Karen A Karp1, Agnieshka Baumritter2, Denise J Pearson2, Maxwell Pistilli3, Darla Nyquist4, Michele Huynh5, Kelli Satnes5, Rachel Keith6, Gui-Shuang Ying3, Graham E Quinn7. 1. Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: kmakarp@gmail.com. 2. Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 3. Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania. 4. University of Minnesota Masonic Children's Hospital, University of Minnesota Department of Pediatrics-Section of Neonatology, Minneapolis, Minnesota. 5. Oklahoma University Health Sciences Center Department of Pediatrics-Section of Neonatology, Oklahoma City, Oklahoma. 6. University of Louisville School of Medicine, Department of Pediatrics, Louisville, Kentucky. 7. 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.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
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Authors: Mark B Horton; Christopher J Brady; Jerry Cavallerano; Michael Abramoff; Gail Barker; Michael F Chiang; Charlene H Crockett; Seema Garg; Peter Karth; Yao Liu; Clark D Newman; Siddarth Rathi; Veeral Sheth; Paolo Silva; Kristen Stebbins; Ingrid Zimmer-Galler Journal: Telemed J E Health Date: 2020-03-25 Impact factor: 3.536