Protocol and quality assurance for carotid imaging in 100,000 participants of UK Biobank: development and assessment.

Abstract

Background Ultrasound imaging is able to quantify carotid arterial wall structure for the assessment of cerebral and cardiovascular disease risks. We describe a protocol and quality assurance process to enable carotid imaging at large scale that has been developed for the UK Biobank Imaging Enhancement Study of 100,000 individuals. Design An imaging protocol was developed to allow measurement of carotid intima-media thickness from the far wall of both common carotid arteries. Six quality assurance criteria were defined and a web-based interface (Intelligent Ultrasound) was developed to facilitate rapid assessment of images against each criterion. Results and conclusions Excellent inter and intra-observer agreements were obtained for image quality evaluations on a test dataset from 100 individuals. The image quality criteria then were applied in the UK Biobank Imaging Enhancement Study. Data from 2560 participants were evaluated. Feedback of results to the imaging team led to improvement in quality assurance, with quality assurance failures falling from 16.2% in the first two-month period examined to 6.4% in the last. Eighty per cent had all carotid intima-media thickness images graded as of acceptable quality, with at least one image acceptable for 98% of participants. Carotid intima-media thickness measures showed expected associations with increasing age and gender. Carotid imaging can be performed consistently, with semi-automated quality assurance of all scans, in a limited timeframe within a large scale multimodality imaging assessment. Routine feedback of quality control metrics to operators can improve the quality of the data collection.The author(s) disclosed receipt of the following financial support for the research, athoership, and/or publication of this article: UK Biobank has received funding from the UK Medical Research Council, Wellcome Trust, Department of Health, British Heart Foundation, Diabetes UK, Northwest Regional Development Agency, Scottish Government and Welsh Assembly Government. SC was supported by the UK Engineering and Physical Sciences Research Council (EPSRC) (Impact acceleration award EP/K503769/1) and Heart Research Australia. The QA tool was developed as part of the InnovateUK and EPSRC funded AQABUS project (EP/ L505316/1). RC is supported by a BHF personal chair. PL acknowledges support from the British Heart Foundation, Wellcome Trust, NIHR Oxford Biomedical Research Centre and Oxford BHF Centre for Research Excellence