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Online continuous quality improvement for diabetic retinopathy tele-screening
Steven H Stumpf1, Dinesh Verma, Rod Zalunardo
1Advanced BioTelecommunications and BioInformatics Center, University of Southern California Keck School of Medicine, Los Angeles, California, USA. sstumpf@charter.net
Summary
Non-professional photographers can effectively capture diabetic retinopathy images using digital fundus cameras. An online continuous quality improvement (CQI) protocol helps maintain and improve their image acquisition skills over time.
Area of Science:
- Ophthalmology
- Medical Imaging
- Public Health
Background:
- Non-mydriatic digital fundus cameras are crucial for diabetic retinopathy tele-screening.
- Training non-professional photographers is essential for expanding screening accessibility.
Purpose of the Study:
- To assess skill reinforcement and maintenance in non-professional photographers using an online continuous quality improvement (CQI) protocol.
- To evaluate the long-term effectiveness of remote quality assessment for fundus image acquisition.
Main Methods:
- 1-day seminar training for amateur photographers on fundus image capture without dilation.
- Online evaluation of 2,917 images submitted by 58 non-professional photographers over 19 months.
- CQI scoring by a professional photographer to track skill acquisition and maintenance.
Main Results:
- Over 93% of captured images were sufficient for clinical grading.
- Skill acquisition and maintenance were sustained throughout the study period.
- Exposure and focus were the most challenging aspects, while camera operation was easily learned.
Conclusions:
- An online CQI protocol effectively reinforces and sustains image capture skills in non-professional photographers.
- This approach is valuable for tele-screening programs, especially with staff turnover.
- Digital fundus cameras are user-friendly for non-professionals, reducing the need for specialized personnel.
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