrasound diagnosis). The rank sum test was used to compare the differences in various indicators between secondary and tertiary hospitals, and P<0.05 was considered statistically significant.

In terms of structural quality analysis indicators, the average monthly workload of ultrasound physicians in tertiary hospitals was significantly higher than that in secondary hospitals [795.75 (551.86, 972.45) person times/month vs 461.63 (347.00, 597.23) person times/month, U=135.00, P=0.005], and the ultrasound doctor-patient ratio in tertiary hospitals was significantly lower than that in secondary hospitals [1.04 (0.86, 1.51) person times/10000 person times vs 1.80 (1.39, 2.40) person times/10000 person times, U=134.50, P=0.005]. There was no statistically significant difference in the quality inspection rate of ultrasound instruments, the number of ultrasound physicians, or the number of diagnostic instruments (P>0.05). Regarding process quality analysis indicators, the reporting rate of ultrasound critical values within 10 minutes [100 (100, 100)% vs 100.00 (100, 100)%, U=22.50, P=0.024] and the BI-RADS classification rate of breast lesions [99.46 (97.30, 100.00)% vs 95.06 (88.88, 99.12)%, U=130.50, P=0.003] were significantly higher in tertiary hospitals than in secondary hospitals. There was no statistically significant difference in the qualified rate of ultrasound report writing or the completion rate of inpatient ultrasound examination within 48 hours (P>0.05). With regard to quality analysis indicators, the positive rate of ultrasound reports in outpatient and emergency departments [76.75 (65.51, 81.96)% vs 64.86 (54.30, 72.21)%, U=153.00, P=0.016], the ultrasound diagnostic accuracy [92.08 (88.84, 94.34)% vs 85.30 (83.20, 90.44)%, U=116.50, P=0.009], the ultrasound diagnostic accuracy for breast masses [86.29 (79.03, 92.07)% vs 79.63 (76.12, 85.20, 90.47)%, U=103.00, P=0.046], and the detection rate of major fatal malformations in ultrasound screening [0.03 (0.00, 0.08)% vs 0.00 (0.00, 0.00)%, U=109.00, P=0.004] were significantly higher in tertiary hospitals than in secondary hospitals. There was no significant difference in the positive rate of in-patient ultrasound reports in secondary and tertiary hospitals (P>0.05).

There are differences in multiple ultrasound quality control indicators between secondary and tertiary hospitals in Hainan Province. Based on the development status of ultrasound departments in secondary and tertiary hospitals in Hainan Province, especially the low compliance rate of ultrasound diagnosis in secondary hospitals compared to tertiary hospitals, the Hainan Ultrasound Medical Quality Control Center will further improve the quality control system, procedures, standards, and plans, and carry out quality control and improvement work in a standardized manner to achieve standardization and homogenization of ultrasound medicine in Hainan Province.

To investigate the basic situation of thyroid ultrasound examination and the use of TIRADS classification in hospitals in Haidian District, and explore the feasibility of promoting the use of the Chinese version of TIRADS (C-TIRADS) to improve the ultrasound diagnosis quality.

An online questionnaire was administered and collected through a WeChat application, and the subjects of the survey were ultrasound departments of hospitals in Haidian District. The questionnaire mainly included three parts: general information of thyroid ultrasound examination, the use of the TIRADS classification, and the report positive rate and diagnostic accordance rate.

A total of 105 questionnaires were collected, of which 91 were valid after removing invalid ones. Seventy (76.9%) hospitals routinely performed thyroid ultrasound examinations, including 12 tertiary and 12 secondary hospitals, as well as 46 primary hospitals. Approximately 12.9% (9/70) of them, mainly tertiary hospitals, performed ultrasound-guided thyroid intervention techniques (including biopsy). Only one secondary hospital conducted these procedures, and none of primary hospitals performed. A total of 35 hospitals (50.0%) used TIRADS classification systems in their ultrasound reports, of which 22 (62.9%) used the C-TIRADS, 11 (31.4%) used the ACR-TIRADS, and 2 (5.7%) used the ATA guidelines. The average report positive rate of thyroid ultrasound was 73.1% and the average diagnostic accordance rate was 85.3%.

Further improvement in the coverage of C-TIRADS usage in hospitals in Haidian District is needed. The Ultrasound Medical Quality Control and Improvement Center of Haidian District will continue to strengthen the quality control of thyroid ultrasonography, promote the use of C-TIRADS in the diagnosis of thyroid nodules, and improve the diagnostic accordance rate.

To evaluate the effectiveness of ultrasound quality control combined with standardized resident training in ultrasound department.

Ten trainees who underwent standardized training at the ultrasonography department of Cancer Hospital of Chinese Academy of Medical Sciences in 2022-2023 were selected as subjects. Through the establishment of a quality control/residency training management practice group, multiple quality control management measures were carried out, including standardized report writing, standard ultrasonography plane teaching, real-time quality control in clinical work, case follow-up, and phased summary evaluation. The effectiveness was evaluated through ultrasound examination, ultrasound diagnosis, report writing simulation assessment, and anonymous questionnaire survey. This Mann-Whitney U test was used to analyze the results.

The score for ultrasound examination increased significantly after implementing quality control measures [88.25 (84.25, 91.25) vs 82.50 (77.50, 85.75); Z=-2.118, P=0.034]. The score for ultrasound diagnosis and report writing also increased significantly after implementing quality control measures [86.00 (82.75, 92.50) vs 81.50 (76.13, 84.50); Z=-2.005, P=0.045]. The survey questionnaire statistics showed that the standardization of reporting, standard level of ultrasound examination, clinical thinking ability, diagnostic accuracy, and comprehensive work ability of resident trainees were all improved to varying degrees, with the most significant improvement observed in the standard level of ultrasound examination.

The combination of quality control and standardized resident training can form a virtuous circle, effectively improving teaching management level of the department, and enhancing the ultrasound examination, ultrasound diagnosis, and report writing abilities of ultrasound resident trainees.

To survey the basic situation of ultrasonic medical institutions at all levels in Tibet Autonomous Region, to explore the problems in ultrasonic quality control, and to propose some improvement measures.

From January to December, 2022, Tibet Ultrasound Medical Quality Control Center, with the assistance of Tibetan medical aid team, investigated the basic situation of ultrasound diagnosis and related data of quality indicators in 87 hospitals in Tibet Autonomous Region, and put forward a series of improvement strategies for establishing ultrasound quality.

The survey showed that the ultrasonic medical institutions in Tibet Autonomous Region were mainly secondary hospitals (78%, 68/87), with limited tertiary hospitals accounting for only 22% (19/87). High-grade hospitals were unevenly distributed in the region. The proportion of ultrasound physicians in the secondary and tertiary hospitals in Tibet Autonomous Region was obviously low, with the majority being residents and attending physicians (71%, 273/387), and the ultrasound physicians with associate senior title or above accounted for only 9% (33/387). The skills of doctors in the second and tertiary hospitals in the region were poor, their understanding of ultrasound critical value was insufficient, and the reporting rate was low (tertiary hospitals: 802 cases; secondary hospitals: 610 cases).

In accordance with the national guidelines for ultrasound quality control, a quality control and improvement plan is being developed to establish a sound ultrasound quality control system in the Tibet Autonomous Region, with an aim to improve the level of ultrasound medical services in the region.

To identify the factors affecting the conformity rate of ultrasonic diagnosis.

The echelon of personnel in ultrasound department and ultrasonic quality control indexes uploaded by Anhui provincial sentinel hospitals (including secondary and tertiary hospitals), as well as the special training carried out by Anhui provincial ultrasonic quality control center during 2020-2021 were analyzed.

Compared with the figures in 2020, the number of senior doctors in secondary and tertiary hospitals in Anhui Province has increased significantly in 2021 [194 (20.00%) vs 128(15.67%); 336 (27.18%) vs 249 (23.71%)]. From 2020 to 2021, the coincidence rate of ultrasonic diagnosis in hospitals in Anhui province showed an increasing trend, especially in tertiary hospitals [86.65% (1586/1830) vs 83.01% (1519/1830)]. In 2020 and 2021, the qualification rate of ultrasound report writing in both secondary and tertiary sentinel hospitals in Anhui Province exceeded 90%. Compared with the rate in 2020, the qualification rate of ultrasound report writing in secondary sentinel hospitals in Anhui Province increased significantly in 2021 [99.40% (2326/2340) vs 93.93% (2198/2340)]. Compared with the rate in 2020, the qualified rate of ultrasonic instrument quality detection in secondary sentinel hospitals in Anhui Province increased significantly in 2021 [96.39% (321/333) vs 93.09% (310/333)]. The number of quality control training times in Anhui Province in 2021 increased significantly compared with that in 2020 (53 vs 22). From 2020 to 2021, the utilization rate of BI-RADS classification and the accuracy of ultrasound diagnosis of breast masses in secondary hospitals increased from 69.15% (1618/2340) to 82.44% (1929/2340) and from 71.67% (1677/2340) to 75.30% (1762/2340), respectively. The utilization rate of BI-RADS classification and the accuracy of ultrasound diagnosis of breast masses in tertiary hospitals increased from 89.62% (1640/1830) to 93.88% (1718/1830) and from 78.14% (1430/1830) to 81.58% (1493/1830), respectively.

The conformity rate of ultrasonic diagnosis is affected by many factors. Improving the qualified rate of ultrasonic report writing, the professional level of ultrasound physicians through special training, and the standardized diagnosis of breast masses is important for improving the conformity rate of ultrasonic diagnosis.

To assess the value of PDCA cycle in continuous improvement of ultrasonic critical value management system.

The data of inspection, registration, follow-up, and quality control of ultrasonic critical value before (November 2020 to October 2021) and after (November 2021 to April 2022) the implementation of PDCA cycle were collected from the Department of Ultrasound of Fujian Medical University Union Hospital, and the differences in relevant indicators of ultrasonic critical value before and after the implementation of PDCA cycle were compared by the χ² test.

The number of ultrasound emergency cases before the implementation of PDCA cycle was 41, and it was 21 after the implementation of PDCA cycle. Before and after PDCA cycle implementation, the notification rate of ultrasonic critical value was both 100%; the accuracy rate of ultrasonic critical value reports, the timely rate of ultrasonic critical value reports, and the timely follow-up rate of ultrasonic critical value increased from 63.41% (26/41), 30.77% (8/26), and 19.23% (5/26) to 90.48% (19/21), 89.47% (17/19), and 57.89% (11/19) respectively, and the differences were statistically significant (χ²=5.110, 15.322 and 7.162, P=0.024, ＜0.001, =0.007); the qualified rate of ultrasonic critical value reports, diagnostic coincidence rate of ultrasonic critical value, and timely registration rate of paper version of ultrasonic critical value were also improved to varying degrees, but the differences were not statistically significant (P＞0.05 for all).

PDCA cycle helps to continuously improve the management system of critical value in ultrasound department as well as the quality and efficiency of critical value report.

To evaluate the value of standard section quality control in improving the detection rate of fetal structural abnormality.

A total of 4742 pregnant women who underwent second-trimester obstetric ultrasound examination at our hospital from October 2018 to September 2020 were retrospectively analyzed. Taking the time of beginning to implement quality control as the cutoff point (October 2019), the included cases were divided into either a before-quality control (B-QC) group or an after-quality control (A-QC) group. A total of 36 standard sections of fetal skull, chest, abdomen, limbs, and appendages were analyzed. The number of images retained for each pregnant woman was calculated. If the images were clear and the sections were complete and accurate, the standard sections were defined as image coincidence. The χ² test was used to compare the coincidence rate of standard sections, the detection rate of fetal structural abnormality, and the rates of missing diagnosis and misdiagnosis between the two groups.

In the B-QC group, there were 47 ultrasonographic images per pregnant woman on average, and the coincidence rate of standard sections was 73%. In the A-QC group, there were 89 ultrasonographic images per pregnant woman on average, and the coincidence rate of standard sections was 89%. The detection rate of four standard sections (left plantar section, right plantar section, diaphragm coronal section, and double kidney transverse section) in the A-QC group was significantly higher than that in the B-QC group (84.5% vs 11.0%, 84.5% vs 11.0%, 91.0% vs 20.5%, and 92.5% vs 30.0%, χ²=124.831, 124.831, 201.475, and 164.582, respectively, P＜0.001 for all). Compared with the B-QC group, the coincidence rates of the horizontal transverse section of the eyes, the coronal section of the nose and lip, and the median sagittal section of the face in the A-QC group were significantly higher than those in the B-QC group (89.0% vs 53.5%, 100% vs 89.0%, and 94.0% vs 76.5%, χ²=61.523, 23.280, and 24.355, respectively, P＜0.001 for all). The coincidence rates of left ventricular outflow tract section, three-vessel section, three-vessel trachea section, and fetal heart rate section in the A-QC group were significantly higher than those in the B-QC group (93.0% vs 84.0%, 86.5% vs 61.0%, 92.0% vs 53.5%, and 95.0% vs 36.0%, χ²=7.959, 33.588, 74.769, and 154.044, respectively, P＜0.001 for all). The detection rates of fetal structural abnormality and fetal malformation in the A-QC group were significantly higher than those in the B-QC group (15.7% vs 13.3% and 1.3% vs 0.5%, χ²=7.566 and 7.571, P=0.006 and 0.006, respectively). The rates of missed and misdiagnosis were decreased (0.8% vs 0.9% and 0.2% vs 0.3%, respectively), but there was no statistical difference between the two groups (χ²=1.156 and 0.269, P=0.604 and 0.282, respectively).

The quality control of the standard sections of ultrasound can improve the coincidence rate of the standardized image retention in grade Ⅲ obstetric ultrasound examination and increase the detection rate of fetal structural abnormality, thus providing a basis for clinical decision-making.

To evaluate the quality of ultrasonic diagnosis of retroperitoneal schwannomas and its influencing factors to find the measures to improve the diagnosis quality.

From January 2015 to April 2022, patients with retroperitoneal schwannomas who underwent surgery at Peking Union Medical College Hospital were studied. All of the cases were confirmed by pathology. The results of preoperative ultrasound reports were summarized, and the quality of ultrasound diagnosis was evaluated by localization diagnosis and qualitative diagnosis.

There were 21 cases of retroperitoneal schwannomas with preoperative ultrasound report, all of them were single, and one case (4.8%) was missed by preoperative ultrasound. The maximal diameter of the 20 schwannomas diagnosed by preoperative ultrasound was (6.7±3.6) cm, of which 16 (80.0%) were located in the abdominal retroperitoneum and 4 (20.0%) were located in the pelvic retroperitoneum; 14 (70.0%) manifested as a heterogeneous solid and cystic mass, and 6 (30.0%) presented as a hypoechoic solid mass. Among the 20 cases, 17 (85.0%) were in accordance with the localization diagnosis and 3 (15.0%) were not; 2 (10.0%) were qualified for qualitative diagnosis and 18 (90.0%) were not.

Ultrasound has a high accuracy for the localization diagnosis of retroperitoneal schwannomas. Retroperitoneal schwannomas lack typical sonogram characteristics, and sonographers should be familiar with the anatomy and pay attention to the medical history collection to further improve the accuracy of its qualitative diagnosis.

To summarize the problems and improvements in the quantitative assessment of mitral regurgitation (MR) by echocardiography.

We retrospectively analyzed the image sequences of 196 patients who underwent MR evaluation by echocardiography from August 2021 to April 2023 at the Renmin Hospital of Wuhan University. The patients were divided into a pre-quality control group and a post-quality control group. The control group consisted of 107 patients who underwent MR evaluation between August 2021 and August 2022, while the observation group consisted of 89 patients who underwent MR between September 2022 and April 2023. According to the 2017 American Society of Echocardiography guidelines and standards, the degree of MR was divided into four grades (mild, moderate, moderate-severe, and severe). The inconsistency between the grade to which four quantitative parameters, namely, vena contracta width (VCW), effective regurgitant orifice area (EROA), regurgitant volume (RVol), and regurgitant fraction (RF), belonged and the degree of regurgitation within each grade group was counted and classified as complete consistency (all 4 parameters were consistent), low inconsistency (1 parameter inconsistent), medium inconsistency (2 parameters inconsistent), and high inconsistency (3 parameters inconsistent). The χ² test was used to compare the differences in inconsistency between various grade groups and before and after quality control. The intraclass correlation coefficient (ICC) was utilized for the repeatability test.

Among the 196 MR patients, there were 31, 35, 51 and 79 cases in the mild group, moderate group, moderate-severe group, and severe group, respectively. In the mild, moderate, moderate-severe, and severe groups, the percentages of complete consistency, low inconsistency, moderate inconsistency, and high inconsistency were 16.13%, 51.61%, 29.03%, and 3.23%, 14.29%, 62.86%, 17.14%, and 5.71%, 0%, 41.18%, 45.10%, and 13.73%, and 68.35%, 18.99%, 10.13%, and 2.53%, respectively. Patients with severe MR had the highest percentage of complete consistency (mild vs moderate vs moderate-severe vs severe: 16.13% vs 14.29% vs 0% vs 68.35%, χ²=79.734, P＜0.001), while the highest percentage of low inconsistency was seen in patients with moderate MR (mild vs moderate vs moderate-severe vs severe: 51.61% vs 62.86% vs 41.18% vs 18.99%, χ²=24.012, P＜0.001). Moderate-severe MR patients had the highest percentage of medium inconsistency (mild vs moderate vs moderate-severe vs severe: 29.03% vs 17.14% vs 45.10% vs 10.13%, χ²=22.427, P＜0.001). The highest percentage of high inconsistency was observed in moderate-severe MR patients, but the difference between groups was not statistically significant (P＞0.05). The percentage of incomplete consistency was significantly lower in the post-quality control group compared to the pre-quality control group (58.43% vs 74.77%, χ²=5.899, P=0.015). All the inter-observer and intra-observer ICCs were higher than 0.9.

When performing the quantitative assessment of MR, patients with severe MR have a higher degree of consistency than the other groups, and quality control is successful in decreasing the inconsistency. Therefore, quality control for quantitative MR assessment needs to be highlighted and popularized.

To evaluate the effectiveness of CT-ultrasound comparison as a quality control method for the missed diagnosis of focal liver lesions by ultrasound.

The study subjects were patients who underwent imaging examinations at Peking University Shenzhen Hospital from December 2022 to April 2023. Using the CT examination results as the "gold standard", cases were divided into three groups based on the maximum diameter of the focal lesions suggested by CT: "≤1.0 cm", "1.1-2.0 cm", and "＞2.0 cm". The lesion locations and maximum diameters were analyzed, and the CT-ultrasound comparison results were classified as "weakly inconsistent (≤1.0 cm)", "moderately inconsistent (1.1-2.0 cm)", "strongly inconsistent (＞2.0 cm)", and "possibly consistent". Statistical analysis was then conducted. Based on the chronological order of CT and ultrasound reports, the paired records were categorized into "pre-examination quality control" (CT report before ultrasound report) and "post-examination quality control" (CT report after ultrasound report), and the quantity of records in each category was recorded. Records of "strongly inconsistent" were reviewed, followed by data analysis and quality control feedback.

Among the 2397 cases of CT-ultrasound paired focal liver lesions, the "inconsistency rate" was 24.53% (588/2397); the inconsistency rate of the "≤1.0 cm" group was the highest (42.62%, 430/1009), and that of the "＞2.0 cm" group was the lowest (7.66%, 49/640). The proportions of "weakly inconsistent", "moderately inconsistent", and "strongly inconsistent" categories were 17.94% (430/2397), 4.55% (109/2397), and 2.04% (49/2397), respectively. Cases of "strongly inconsistent" were mainly concentrated near the capsule of the left outer lobe of the liver and the diaphragmatic top of the right lobe. Among all inconsistent cases, 47.96% (282/588) were in the "pre-examination quality control" category.

The method of CT-ultrasound comparison can serve as a practical quality control strategy to improve the missed diagnosis of focal liver lesions in ultrasound examinations.

To evaluate the application value of PDCA cycle in the construction of superficial organ ultrasound subspecialty.

Fifty ultrasound images of thyroid and breast nodules and 50 issued reports were randomly selected at the Department of Ultrasound Medicine of the First Affiliated Hospital of Nanchang University from July to December 2017. They were reviewed and scored (≥85 were classified as class A cases, 80-85 as class B cases, and <80 as class C cases). In June 2018, PDCA cycle was adopted to improve the medical quality of thyroid and breast nodule ultrasound image storage and issued reports. Fifty thyroid and breast nodule ultrasound images and 50 issued reports were randomly selected from January to June 2019, reviewed and scored. Independent sample t-test was used to compare the difference in the score between the two groups.

The average score of ultrasound images of thyroid and breast nodules and issued reports after the implementation of PDCA cycle was significantly higher than that before the implementation of PDCA cycle [(90.87±4.11) vs (75.84±8.69), t=15.635, P<0.001], and the mean difference was 15.030.

The implementation of PDCA cycle can significantly improve the quality of storage of images of thyroid and breast nodules and report writing, which is helpful to improve the quality of superficial organ ultrasound. PDCA cycle plays an important role in the construction of superficial organ ultrasound subspecialty.

To explore the effect of quality control circle activities in improving the detection rate of prostate cancer by puncture biopsy.

The Department of Ultrasound, Yinzhou Second Hospital carried out quality control circle activities from April to September 2022, with the theme of "multidisciplinary joint improvement of prostate cancer detection rate by puncture biopsy". The data of 60 patients who underwent prostate puncture from April 11, 2022 to April 22, 2022 were collected to analyze the main reasons affecting the prostate cancer detection rate by puncture biopsy, discuss and formulate corresponding countermeasures, and implement the formulated countermeasures. The data of 60 patients who underwent prostate puncture from August 1, 2022 to August 14, 2022 were collected to confirm the effect, calculate the goal achievement rate and progress rate, and standardize and continue to implement the countermeasures. The data of patients who underwent prostate puncture before (March 1 to March 31, 2022) and within one month after the implementation of the quality control circle activities (October 1 to October 30, 2022) were collected to calculate the detection rate of prostate cancer, and the χ² test was used to compare the changes in the prostate cancer detection rate by puncture biopsy between before and after implementing the quality control circle activities.

After the implementation of the countermeasures, the goal achievement rate was 107.3%, and the progress rate was 65.3%. The total number of punctures in one month after the implementation of the quality control circle activities was 141, including 76 cases of prostate cancer diagnosed by puncture pathology, and the puncture detection rate of prostate cancer was 53.9%. The total number of punctures in the month before the implementation of the quality control circle activities was 154, including 42 cases of prostate cancer diagnosed by puncture pathology, and the detection rate of prostate cancer was 27.3%. The difference in the detection rate of prostate cancer was statistically significant between before and after implementing the quality control circle activities (χ²=21.746, P<0.001).

Quality control circle activities have been carried out to standardize the operation process of prostate puncture, and the detection rate of prostate cancer by puncture biopsy has been effectively improved.