title: Quality assurance in ultrasound screening for hepatocellular carcinoma using a standardized phantom and standard clinical images: a 3-year national investigation in Korea.
abstract: OBJECTIVE
  The purpose of this study was to investigate the quality of ultrasound (US) imaging for hepatocellular carcinoma screening.
  
  
  METHODS
  The investigation was performed at all medical institutes participating in the National Cancer Screening Program in Korea. For assessment of personnel, we inquired who was performing the US screenings. For phantom image evaluation, the dead zone, vertical and horizontal measurements, axial and lateral resolution, sensitivity, and gray scale/dynamic range were evaluated. For clinical image evaluation, US images of patients were evaluated in terms of the standard images, technical information, overall image quality, appropriateness of depth, foci, annotations, and the presence of any artifacts.
  
  
  RESULTS
  Failure rates for phantom and clinical image evaluations at general hospitals, smaller hospitals, and private clinics were 20.9%, 24.5%, 24.1% and 5.5%, and 14.8% and 9.5%, respectively. No statistically significant difference was observed in the failure rates for the phantom images among groups of different years of manufacture. For the clinical image evaluation, the results of radiologists were significantly better than those of other professional groups (P = .0001 and .0004 versus nonradiology physicians and nonphysicians, respectively). The failure rate was also higher when the storage format was analog versus digital (P < .001).
  
  
  CONCLUSIONS
  Approximately 20% of US scanners failed the phantom image evaluation. The year of scanner manufacture was not significantly associated with the results of the phantom image evaluation. The quality of the clinical images obtained by radiologists was the best.
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.).
authors.forename: Joon-Il
authors.initials: JI
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.). sejung@catholic.ac.kr.
authors.forename: Seung Eun
authors.initials: SE
authors.lastname: Jung
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.).
authors.forename: Pyo Nyun
authors.initials: PN
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.).
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Cha
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.).
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Jun
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.).
authors.forename: Hoo-Yeon
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, School of Medicine, Catholic University of Korea, Seoul, Korea (J.-I.C., S.E.J.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (P.N.K.); Department of Radiology, Ansan Hospital, College of Medicine, Korea University, Ansan-si, Korea (S.H.C.); National Cancer Control Institute, National Cancer Center, Goyang-si, Korea (J.K.J.); Department of Social Medicine, College of Medicine, Dankook University, Cheonan-si, Korea (H.-Y.L.); and Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (E.-C.P.).
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008403:Mass Screening / Q000592:standards*; D015588:Observer Variation; D019047:Phantoms, Imaging / Q000592:standards*; D011785:Quality Assurance, Health Care; D012016:Reference Values; D015203:Reproducibility of Results; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000295:instrumentation* / Q000592:standards*
keywords: hepatocellular carcinoma; phantom; public policy; quality assurance; screening; ultrasound