Implementation of nuchal translucency image-scoring method during ongoing audit

Objective The aim of this study was to evaluate the contribution of an ongo ing audit, using the image-scoring method, to the quality of nuchal translu cency images and to set the basic standards required from the examiners. Design Evaluation of nuchal translucency images, before, during and after t he implementation of no ongoing audit, without knowledge of the time period or the examiner. Subjects A total of 315 nuchal translucency scans were performed by three e xaminers. Methods Each of the retrospective intermediate and prospective time periods included blind scoring of 105 images. The effect of the ongoing audit was examined by comparing the distribution of the quality groups and the mean f inal score between the time periods, for all cases and for each examiner se parately. Improvement of the criteria was assessed by comparing the rate of scans meeting the demands between the time periods. Results The quality of the images improved significantly as the mean final score changed from 4.62 +/- 0.21 to 6.19 +/- 0.19 and to 6.91 +/- 0.16 (p < 0.0001) and the rate of obtaining acceptable scans rose from 72% to 88% an d to 92% (p<0.001), respective to the three time periods. Whereas the three major criteria improved significantly before and after implementation of t he audit (mid-sagittal section from 48% to 94%, caliper placement from 60% to 75% and skin line from 19% to 77%), the minor criteria remained unchange d (image size 90%, amnion demonstration 25% and head position 77%). The ave rage scores of two examiners, for whom improvement tc,ns more pronounced, w ere used to determine the basic standards required front examiners subjecte d to the audit as follows: unacceptable, none; intermediate, 5%; reasonable , 65%; excellent, 30%; with a mean final score of 7.25. Conclusions Implementation of an ongoing audit, using the image-scoring met hod, proved to be an efficient method for surveillance and improving the qu ality of nuchal translucency images. We recommend centers or individuals pr acticing first-trimester ultrasound screening to consider its routine utili zation, in an unbiased and strict manner.