The quality of Hysterosalpingography
Hysterosalpingography (HSG) is a diagnostic investigation used to delineate the anatomy of the female reproductive tract.It is recommended by NICE as the first line investigation in sub-fertility to assess tubal patency.
The aim of this audit is to assess performance of Hysterosalpingography.
There are no published standards for diagnostic quality of images and therefore a suggested standard was developed following a review of the published literature.
There is no national standard for performing an HSG. However a review of the literature identified at least four key images that should be obtained during a study. The key images should be of good diagnostic quality and the report should be accurate.
• All 4 key images obtained - 100%
• Study quality - 100% diagnostic
• Report accuracy - 95% concordance with original report on review
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The indicator
1. Key images- early uterine filling, late uterine / early tubal filling, late tubal filling, and free spill of contrast.
2. Study quality – scored as poor, average or good with respect to anatomical delineation during all the phases of filling. To be deemed diagnostic, the image quality should be average or good.
3. Report accuracy – the report is deemed accurate if retrospective analysis agrees with the contemporaneous report.
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Data items to be collected
• The number of images obtained during the study.
• Whether the key images obtained.
• The device used
• Study quality
• Report accuracy
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Suggested number
100 studies
• Are 4 key images being obtained?
• Consider changing cannulation device used. Although multiple instruments are available for performing the procedure including the Leech Wilkinson Cannula, the Margolin Cannula and HSG Balloon Cannula, there is no conclusive evidence that one has superior performance characteristics over the other. This may be worth reviewing locally.
• Awareness of both literature, review training / supervision, this may be of importance if studies principally performed by registrars on rotational basis
Consultant radiologist to review and score the studies (5 hours total).
1 Simpson W, Beitia L, Mester J. Hysterosalpingography: A Re-emerging Study
Radio Graphics 2006; 26: 419-431.
2 Tur-Kaspa I, Seidma DS, Soriano D, Greenberg I, Dor J, Bider D. Hysterosalpingography with a balloon versus a metal cannula: a prospective, randomized, blinded comparative study. Human Reproduction 1998; 13 (1): 75-77.
1.NICE: Fertility: assessment and treatment for people with fertility problems,Clinical guidelines CG11; Issued: February 2004
[link]http://guidance.nice.org.uk/CG11[link]
3.
For an audit on dose and success of cannulation see
Warren Davis
13 February 2010