Development of Quality Indicators for the Ultrasound Department through a Modified Delphi Method

Round 1

Reviewer 1 Report

The purpose of the study was to construct a set of quality indicators that are important and feasible for measuring the quality and prompting improvement in ultrasound performance on the basis of literature, expert consensus and hospital application to ensure accurate diagnosis and treatment. In my opinion, quality assurance is especially important in the field of diagnostic imaging. Modalities like ultrasonography are fast developing, relatively easy to use and inexpensive. However, method is still highly operator dependent. The study is well constructed and manuscript well written. I found only minor mistakes.

English language: appropriate and easy to read

Citations: appropriate, manuscript is not under- or over-cited

Title: in accordance with the content

Introduction: appropriately long and provide sufficient background

Materials and methods: The process of developing ultrasound quality indicators included a literature review and three-round modified Delphi consensus process. Methods are well described and in accordance with the purpose of the study. Expert panel selection criteria are good and a large number of institutions were included. All 13 quality indicators can be applied to many levels, enable comparisons across institutions, monitor changes (two years in study) and determine whether an action has resulted in improvement.

Discussion: the meaning of quality indicators is well explained in this section. Future directions and limitations of study are well described at the end of discussion. However, only time and further investigations will tell us, if following those 13 indicators improve diagnostic procedure and patients experience.  

Table 5. Title1, 2 and 3 should be replaced with, probably, year 2020, 2021 and p value.

Author Response

Thank you for your valuable suggestion regarding Table 5's titles.

We've carefully considered your recommendation, and in response, we've updated Table 5 as follows: 'Title1' has been replaced with 'Year 2020', 'Title2' with 'Year 2021', and 'Title3' with 'p-value'. These changes have been marked with red highlights for clarity within the updated table.

We appreciate your attention to detail, which has guided us in enhancing the clarity and precision of Table 5 to better align with the content presented.

Reviewer 2 Report

Pls finalize some english wording. Otherwise congtatulations for huge effort. 
some suggestions regarding wording in PDF 

Comments for author File: Comments.pdf

Pls see above

Author Response

We sincerely thank you for your feedback which would help to improve the quality of our manuscript.

Lines have been added to Table 4 to present the results more clearly. We have also made corresponding modifications according to your suggestions regarding the words. (Highlighted in yellow)

Recognizing the importance of linguistic accuracy, we have taken proactive steps to address these concerns. Specifically, we have engaged the services of American Journal Experts (AJE) to meticulously review and polish the language throughout the manuscript.

Once again, we are grateful for your valuable input, which has contributed significantly to the refinement of our manuscript.

Reviewer 3 Report

The paper is not really interesting for general US user and, for more, the general idea is somehow not correct as some indicators are not reflecting the quality of the sonography department but the quality of the referral (i.e. to use the positive rate of all reports as an outcomes indicator or the coincidence rate of US esaminations) that is appropriateness and not quality of the US seervice. In the process indicators it is used the waitinig time in the inpatients departement, I wonder why it is not used the outpatients waiting time as well. 

The panel is formed by chiefs of the centers and this is usually not an indicator of real knowledge of US (usually the ones who do the daily work are better than their chief, which are not doing US everyday)

In general, english text is really poor and lines 129-143 should be moved in another section (i.e. discussion).

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

Dear authors, 

I have perused the article pertaining to the identification of novel quality indicators for the ultrasound departments, and it has piqued my intellectual curiosity. The research publication titled "Development of quality indicators for the ultrasound department through a modified Delphi method" could perhaps attract attention from the medical world. However, prior to its publication, some modifications need to be taken into account.

1. Abstract: The background section of the abstract lacks a clear subject and predicate. It would have been more appropriate to commence with the statement, 'The objective of this study is...'. Furthermore, it is necessary to adjust the actual content of the abstract.

2. References: The references cited in the introduction and discussions demonstrate a considerable temporal distance from the present, as shown by their publication dates. In the preceding five-year period, just four references had been identified. It is recommended to incorporate information from more recent studies and research.

3. Discussions: The discussion section should incorporate the findings of the present investigation in comparison to existing literature. This section includes references to papers such as the BI-RADS lexicon for ultrasound and mammography, as well as the ACR BI-RADS breast imaging atlas. The integration of publications with similar research directions should be incorporated into the discussion, allowing for a comparative analysis. 

4. Additionally, it would be interesting to compare the present findings with those elucidated in your aforementioned scholarly publication titled 'A National Quality Improvement Program on Ultrasound Department in China: A Controlled Cohort Study of 1297 Public Hospitals'. (Tao, X., Li, J., Gu, Y., Ma, L., Xu, W., Wang, R., Gao, L., Zhang, R., Wang, H., & Jiang, Y. (2022). A National Quality Improvement Program on Ultrasound Department in China: A Controlled Cohort Study of 1297 Public Hospitals. International journal of environmental research and public health, 20(1), 397. https://doi.org/10.3390/ijerph20010397)

5. The manuscript contains some grammatical errors. The majority of these mistakes relate to the person and time of the verbs. A review of this one would be required.

The manuscript contains some grammatical errors. The majority of these mistakes relate to the person and time of the verbs. A review of this one would be required.

Moderate editing of English language required

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 5 Report

The authors systematized several quality indicators and developed the new indicators in order to estimate the quality of ultrasound performance. The work is correctly and clearly presented. I suggest to add more comparison with other studies' results in the Discussion section.

Minor gramatical and style errors.

Author Response

Dear reviewer,

Thank you for your positive and constructive feedback on our manuscript.

In response to your suggestion, we've expanded the comparison with other studies' results in the Discussion section, specifically in lines 338-345 and lines 449-463. These additions, highlighted in purple, aim to provide a more comprehensive analysis by juxtaposing our findings with relevant literature.

Regarding the minor grammatical and style errors, we've taken proactive steps to ensure language refinement. We've engaged the services of American Journal Experts (AJE) to polish the manuscript, aiming for improved language quality and stylistic coherence.

Additionally, we've thoroughly reviewed all references to ensure their relevance to the manuscript's content.

Your insightful comments have been instrumental in refining the discussion and improving the overall quality of our manuscript. We are committed to delivering an enhanced version that aligns with the journal's standards.

Round 2

Reviewer 3 Report

The quality of the paper hai been improved

Fine

Author Response

Dear Reviewer,

Thank you for your feedback on the manuscript. We've carefully reviewed and revised the language throughout the manuscript to ensure clarity and coherence. We've addressed grammatical and stylistic issues to enhance the readability of the manuscript.

We appreciate your consideration and hope that the revisions meet the standards required for publication.

Sincerely,

Authors

Reviewer 4 Report

Dear authors,

I have thoroughly examined the revised version regarding the identification of new quality indicators for ultrasound departments, which has sparked my intellectual interest. The research work entitled "Development of quality indicators for the ultrasound department through a modified Delphi method" has the potential to garner interest among the medical community. 

The quality of the text has significantly improved from the previous revisions. I express my gratitude to the authors for their diligent evaluation of the proposed aspects by reviewers.

Only one mention would be related to these requirements of the Diagnostics journal. Original research articles: more than 4000 words in the main body; around or more than 30 references; at least five tables or figures with detailed experimental results are recommended.

I would recommend augmenting the number of pertinent references, if feasible, to reach a total of approximately 30 references.

Author Response

Dear Reviewer,

Thank you for your insightful comments on the introduction and references in our manuscript. We have diligently revised the introduction section to ensure it provides comprehensive background information supported by relevant references that highlight the significance of our study.

To specifically address your concerns:

1.Sufficient Background and References: We have meticulously reviewed and augmented the introduction with additional information to bolster the background of ultrasound services in healthcare. We have also ensured the inclusion of key references that substantiate the importance of establishing quality indicators in this field.

2.Relevance of Cited References: Every cited reference has been rigorously examined to ensure its relevance to our research. We have cross-checked each reference to align with the scope and focus of our study.

3.Augmenting Relevant References: In response to your recommendation, we have included more recent studies and findings that emphasize the critical need for quality indicators in ultrasound services. This effort has expanded the total number of references to approximately 30, enriching the literature base and strengthening the scholarly foundation of our work.

We genuinely appreciate your guidance and have taken significant steps to enhance the introduction and enrich the references. We hope these revisions address your concerns adequately.

Sincerely,

Authors