Objective To explore the application of "quality control specialized management" model in ultrasound department for medical quality management and effect evaluation.Methods The "quality control specialized management" model was applied for medical quality management in ultrasound department.We explored the changes of clinical and patients' satisfaction before and after the implementation of the model by taking the measures of quality control management by special responsible person,improving patient visit process,strengthening professional training to improve doctors' ability,strengthening humanistic literacy,and improving service attitude.Before and after implementation,clinical satisfaction and patients' satisfaction were evaluated.The comparison of clinical satisfaction before and after the implementation of "quality control specialized management" and the comparison of patient satisfaction was conducted by x2 test.Results After the implementation of "quality control specialized management" model,the clinical satisfaction score was (95.5 ± 0.3) points,which was significantly higher than that before the model was applied [(90.1± 1.5) points;t=7.541,P ＜ 0.01);the patients' satisfaction score was (95.8±0.3) points,which was also significantly higher than that before the model was applied [(92.8±0.7) points;t=5.230,P ＜ 0.01).Conclusion The "quality control specialized management" model can improve clinical and patients' satisfaction effectively,representing an effective way to guarantee and improve the quality of ultrasound medical services.

Objective To investigate the basic situation of ultrasound departments in secondary and tertiary public hospitals in Anhui Province.Methods Ultrasonic quality baseline survey forms were issued by the Ultrasonic Medical Quality Control Center of Anhui Province in November 2018,and the subjects of the survey were ultrasound departments of public secondary and tertiary hospitals in Anhui Province.The survey consisted of six parts,including the basic information of the head of ultrasound department,the number of staff,the area of ultrasound department,the number of ultrasonic diagnostic instrument rooms,the number of ultrasonic diagnostic instruments,and the number of beds actually opened in the hospital.Results In this survey,the results of 205 hospitals in 15 prefectures and cities in Anhui Province were received.Among them,there were 62 tertiary hospitals and 143 secondary hospitals.Most of the heads of ultrasound departments in Anhui public secondary and tertiary hospitals had a bachelor's degree,a middle or senior professional title,and a professional life of more than 20 years.The average number of ultrasound department staff was 9.3 in the secondary hospitals and 19.3 in the tertiary hospitals.The average area of the ultrasound department was 195.1m2 in the secondary hospitals and 505.9 m2 in the tertiary hospitals.The average number of ultrasonic diagnostic instrument rooms was 4.9 in the secondary hospitals and 11.3 in the tertiary hospitals.The average number of ultrasound instruments was 4.9 in the secondary hospitals and 11.5 in the tertiary hospitals.The average number of beds actually opened was 510.7 in the secondary hospitals and 1407.5 in the tertiary hospitals.Conclusions At present,ultrasound instruments in secondary hospitals in Anhui Province can basically meet the needs of clinical work,and there is a relative shortage of ultrasound instruments in tertiary hospitals.The shortage of staff in ultrasound department is a common problem faced by secondary and tertiary hospitals,especially tertiary hospitals.

Objective To explore the main problems of ultrasonic quality management in Qinghai Province.Methods The ultrasound departments of 19 tertiary hospitals and 51 secondary hospitals in Qinghai Province were investigated.The x2 test was carried out to analyze the setting of departments,subspecialty,instrument status,ultrasonic quality control,workload,and personnel specialty and educational composition ratio.Results There was a statistically significant difference between tertiary and secondary hospitals in department settings,sub-specialty,instrument status,ultrasound quality control,workload,personnel specialty,and personnel qualifications (x2=30.49,38.208,36.87,7.913,28.518,7.111 and 322.363,respectively,P ＜ 0.01 for all).Conclusions The above-mentioned observation indexes are better in the 19 tertiary hospitals than in the 51 secondary hospitals in Qinghai Province.Strengthening construction from these aspects and improving ultrasound quality control management play an important role in improving the level of ultrasound diagnosis and promoting the homogeneity of ultrasound diagnosis.

Objective To explore the application value of ultrasound medical imaging workstation in quality control of ultrasound reports issued by resident doctors.Methods The pancreatic ultrasound reports of outpatients provided by resident doctors with 6 months and 12 months of training were derived from the ultrasound medical imaging workstation as 6-month group (G6M) and 12-month group (G12M),respectively.There were 1582 ultrasound reports in the G6M,including 420 for males and 962 for females,with 1318 for patients ＜ 65 years old and 264 for patients ≥ 65 years old.There were 2723 ultrasound reports in the G12M,including for 760 males and 1963 for females,with 2323 for patients ＜ 65 years old and 400 for patients ≥ 65 years old.Frequency of"unclear tail of the pancreas" in the report,standard image,and body markers were recorded.The chi-square test was used to compare patient gender,age,and the quality of resident reports between the two groups.Results The chi-square test showed that there was no significant difference in sex or age composition between the two groups (all P ＞ 0.05).The number of cases of"unclear tail of the pancreas" reported in the G6M and G12M was 554 (35.02％) and 734 (26.96％),respectively,and there was a statistical difference between the two groups (x2=31.029,P ＜ 0.001).In the reports with "unclear tail of the pancreas",the number of reports with "no map" was 8 (1.44％) and 14 (1.91％) in the G6M and G12M,respectively,and there was no significant difference between the two groups (P ＞ 0.05).As to "map without marker" and "map with marker",there were 337 (60.83％) vs 209 (37.73％) and 308 (41.96％) vs 412 (56.13％) in the G6M and G12M,respectively,and the chi-square test showed that there were significant differences between the two groups (x2=44.960 and 42.834,all P ＜ 0.001).Conclusion Ultrasound medical imaging workstation can be used for periodic spot check,evaluation,and feedback of resident reports,which has a positive role in promoting the quality control of ultrasound reports.

Objective To analyze the current situation of the quality of critical value management in ultrasound department,and to explore the application and effect of PDCA cycle method in critical value management.Methods The quality status of emergency data during the period from January 2015 to January 2019 after the PDCA cycle was adopted was analyzed.The PDCA cycle method was applied to improve the overall quality.The reporting rate,awareness rate,qualified rate of writing,and timely rate of clinical treatment were compared before and after the PDCA cycle was adopted to evaluate the effect of PDCA cycle method.Results From January 2015 to January 2019,the reporting rate was 96.4％,98.0％,94.5％,and 96.7％,the awareness rate of critical value was 63.2％,78.6％,84.8％,and 92.2％,the qualified rate of writing was 70.4％,77.2％,85.3％,and 94.0％,and the timely rate of clinical treatment was 50.9％,71.7％,81.1％,and 85.5％,respectively.The awareness rate,the qualified rate of writing,and the timely rate of clinical treatment were significantly improved (x2=12.464,38.184,52.926,all P ＜ 0.05).Conclusion PDCA cycle method can improve the quality of emergency management in ultrasound department.

Objective To evaluate the application value of fetal heart echocardiography intelligent navigation (5D Heart) in the display of key diagnostic elements in five rapid screening fetal echocardiographic views.Methods Three hundred and eighty-four 3D volume datasets of 220 normal singleton fetuses in the second and third trimesters were acquired.After processing the datasets using 5D Heart,five rapid screening views were acquired,and 21 key diagnostic elements of the five cardiac diagnostic sections were graded.The 2 test was used to compare the difference in the key diagnostics elements of the five rapid screening views between 5D heart and the traditional technique.Pearson correlation was used to compare the detection rate of key diagnostic elements between 5D Heart technique and traditional two-dimensional echocardiography in normal fetuses and fetuses with congenital heart disease.The rank sum test was used to detect the consistency and reliability of the results.Results A total of 384 fetal volume datasets were obtained from 220 fetuses,of whom 317 heart volume datasets were available for analysis,with a success rate of 82.6％.There was no difference in the key diagnostic elements of the five rapid screening views between 5D heart and the traditional technique (x2=5.17,P=0.27).Compared with the abnormal fetal heart group (89.6％),the detection rate of diagnostic elements in the normal fetal heart group was 85.2％ (r=0.94,P=0.02).No significant differences were found when comparing the grading results of one observer in different periods of time,the grading results between two experienced doctors,or the grading results among the experienced doctor and one relatively inexperienced doctor (P ＞ 0.05).Conclusions Fetal cardiac ultrasound intelligent navigation technique has high reliability and repeatability in obtaining fetal rapid screening views and displaying fetal elemental diagnostic information.It has tremendous potential in standardized data collection and analysis of cardiac diagnostic sections in fetuses with congenial heart disease,as well as in training and teaching,remote medical consultation,and screening in primary hospitals.

Objective To explore the characteristics of branch pulmonary artery flow patterns in fetuses with left heart hypoplasia syndrome (HLHS).Methods HLHS fetuses were divided into an unobstructed group and an obstructed group according to the blood flow pattern across the interatrial septum.Main pulmonary artery diameter,right pulmonary artery diameter,and Doppler parameters of first-order right pulmonary artery of both groups were measured by fetal echocardiography and compared with those of normal controls.Results There was a significant difference in the diameter of pulmonary trunk among different the three groups (F=198.56,P ＜ 0.05),and the main pulmonary artery diameter in the two groups of HLHS fetuses were larger than that in normal controls (t=-18.501,-13.97,P ＜ 0.05),but there was no significant difference between the two groups of HLHS fetuses (P=0.85).There was no significant difference in right pulmonary artery diameter among the three groups (P=0.59).The end-diastolic velocity,time-averaged maximum velocity,and velocity-time integral in the two HLHS groups were lower than those in normal controls,and these parameters in the obstructed group were less than those in the unobstructed group.The pulmonary artery pulsatility index in the two HLHS groups was higher than those in normal controls,and it was higher in the obstructed group than in the unobstructed group.There was no statistically significant difference in peak systolic velocity among the three groups (P=0.34).Conclusion The antegrade resistance of the pulmonary arteries of HLHS fetuses increase and these pathologcial conditions are more obvious in those with obstructed flow across the atrial septum compared to those with unobstructed flow.

Objective To investigate the capability oftomography ultrasound (TUI) in evaluating the development of the normal anorectal structure to provide a reference for prenatal diagnosis of imperforate anus.Methods From June 2017 to July 2018,315 singleton pregnant women at 19-40 weeks of gestational age were selected from Beijing Tiantan Hospital,and they ranged in age from 23 to 40 years,with an average age of 29±3 years.The TUI technique was applied to measure the fetal anal sphincter diameter (ASD),anal canal diameter (ACD),and anal canal length (ACL).The correlation between ASD,ACD,or ACL and gestational age was analyzed by Pearson correlation analysis,and the regression equation and curve were established.The intraclass correlation coefficient (ICC) and 95％ confidence interval (CI) were used to evaluate the repeatability of the measurement ofASD,ACD,and ACL.Results The display rate of fetal anorectum in all fetuses by the TUI technique was 97.8％ (308/315).Pearson correlation analysis showed that the normal fetal ASD,ACD,and ACL were positively correlated with the gestational age of the fetus,and the regression equations are:ASD,Y=-0.001X2 + 0.421X-1.726 (r=0.83,P ＜ 0.01);ACD,Y=0.418X-4.207 (r=0.89,P ＜ 0.01);and ACL,Y=0.526X-1.062 (r=0.87,P ＜ 0.01).Conclusion TUI for assessment of fetal anorectum is feasible.This method can be applied to improve the display rate of fetal anorectum.

Objective To evaluate the transmural myocardial strain in three specific layers of the left ventricle at the papillary muscle level in short-axis view in SD rats before and after doxorubicin administration usmg myocardial layer-specific strain imaging based on two-dimensional ultrasound speckle tracking imaging (2D-STI),and to demonstrate the myocardial mechanical characteristics of doxorubicininduced early-stage acute cardiac toxicity in rats.Methods Thirty-two SD male rats weighing 300-350 g were randomly divided into a doxorubicin group (DOX group,n=16) and a control group (n=16).In the doxorubicin group,doxorubicin hydrochloride (concentration,2 mg/ml) was injected intraperitoneally at a single dose of 12 mg/kg,while the control group was given equal volume of 0.9％ sodium chloride solution.LVEDD,LVESD,IVSd,LVPWd,FS,and LVEF were measured and derived using two-dimensional gray-scale echocardiography at the left ventricular papillary muscle level in short-axis view at three time points (before administration and 24 and 48 hours after administration).The circumferential strain in the subendocardium,medium,and subepicardium at the left ventricular papillary muscle level in short-axis view were obtained using ultrasonic 2D-STI.The values of FS,LVEF,and the global myocardial circumferential strain in different layers of the left ventricular wall at the papillary muscle level in short axis view at three time points were compared between the two groups.After echocardiographic examinations at 48 h and 72 h,the hearts of three rats in each group were randomly selected,sliced,and HE-stained for myocardial pathological observation.Results In both groups,there was a circumferential strain gradient of the left ventricular wall at the papillary muscle level in the short-axis view:subendocardium ＞ medium ＞ epicardial myocardium.In the DOX group,the circumferential strain in the subendocardial myocardium decreased at 48 hours after DOX administration;the difference was statistically significant between the two groups (-25.13± 10.6 vs -17.04± 2.89,t=2.3,P ＜ 0.05).There was no significant difference in myocardial circumference strain in the three layers,as well as LVEDD,LVESD,IVS,LVPW,FS,or LVEF at three time points between the control group and DOX group (P ＞ 0.05).The pathological changes were mainly myocardial cell edema,vascular degeneration,myocardial nucleus atrophy,dissolution,interstitial edema,and capillary dilatation in the doxorubicin group,which were especially obvious in subendocardial cardiomyocytes.Conclusion 2D-STI technology based layer-specific strain imaging could be used to detect and quantitatively evaluate the deformation damage of the transmural left ventricular wall in SD rats.

Objective To summarize prenatal two-dimensional ultrasound examination results of different types of fetal limb deformity,and emphasise on some rare deformity disease such as phocomelia and sirenomelia.To investigate the value of systematic continuous sequence approach in the examination of fetal limb during pregnancy periods.Methods Eighteen thousand seven hundred and eight cases of fetus were selected from September 2014 to August 2016 in the 105th Hospital of Chinese People's Liberation Army,which were screened by routine and systematic ultrasonography.The systematic continuous sequence approach was used to focus on examination of the fetal limb.All fetuses with abnormal limbs were followed up.The ultrasonographic images were compared with the results of pathological examination and X-ray examination to summarize the ultrasonographic features of fetal limb deformities.Results Seventy-six cases of fetal limb deformity were detected by prenatal ultrasotmd system in 18 708 cases.Three cases were detected at 11-13 + 6 weeks of gestation,18 at 14-19 + 6 weeks,38 at 20-27 + 6 weeks,17 at 28-35 + 6 weeks.Types of limb deformities are as fllowing,11 cases of abnormal number of fingers (adactylism,polydactyly,syndactyly),2 cases of cleft hand deformity,45 cases of foot varus,1 case of sirenomelia and 4 cases of short limbs.Thirty-seven cases of fetal limb deformity combined with other system malformations and 12 cases were with multiple system malformations.Karyotypes were abnormal in 11 cases,including 3 cases of trisomy 21,6 cases of trisomy 18 and 3 cases of trisomy 13.One case of prenatal ultrasound diagnosis of twins with sirenomelia.An autopsy of twin fetus indicated that there were epactal toes at the left foot.Prenatal ultrasonography.Conclusions The systematic continuous sequence approach in early and middle pregnancy play the advantages of each pregnancy examination.The fetal limb deformity can be detected early by combining application of systematic continuous sequence approach.