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Lin Q, Zhou Y, Shi S, Zhang Y, Yin S, Liu X, Peng Q, Huang S, Jiang Y, Cui C, She R, Xu J, Dong F. How much can AI see in early pregnancy: A multi-center study of fetus head characterization in week 10-14 in ultrasound using deep learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107170. [PMID: 36272307 DOI: 10.1016/j.cmpb.2022.107170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To investigate if artificial intelligence can identify fetus intracranial structures in pregnancy week 11-14; to provide an automated method of standard and non-standard sagittal view classification in obstetric ultrasound examination METHOD AND MATERIALS: We proposed a newly designed scheme based on deep learning (DL) - Fetus Framework to identify nine fetus intracranial structures: thalami, midbrain, palate, 4th ventricle, cisterna magna, nuchal translucency (NT), nasal tip, nasal skin, and nasal bone. Fetus Framework was trained and tested on a dataset of 1528 2D sagittal-view ultrasound images from 1519 females collected from Shenzhen People's Hospital. Results from Fetus Framework were further used for standard/non-standard (S-NS) plane classification, a key step for NT measurement and Down Syndrome assessment. S-NS classification was also tested with 156 images from the Longhua branch of Shenzhen People's Hospital. Sensitivity, specificity, and area under the curve (AUC) were evaluated for comparison among Fetus Framework, three classic DL models, and human experts with 1-, 3- and 5-year ultrasound training. Furthermore, 4 physicians with more than 5 years of experience conducted a reader study of diagnosing fetal malformation on a dataset of 316 standard images confirmed by the Fetus framework and another dataset of 316 standard images selected by physicians. Accuracy, sensitivity, specificity, precision, and F1-Score of physicians' diagnosis on both sets are compared. RESULTS Nine intracranial structures identified by Fetus Framework in validation are all consistent with that of senior radiologists. For S-NS sagittal view identification, Fetus Framework achieved an AUC of 0.996 (95%CI: 0.987, 1.000) in internal test, at par with classic DL models. In external test, FF reaches an AUC of 0.974 (95%CI: 0.952, 0.995), while ResNet-50 arrives at AUC∼0.883, 95% CI 0.828-0.939, Xception AUC∼0.890, 95% CI 0.834-0.946, and DenseNet-121 AUC∼0.894, 95% CI 0.839-0.949. For the internal test set, the sensitivity and specificity of the proposed framework are (0.905, 1), while the first-, third-, and fifth-year clinicians are (0.619, 0.986), (0.690, 0.958), and (0.798, 0.986), respectively. For the external test set, the sensitivity and specificity of FF is (0.989, 0.797), and first-, third-, and fifth-year clinicians are (0.533, 0.875), (0.609, 0.844), and (0.663, 0.781), respectively.On the fetal malformation classification task, all physicians achieved higher accuracy and F1-Score on Fetus selected standard images with statistical significance (p < 0.01). CONCLUSION We proposed a new deep learning-based Fetus Framework for identifying key fetus intracranial structures. The framework was tested on data from two different medical centers. The results show consistency and improvement from classic models and human experts in standard and non-standard sagittal view classification during pregnancy week 11-13+6. CLINICAL RELEVANCE/APPLICATION With further refinement in larger population, the proposed model can improve the efficiency and accuracy of early pregnancy test using ultrasound examination.
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Affiliation(s)
- Qi Lin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yuli Zhou
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Siyuan Shi
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Yujuan Zhang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoli Yin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xuye Liu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Qihui Peng
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoting Huang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yitao Jiang
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Chen Cui
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China.
| | - Ruilian She
- Department of Obstetric, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
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Thornburg LL, Bromley B, Dugoff L, Platt LD, Fuchs KM, Norton ME, McIntosh J, Toland GJ, Cuckle H. United States' experience in nuchal translucency measurement: variation according to provider characteristics in over five million ultrasound examinations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:732-737. [PMID: 33634915 DOI: 10.1002/uog.23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The Nuchal Translucency Quality Review (NTQR) program has provided standardized education, credentialing and epidemiological monitoring of nuchal translucency (NT) measurements since 2005. Our aim was to review the effect on NT measurement of provider characteristics since the program's inception. METHODS We evaluated the distribution of NT measurements performed between January 2005 and December 2019, for each of the three primary performance indicators of NT measurement (NT median multiples of the median (MoM), SD of log10 NT MoM and slope of NT with respect to crown-rump length (CRL)) for all providers within the NTQR program with more than 30 paired NT/CRL results. Provider characteristics explored as potential sources of variability included: number of NT ultrasound examinations performed annually (annual scan volume of the provider), duration of participation in the NTQR program, initial credentialing by an alternative pathway, provider type (physician vs sonographer) and number of NT-credentialed providers within the practice (size of practice). Each of these provider characteristics was evaluated for its effect on NT median MoM and geometric mean of the NT median MoM weighted for the number of ultrasound scans, and multiple regression was performed across all variables to control for potential confounders. RESULTS Of 5 216 663 NT measurements from 9340 providers at 3319 sites, the majority (75%) of providers had an NT median MoM within the acceptable range of 0.9-1.1 and 85.5% had NT median MoM not statistically significantly outside this range. Provider characteristics associated with measurement within the expected range of performance included higher volume of NT scans performed annually, practice at a site with larger numbers of other NT-credentialed providers, longer duration of participation in the NTQR program and alternative initial credentialing pathway. CONCLUSIONS Annual scan volume, duration of participation in the NTQR program, alternative initial credentialing pathway and number of other NT-credentialed providers within the practice are all associated with outcome metrics indicating quality of performance. It is critical that providers participate in ongoing quality assessment of NT measurement to maintain consistency and precision. Ongoing assessment programs with continuous feedback and education are necessary to maintain quality care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L L Thornburg
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - B Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - L Dugoff
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - L D Platt
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA, USA
| | - K M Fuchs
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - M E Norton
- Department of Obstetrics and Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - J McIntosh
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - G J Toland
- Perinatal Quality Foundation, Oklahoma City, OK, USA
| | - H Cuckle
- Tel Aviv University, Faculty of Medicine, Ramat Aviv, Israel
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Real-time quality control of nuchal translucency measurements using the exponentially weighted moving average chart. Taiwan J Obstet Gynecol 2021; 60:84-89. [PMID: 33495014 DOI: 10.1016/j.tjog.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The establishment of ongoing audits for first-trimester nuchal translucency (NT) measurements is of paramount importance. The exponentially weighted moving average (EWMA) chart has been published as an efficient tool for NT quality control with the advantages of being suitable for real-time long-term monitoring. This study aimed to assess the efficacy of real-time NT quality control using EWMA charts. MATERIALS AND METHODS This was an ongoing prospective study conducted from January 2011 to December 2017 at the Centre for Fetal Medicine Gennet in Prague. The quality of NT measurements was assessed using the NT retrospective distribution parameters and EWMA charts, and the results were presented to the sonographers during collective meetings. RESULTS Overall, 28,928 NT measurements obtained from six sonographers were eligible for the study. Looking at individual EWMA charts, we observed four main outcomes. First, there was a clear improvement in the performance of sonographers with initially poor performances. Second, the performance of sonographers with an initially satisfactory quality was maintained. Third, there was an observed deterioration of the performance without the audits. Last, the sonographers appreciated an unequivocal and straightforward graphical presentation of EWMA curves. CONCLUSION EWMA proved to be an efficient and suitable tool for real-time monitoring of NT quality and led to an overall improvement of the sonographers' performance.
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Badal B, Ballesteros A, Crespo M, Morell-Garcia D, Bauçà JM, Pastor M, Ruiz de Gopegui R, Martín I. Quality control of ultrasonography markers for Down's syndrome screening: a retrospective study by the laboratory. Diagnosis (Berl) 2021; 0:dx-2021-0007. [PMID: 34090321 DOI: 10.1515/dx-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Quality control of ultrasonography markers is necessary to ensure greater efficacy of prenatal aneuploidy screening. The aim of this study was to assess the quality of the crown-rump length (CRL) and nuchal translucence (NT) measurement accuracy by the laboratory according to quality indicators. METHODS Retrospective observational study on 4,908 single-foetus pregnant women who underwent prenatal aneuploidy screening in the first trimester of pregnancy. Euploid foetuses with CRL between 45 and 84 mm were included, while those with NT≥3.5 mm were excluded. CRL measurement was considered to be accurate if the median multiples of the median (MoM) for pregnancy-associated plasma protein A (PAPP-A) was between 0.90 and 1.10. Fifteen sonographers participated in the study, six of whom comprised the control group. Systematic error for a sonographer was considered when CRL measurement was greater than ±2 mm with respect to the control group. Quality for NT was assured by means of the WHIRI method and each sonographer cumulative sum control chart (CUSUM). RESULTS For CRL accuracy, five sonographers underestimated the measurements, while another four overestimated them, with no statistical differences. For smaller sized foetuses, all sonographers met the established specifications. Regarding NT control, three sonographers did not meet the quality criteria for the median MoM. All sonographers met the specifications for the logarithmic standard deviation of the NT MoM levels. Thirteen sonographers met the CUSUM specifications. CONCLUSIONS Evaluation of a quality control of ultrasonography parameters by laboratory professionals is necessary to avoid under- or overestimation tendencies for CRL and NT measurements. CUSUM is a useful tool for the immediate correction of errors in NT measurements.
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Affiliation(s)
- Blanca Badal
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antonieta Ballesteros
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Miriam Crespo
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Morell-Garcia
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Josep Miquel Bauçà
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Maria Pastor
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Rosa Ruiz de Gopegui
- Gynecology and Obstetrics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Inmaculada Martín
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Torrent A, Manrique G, Gómez-Castelló T, Baldrich E, Cahuana M, Manresa JM, Borrell A. Sonologist's characteristics related to a higher quality in fetal nuchal translucency measured in primary antenatal care centers. Prenat Diagn 2019; 39:934-939. [PMID: 31237971 DOI: 10.1002/pd.5512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the quality of nuchal translucency (NT) measurements in primary care and the sonologist's characteristics related with a higher quality. METHODS The median NT expressed in multiples of the median (MoM) was calculated for each sonologist of 14 participating antenatal primary care centers of the Catalan Institute of Health. A survey to the sonologists was used to establish variables related to higher-quality measurements. RESULTS The median NT MoM obtained in 16 448 NT measurements, performed by 102 sonologists, was 0.94 MoM. NT underestimation was observed in 46% of the sonologists. Underestimation were less frequent among professionals who performed more than 230 ultrasounds per year (26% vs 53%;p = .022), those who completed the online Fetal Medicine Foundation (FMF) course (22% vs 54%; p = .021), and those who were subject to periodic audits (24% vs 56%; p = .021). Underestimation rate decreased from 60%, to 33% and 14% with the increase of the years of experience from less than 5 years, to 6 to 15 years and more than 15 years of experience, respectively (p = .029). CONCLUSIONS Higher-quality measurements were demonstrated in sonologists who performed more ultrasounds per year, those with more years of scanning experience, those who completed the online FMF course, and those periodically audited.
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Affiliation(s)
- Anna Torrent
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mollet, Institut Catala De La Salut, Barcelona, Spain.,GRASSIR Emerging Consolidated Research Group on Sexual and Reproductive Health, Institut de Recerca en Atencio Primaria Jordi Gol
| | - Gemma Manrique
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mollet, Institut Catala De La Salut, Barcelona, Spain
| | - Teresa Gómez-Castelló
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mataró, Institut Catala De La Salut, Barcelona, Spain
| | - Elisabeth Baldrich
- Obstetrics and Gynecology Primary Care Center (ASSIR) Sabadell, Institut Catala De La Salut, Barcelona, Spain
| | - Marc Cahuana
- GRASSIR Emerging Consolidated Research Group on Sexual and Reproductive Health, Institut de Recerca en Atencio Primaria Jordi Gol.,Obstetrics and Gynecology Primary Care Center (ASSIR) Sabadell, Institut Catala De La Salut, Barcelona, Spain
| | - Josep M Manresa
- Unitat Suport Recerca Metropolitana Nord, Institut de Recerca en Atencio Primaria IDIAPJGol, Sabadell, Spain.,Departament d'Infermeria, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Antoni Borrell
- Department of Maternal-Fetal Medicine Barcelona, Institute Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
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Quarello E, Jacquemard F. [E. Quarello et F. Jacquemard in reply to the article by M. Constant: Nuchal translucency: not so simple! Gynecol Obstet Fertil 2014;42:820-21]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2015; 43:332-333. [PMID: 25824713 DOI: 10.1016/j.gyobfe.2015.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Indexed: 06/04/2023]
Affiliation(s)
- E Quarello
- Unité d'échographie de diagnostic prénatal, hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex 08, France; Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France.
| | - F Jacquemard
- Centre de diagnostic prénatal, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
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Cuckle H, Platt LD, Thornburg LL, Bromley B, Fuchs K, Abuhamad A, Benacerraf B, Copel JA, Depp R, D'Alton M, Goldberg J, O'Keeffe D, Spitz J, Toland G, Wapner R. Nuchal Translucency Quality Review (NTQR) program: first one and half million results. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:199-204. [PMID: 24753079 DOI: 10.1002/uog.13390] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/10/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the performance of first-trimester nuchal translucency (NT) measurement by providers (physician-sonologists and sonographers) within the Nuchal Translucency Quality Review (NTQR) program. METHODS After training and credentialing providers, the NTQR monitored performance of NT measurement by the extent to which an individual's median multiple of the normal median (MoM) for crown-rump length (CRL) was within the range 0.9-1.1 MoM of a published normal median curve. The SD of log10 MoM and regression slope of NT on CRL were also evaluated. We report the distribution between providers of these performance indicators and evaluate potential sources of variation. RESULTS Among the first 1.5 million scans in the NTQR program, performed between 2005 and 2011, there were 1 485 944 with CRL in the range 41-84 mm, from 4710 providers at 2150 ultrasound units. Among the 3463 providers with at least 30 scans in total, the median of the providers' median NT-MoMs was 0.913. Only 1901 (55%) had a median NT-MoM within the expected range; there were 89 above 1.1 MoM, 1046 at 0.8-0.9 MoM, 344 at 0.7-0.8 MoM and 83 below 0.7 MoM. There was a small increase in the median NT-MoM according to providers' length of time in the NTQR program and number of scans entered annually. On average, physician-sonologists had a higher median NT-MoM than did sonographers, as did those already credentialed before joining the program. The median provider SD was 0.093 and the median slope was 13.5%. SD correlated negatively with the median NT-MoM (r = -0.34) and positively with the slope (r = 0.22). CONCLUSION Even with extensive training, credentialing and monitoring, there remains considerable variability between NT providers. There was a general tendency towards under-measurement of NT compared with expected values, although more experienced providers had performance closer to that expected.
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Affiliation(s)
- H Cuckle
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
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Dhombres F, Khoshnood B, Bessis R, Fries N, Senat MV, Jouannic JM. Quality of first-trimester measurement of crown-rump length. Am J Obstet Gynecol 2014; 211:672.e1-5. [PMID: 24912098 DOI: 10.1016/j.ajog.2014.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/07/2014] [Accepted: 06/04/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the quality of crown-rump length (CRL) measurements in scans judged to be of high quality for the measurement of the nuchal translucency. STUDY DESIGN We analyzed prospective data on 68,250 scans by 1913 sonographers that were collected by the French College of Fetal Echography (CFEF) national practice assessment program for the first-trimester scan. The scans were evaluated according to the CFEF image scoring method (CFEF-ISM), which includes items to measure the quality of the scan for both nuchal translucency and the CRL measurements. The scans were classified into 4 quality groups with the use of the full CFEF-ISM score and then a shortened version of the CFEF-ISM that excluded the item on quality of CRL measurement. The proportion of scans with an inaccurate CRL measurement was compared across the different quality groups. RESULTS Overall, 21.67% of scans were of insufficient quality for CRL measurement. Among 23,764 "excellent" scans according to the full CFEF-ISM, 965 scans (4.06%) had insufficient CRL quality vs 9.24% of scans with "excellent" quality on the short CFEF-ISM (relative risk, 2.27; 95% confidence interval, 2.11-2.44; P < .001). CONCLUSION High scores of the quality of nuchal translucency measurement do not guarantee accurate measurement of crown-rump length. Specific measures are needed to evaluate and to improve the quality of the measurement of crown-lump length.
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Hermann M, Fries N, Mangione R, Boukobza P, Ville Y, Salomon LJ. Nuchal translucency measurement: are qualitative and quantitative quality control processes related? Prenat Diagn 2013; 33:770-4. [DOI: 10.1002/pd.4121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/10/2013] [Accepted: 03/21/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Monika Hermann
- Department of Obstetrics and Gynecology; Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris; Paris France
- Société Française pour l'Amélioration des Pratiques Echographiques (SFAPE); Paris France
- Université Paris Descartes; Paris France
| | - Nicolas Fries
- Collège Français d'Echographie Fœtale (CFEF); France
| | | | | | - Yves Ville
- Department of Obstetrics and Gynecology; Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris; Paris France
- Société Française pour l'Amélioration des Pratiques Echographiques (SFAPE); Paris France
- Université Paris Descartes; Paris France
| | - Laurent J. Salomon
- Department of Obstetrics and Gynecology; Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris; Paris France
- Société Française pour l'Amélioration des Pratiques Echographiques (SFAPE); Paris France
- Université Paris Descartes; Paris France
- Collège Français d'Echographie Fœtale (CFEF); France
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Ranta JK, Marttala J, Laitinen P, Kultti J, Kauhanen O, Romppanen J, Hämäläinen E, Heinonen S, Pulkki K, Ryynänen M. First trimester biochemistry at different maternal ages. Clin Chem Lab Med 2012; 50:549-55. [DOI: 10.1515/cclm.2011.785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 10/19/2011] [Indexed: 11/15/2022]
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Gabriel CC, Echevarria M, Rodríguez I, Serra B. Analysis of quality of nuchal translucency measurements: its role in prenatal diagnosis. ScientificWorldJournal 2011; 2012:482832. [PMID: 22649294 PMCID: PMC3353280 DOI: 10.1100/2012/482832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. Quantitative analysis of the quality of nuchal translucency (NT) measurements. Methods. First-trimester combined screening for Down syndrome was performed to all pregnant women attended in our Department from October 2003 to November 2009. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians. The performance of NT measurements was retrospectively analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown rump length (CRL) values, and FMF certification was statistically tested. Results. A total of 14978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0,98. (2) Mean percentage of cases >95th and <5th centiles were 5,0% and 4,2%, respectively. (3) Logarithmic mean and SD of the NT MoM values were 0,00 and 0,13, respectively. (4) The DR for trisomy 21 at screening time was 90,7% for a FPR of 6,7% for standard screening strategy. (5) According to Cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Conclusion. Overall, quality standards show optimal NT measurements in our unit. Operator experience, a dedicated profile to fetal medicine, CRL over 60 mm, and FMF certification have a significant positive impact on the quality standards.
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Affiliation(s)
- Carmen Comas Gabriel
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Gran Vía Carles III 71-75, 08028 Barcelona, Spain.
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Lichtenbelt KD, Alizadeh BZ, Scheffer PG, Stoutenbeek P, Schielen PCJI, Page-Christiaens LCML, Schuring-Blom GH. Trends in the utilization of invasive prenatal diagnosis in The Netherlands during 2000-2009. Prenat Diagn 2011; 31:765-72. [PMID: 21692084 DOI: 10.1002/pd.2764] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/22/2011] [Accepted: 03/24/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyze trends in the number and type of invasive procedure, reasons for referral, maternal age and chromosomal abnormalities over a 10-year period and correlate the trends to changes in the national prenatal screening policy. METHODS Data from 10 706 invasive prenatal procedures yielding a full karyotype, performed between 2000 and 2009 were extracted from the cytogenetic database in the central region of The Netherlands. Trends were analyzed. RESULTS Over a 10-year period, the number of invasive procedures halved and the percentage of chromosomal abnormalities detected, increased from 5.5 to 9.4%. After 2007, however, 5.7% of karyotypes in women over 36 years were found to be abnormal, versus 18.1% in women below 36 years. In 2009, 71.5% of women over 36 are still referred for invasive prenatal diagnosis on the indication advanced maternal age. CONCLUSIONS Changes in prenatal screening policy significantly increased referral after screening and improved the efficacy of invasive prenatal diagnosis. We show the continuing effect of the different policies applied in the past to women below and above the age of 36. To further improve efficacy of invasive prenatal diagnosis, first trimester combination screening should be actively offered to women of all ages.
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Affiliation(s)
- Klaske D Lichtenbelt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
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Estrategias para mejorar el cribado de síndrome de Down: experiencia en el Instituto Dexeus (Barcelona). ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.diapre.2010.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lončar D, Stojadinović M, Lončar S. PREDICTIVE VALUE OF FETAL NUCHAL TRANSLUCENCY IN SCREENING OF CHROMOSOMAL ABERRATIONS. ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nisbet DL, Robertson AC, Schluter PJ, McLennan AC, Hyett JA. Auditing ultrasound assessment of fetal nuchal translucency thickness: a review of Australian National Data 2002-2008. Aust N Z J Obstet Gynaecol 2011; 50:450-5. [PMID: 21039379 DOI: 10.1111/j.1479-828x.2010.01207.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nuchal translucency (NT) measurement is the ultrasound component of first trimester combined screening for Down syndrome. In 2002, a NT ultrasound education and monitoring program was established in Australia. Between 2002 and 2008, a total of 728,502 NT scans were audited through this process. OVERALL AIM: To audit the availability and performance of certified operators measuring NT following implementation of the Australian education and monitoring program in 2002. METHODS Retrospective review of the central database that is used to monitor performance of individuals and practices performing NT scans in both public and private practice settings throughout Australia between 2002 and 2008. The performance of operators was assessed by a widely used international standard - that 40-60% of NT measurements should be above the median value for gestational age. RESULTS The number of certified operators has increased (from 184 in 2002 to 477 in 2008). There is wide variation between states in the number of operators per birth. The percentage of certified operators with a measurement distribution meeting the international standard has increased from 40% in 2002 to 55% in 2008. Greatest improvement has been seen in operators performing 30-199 scans per year. There has been no overall improvement in performance over the last three audit cycles. CONCLUSIONS The number of operators certified to perform the NT scan has increased since 2002, although availability in some states remains low. An initial improvement in performance of operators appears to have reached a plateau. It is time to become more proactive in engaging operators in the audit cycle.
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Affiliation(s)
- Debbie L Nisbet
- Pauline Gandel Women's Imaging Department, Royal Women's Hospital, Parkville, Victoria, Australia.
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Lončar D, Stojadinović M, Lončar S. PREDIKATIVNA VREDNOST FETALNE NUHALNE TRANSLUCENCE U SKRININGU HROMOZOMSKIH ABERACIJA. ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0102s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Echevarria M, Comas C, Serra B, Rodríguez I, Sabrià J. Analysis of Quality of Nuchal Translucency Measurements. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10009-1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ABSTRACT
Objective
Quantitative analysis of the quality of nuchal translucency (NT) measurements.
Methods
This is a retrospective single-center study. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians (October 2003-November 2009). The performance of NT measurements was analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown-rump length (CRL) values and FMF certification was statistically tested.
Results
A total of 14,978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0.98. (2) Mean percentage of cases >95th and <5th percentiles were 5.0 and 4.2% respectively. (3) Logarithmic mean and SD of the NT-MoM values were 0.00 and 0.13 respectively. (4) The DR for trisomy 21 at screening time was 90.7% for a FPR of 6.7% for standard screening strategy. (5) According to cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Operator experience, exclusive dedication to FM, FMF certification and a range of CRL values > 60 mm had a statistical impact improving these standards.
Conclusion
Overall quality standards show optimal NT measurements in our unit. Experience a dedicated profile to fetal medicine ultrasound, CRL over 60 mm and FMF certification has a significant positive impact on the quality standards.
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Koster MPH, Stoutenbeek P, Visser GHA, Schielen PCJI. Trisomy 18 and 13 screening: consequences for the Dutch Down syndrome screening programme. Prenat Diagn 2010; 30:287-9. [PMID: 20112231 DOI: 10.1002/pd.2467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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