title: Training retinal imagers for retinopathy of prematurity (ROP) screening.
abstract: To report the training/certification process of nonphysician imagers, image quality, and factors that affected image quality in the National Eye Institute sponsored multicentered e-ROP study.
  
  
  
  Nonphysician imagers underwent rigorous training and certification in obtaining retinal images, with attention to clarity, focus, and optic disk placement. Image readers measured pupil size in pupil image and graded posterior pole, temporal, nasal, superior, and inferior retinal images and classified them as good, adequate, poor, or missing. Good and adequate images were deemed acceptable.
  
  
  
  In 4,003 image sessions of 1,257 infants, 3,453 (86.8%) were complete. Of 39,550 retinal images, 91.7% had acceptable quality, 5.6% poor, and 2.7% were missing. Inadequate pupil dilation negatively affected acceptable image quality: 54% acceptable images for pupil <5 mm versus 93% for >6 mm (P < 0.0001). When ventilatory equipment obstructed access to imaged infant, the percent of acceptable image quality decreased: 94% for no support versus 66.6% for oscillatory ventilation (P < 0.0001). Acceptable image quality rates improved from 87% to 90% (P = 0.03) from first 6 months to last 6 months at low patient volume centers, while high patient volume centers remained stable at 95%.
  
  
  
  Nonphysicians successfully obtained acceptable quality images for ROP evaluation. Skills improved with experience. Image quality was negatively affected by inadequate pupil dilation and the presence of obstructive ventilatory equipment.
authors.affiliation: Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: kmakarp@gmail.com.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Karp
authors.affiliation: Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Agnieshka
authors.initials: A
authors.lastname: Baumritter
authors.affiliation: Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Pearson
authors.affiliation: Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Pistilli
authors.affiliation: University of Minnesota Masonic Children's Hospital, University of Minnesota Department of Pediatrics-Section of Neonatology, Minneapolis, Minnesota.
authors.forename: Darla
authors.initials: D
authors.lastname: Nyquist
authors.affiliation: Oklahoma University Health Sciences Center Department of Pediatrics-Section of Neonatology, Oklahoma City, Oklahoma.
authors.forename: Michele
authors.initials: M
authors.lastname: Huynh
authors.affiliation: Oklahoma University Health Sciences Center Department of Pediatrics-Section of Neonatology, Oklahoma City, Oklahoma.
authors.forename: Kelli
authors.initials: K
authors.lastname: Satnes
authors.affiliation: University of Louisville School of Medicine, Department of Pediatrics, Louisville, Kentucky.
authors.forename: Rachel
authors.initials: R
authors.lastname: Keith
authors.affiliation: Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Graham E
authors.initials: GE
authors.lastname: Quinn
mesh_terms: D000488:Allied Health Personnel / Q000193:education* / Q000592:standards; D002568:Certification; D002983:Clinical Competence / Q000592:standards; D003952:Diagnostic Imaging / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D009885:Ophthalmology / Q000193:education*; D011785:Quality Assurance, Health Care / Q000592:standards; D012178:Retinopathy of Prematurity / Q000145:classification / Q000175:diagnosis*; D013663:Teaching; D017216:Telemedicine / Q000379:methods