Quality Improvement Report: The Sliding Sign Initiative—Facilitating Earlier Detection of Deep Endometriosis in an Academic US Department

A delayed diagnosis of endometriosis can significantly impact a patient's quality of life. To facilitate an earlier diagnosis, we implemented a modified pelvic US protocol that included use of the dynamic sliding sign (SS) maneuver to screen at-risk populations. The aim of this initiative was to improve both SS maneuver performance and SS reporting consistency to 80% and determine the number of new endometriosis cases identified after US. A quality improvement framework based on the plan-do-study-act (PDSA) methodology was used to develop and evaluate interventions. Eligible pelvic US studies were reviewed at regular intervals to track SS maneuver performance and SS reporting, with control charts used to detect intervention-related variation. A chart review of all abnormal SS cases was also performed. The project initiation (PDSA cycle 1) included protocol development and educational sessions. Reminder posters were placed during cycle 2 and revised in cycle 3, and the eligibility criteria were revised. Cycles 4 and 5 consisted of in-person discussions, distribution of a reference guide, and creation of a dictation software macro. In terms of results, sonographers performed the SS maneuver correctly in 52.1% of eligible patients after cycle 1, increasing to 83.9% by cycle 5. In the cases in which the SS maneuver was performed by the sonographer, after PDSA cycle 1, the SS was reported by the radiologist in 69% of cases (including both correct and incorrect interpretations), and both reported and interpreted correctly in 59% of cases, reaching 79.5% by cycle 3, and plateauing thereafter. Thirty-seven patients were newly diagnosed with endometriosis after undergoing US of the SS. The objectives of our SS initiative were met, with improved SS US performance, improved SS reporting and interpretation, and a number of new endometriosis cases diagnosed. ^©RSNA, 2024 Supplemental material is available for this article. See the invited commentary by Jha and VanBuren in this issue.