Image quality management in early pregnancy: The case for improved guidance

Vincent Pelling, Joely Smith, Michael Mills, Lisa Harris, Medical Physics, Brighton and Sussex University Hospitals NHS Trust

Early pregnancy scans for patients with severe and genuine anxiety over pregnancy loss require sensitive care and quick accurate diagnosis. The quality of early pregnancy ultrasound (EPUS) scanning has recently been under review and as a result a small sample of 4 EPUS machines were subject to advanced quality testing. The results were suboptimal supporting the hypothesis that a lack of coordinated professional and management guidelines has been affecting the quality of early pregnancy scanning.

Machines are not managed by the imaging department therefore quality management controls such as governance and procurement are easily overlooked.

Scanning is not covered under ISAS accreditation, or RCR guidelines, and lies outside the remit of FASP.

Users have diverse training, from experienced sonographers, to midwives and rotational specialist trainee grade doctors.

There are no clear published recommendations for quality assurance testing in early pregnancy. Medical physics testing has shown variable performance across early pregnancy machines, using standard and novel methods. The project extends beyond the poster presentation with the aim of providing an objective assessment of performance (a semi-automated MATLAB script to assess the contrast-to-noise ratio (CNR) in phantom anechoic targets) to inform decision making about the need to adjust or replace machines or probes. Preliminary results of Kruskal Wallis testing showed significance (P<0.000) between the CNR of clinically ‘failing’ and adequately performing machines

It is recommended that quality assurance testing is undertaken on all early pregnancy machines and national guidelines produced to improve and standardise service provision.

To continue to develop this piece of work and a base of evidence, Dr Pelling and colleagues are conducting a survey on EPUS. They would welcome your feedback on your EPUS service; click here for the survey

The team at Brighton and Sussex University Hospital would be pleased to hear directly from anyone with a further interest in this project. Please contact Dr Pelling Directly on

View poster here