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Ibarra Vilar P, De Luca L, Badr DA, Cos Sanchez T, Carlin A, Lecomte S, Jani JC, Kang X. Learning curve for fetal postmortem ultrasound. Prenat Diagn 2024; 44:15-27. [PMID: 38117025 DOI: 10.1002/pd.6482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/10/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To determine the learning curve of fetal postmortem ultrasound (PMUS) and evaluate the evolution of its diagnostic performance over the past 8 years. METHODS PMUS was performed by two fetal medicine specialists and two experts on 100 unselected fetuses of 12-38 weeks of gestation in a prospective, double-blind manner. 21 pre-defined internal structures were analyzed consecutively by the trainee alone and the expert, with a comparison of diagnosis and immediate feedback. The learning curves for examination duration, non-recognition of structures and final diagnoses were computed using cumulative summation analysis. Secondly, the expert PMUS diagnostic accuracy using autopsy as the gold standard was compared to the previously published data. RESULTS The trainees reached expert level of PMUS at 28-36 cases for examination duration (12.1 ± 5.2 min), non-diagnostic rate (6.5%, 137/2100), and abnormality diagnosis. In a group of 33 fetuses ≥20 weeks who had an autopsy, the experts PMUS performance was improved after 8 years with a reduction of all organs non-diagnostic rate (6.5 %VS 11.4%, p < 0.01) and higher sensitivity for the heart (100% VS 40.9%, p < 0.01) and the abdomen (100%VS 56.5%, p < 0.05). CONCLUSION PMUS offers a short learning curve for fetal medicine specialists and on-going improvement of diagnostic accuracy over time.
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Affiliation(s)
- Patricia Ibarra Vilar
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura De Luca
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Teresa Cos Sanchez
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Lecomte
- Department of Feto-Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Xin Kang
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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A 10-Year Retrospective Review of Prenatal Applications, Current Challenges and Future Prospects of Three-Dimensional Sonoangiography. Diagnostics (Basel) 2021; 11:diagnostics11081511. [PMID: 34441444 PMCID: PMC8394388 DOI: 10.3390/diagnostics11081511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022] Open
Abstract
Realistic reconstruction of angioarchitecture within the morphological landmark with three-dimensional sonoangiography (three-dimensional power Doppler; 3D PD) may augment standard prenatal ultrasound and Doppler assessments. This study aimed to (a) present a technical overview, (b) determine additional advantages, (c) identify current challenges, and (d) predict trajectories of 3D PD for prenatal assessments. PubMed and Scopus databases for the last decade were searched. Although 307 publications addressed our objectives, their heterogeneity was too broad for statistical analyses. Important findings are therefore presented in descriptive format and supplemented with the authors’ 3D PD images. Acquisition, analysis, and display techniques need to be personalized to improve the quality of flow-volume data. While 3D PD indices of the first-trimester placenta may improve the prediction of preeclampsia, research is needed to standardize the measurement protocol. In highly experienced hands, the unique 3D PD findings improve the diagnostic accuracy of placenta accreta spectrum. A lack of quality assurance is the central challenge to incorporating 3D PD in prenatal care. Machine learning may broaden clinical translations of prenatal 3D PD. Due to its operator dependency, 3D PD has low reproducibility. Until standardization and quality assurance protocols are established, its use as a stand-alone clinical or research tool cannot be recommended.
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Kong CW, Tong LY, Lam WC, Chan LW, To WWK. Learning Curve in Determining Fetal Sex by First Trimester Ultrasound Scan. J Med Ultrasound 2016. [DOI: 10.1016/j.jmu.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cruz-Martínez R, Cruz-Lemini M, Mendez A, Illa M, García-Baeza V, Martinez JM, Gratacós E. Learning Curve for Intrapulmonary Artery Doppler in Fetuses with Congenital Diaphragmatic Hernia. Fetal Diagn Ther 2015; 39:256-60. [DOI: 10.1159/000441026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
Objective: To assess the learning curve for intrapulmonary artery Doppler in fetuses with congenital diaphragmatic hernia (CDH). Methods: Three fetal medicine fellows with the theoretic knowledge, but without prior experience, in the evaluation of intrapulmonary artery Doppler in CDH fetuses were selected. Each trainee and 1 experienced explorer assessed the intrapulmonary artery in the contralateral lung to the side of the hernia for calculation of 2 Doppler parameters - pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) - in a cohort of 90 consecutive CDH fetuses. The average difference between the 3 trainees and the expert was calculated. A difference below 15% was considered as accurate measurement. The average learning curve was delineated using the cumulative sum analysis (CUSUM). Results: Among the total 270 intrapulmonary artery Doppler measurements performed by the 3 trainees, the number of failed examinations was 14 (15.6%) and 16 (17.8%) for PI and PEDRF, respectively. The CUSUM plots demonstrate that the learning curve was achieved by 53 and 63 tests performed for calculations of the intrapulmonary artery PI and PEDRF, respectively. Conclusion: Competence in Doppler evaluation of the intrapulmonary artery in CDH fetuses is achieved only after intensive continuous training.
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Pranpanus S, Kor-anantakul O, Suntharasaj T, Suwanrath C, Leetanaporn R, Hanprasertpong T, Pruksanusak N. Frontomaxillary facial angle in chromosomally normal Thai foetuses at 11 to 13 weeks 6 days’ gestation. J OBSTET GYNAECOL 2015. [DOI: 10.3109/01443615.2015.1030598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hermann NV, Darvann TA, Sundberg K, Kreiborg S, Joergensen C. Maxillary length in 11- to 26-week-old normal fetuses studied by 3D ultrasound. Prenat Diagn 2015; 35:571-6. [DOI: 10.1002/pd.4574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 01/26/2015] [Accepted: 02/01/2015] [Indexed: 11/08/2022]
Affiliation(s)
- N. V. Hermann
- Paediatric Dentistry and Clinical Genetics, School of Dentistry, Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen; Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Denmark); Copenhagen Denmark
| | - T. A. Darvann
- 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen; Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Denmark); Copenhagen Denmark
- Department of Oral and Maxillofacial Surgery; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - K. Sundberg
- Ultrasound Clinic, Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - S. Kreiborg
- Paediatric Dentistry and Clinical Genetics, School of Dentistry, Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- 3D Craniofacial Image Research Laboratory (School of Dentistry, University of Copenhagen; Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet; and DTU Compute, Technical University of Denmark); Copenhagen Denmark
- Department of Clinical Genetics, Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - C. Joergensen
- Ultrasound Clinic, Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
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Frontomaxillary facial angle measurement in screening for trisomy 18 at 11 + 0 to 13 + 6 weeks of pregnancy: a double-centre study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:168302. [PMID: 24195065 PMCID: PMC3806356 DOI: 10.1155/2013/168302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/16/2013] [Accepted: 08/31/2013] [Indexed: 11/27/2022]
Abstract
Objective. The aim of this study was to evaluate the effectiveness of prenatal screening for trisomy 18 with the use of the frontomaxillary facial angle (FMF angle) measurement. Material and Methods. The study involved 1751 singleton pregnancies at 11–13 + 6 weeks, examined between 2007 and 2011. Serum PAPP-A and free beta-hCG levels were assessed, and crown-rump length, nuchal translucency, and FMF angle were measured in all patients. 1350 fetuses with known follow-up were included in the final analysis.
Results. Highly significant (P < 0.01) negative correlation between the CRL and the FMF angle was found. There were 30 fetuses with trisomy 18. FMF angle was highly significantly larger (P < 0.0001) in fetuses with trisomy 18 as compared to chromosomally normal fetuses. Two models of first trimester screening were compared: Model 1 based on maternal age, NT, and first trimester biochemistry test (DR 80–85% and FPR 0.3–0.6%), and Model 2 = Model 1 + FMF angle measurement (DR 87.3–93.3% and FPR 0.8–1.3%). Conclusions. The use of FMF angle measurement increases the effectiveness of the screening for trisomy 18. Introduction of the FMF angle as an independent marker for fetal trisomy 18 risk requires further prospective research in large populations.
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Alphonse J, Cox J, Clarke JL, Robinson CL, Schluter PJ, McLennan A. Frontomaxillary facial angle measurement at 11-14 weeks: assessment of interobserver and intraobserver agreement in 2D and 3D imaging. Fetal Diagn Ther 2013; 34:90-5. [PMID: 23751732 DOI: 10.1159/000350700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/11/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The primary aim of this study was to assess the interobserver and intraobserver reproducibility of the first-trimester frontomaxillary facial angle (FMFA) measurement using both 2D and 3D ultrasound. Assessment of the relationship between crown-to-rump length (CRL) and FMFA measurement was also reviewed. MATERIALS AND METHODS Two experienced operators imaged the same 30 patients over a 1-month period collecting both 2D static images and 3D volumes during nuchal translucency assessment at 11-14 weeks' gestation. The operators were blinded to each other's images and results. RESULTS The mean 2D FMFA measurement was 88.0° and 88.4° for observer 1 and 2, respectively; while the mean 3D FMFA measurement was 87.8° and 88.0°, respectively. Intraclass correlation suggests good intraobserver and interobserver agreement with no statistically significant difference between operators in either 2D (p = 0.14) or 3D (p = 0.11) measurements. The FMFA was unchanged with increasing CRL. DISCUSSION Both 2D and 3D FMFA measurements have been demonstrated to be equivalent and reliable. Strict image acquisition criteria must be followed for accurate and reproducible FMFA measurements. There was no change demonstrated in FMFA measurement with increasing CRL.
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Affiliation(s)
- Jennifer Alphonse
- The University of Sydney, Faculty Health Sciences, Lidcombe, NSW, Australia.
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Panigassi APN, Araujo Júnior E, Nardozza LMM, Moron AF, Pares DBDS. Fetal frontomaxillary facial angle between 11 and 13 + 6 weeks of gestation in a Brazilian population: influence of different races. J Matern Fetal Neonatal Med 2013; 26:1116-20. [DOI: 10.3109/14767058.2013.771164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Effect of Ethnicity on 2D and 3D Frontomaxillary Facial Angle Measurement in the First Trimester. Obstet Gynecol Int 2013; 2013:847293. [PMID: 24288543 PMCID: PMC3830838 DOI: 10.1155/2013/847293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/30/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives. To determine the existence and extent of ethnic differences in 2D or 3D fetal frontomaxillary facial angle (FMFA) measurements. Methods. During routine 11-14 weeks nuchal translucency screening undertaken in a private ultrasound practice in Sydney, Australia, 2D images and 3D volumes of the fetal profile were collected from consenting patients. FMFA was measured on a frozen 2D ultrasound image in the appropriate plane and, after a delay of at least 48 hours, was also measured on the reconstructed 3D ultrasound volume offline. Results. Overall 416 patients were included in the study; 220 Caucasian, 108 north Asian, 36 east Asian and 52 south Asian patients. Caucasians had significantly lower median FMFA measurements than Asians in both 2D (2.2°; P < 0.001) and 3D (3.4°; P < 0.001) images. Median 2D measurements were significantly higher than 3D measurements in the Caucasian and south Asian groups (P < 0.001 and P = 0.04), but not in north and east Asian groups (P = 0.08 and P = 0.41). Conclusions. Significant ethnic variations in both 2D and 3D FMFA measurements exist. These differences may indicate the need to establish ethnic-specific reference ranges for both 2D and 3D imaging.
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Cruz-Martinez R, Figueras F, Jaramillo JJ, Meler E, Méndez A, Hernandez-Andrade E, Gratacos E. Learning curve for Doppler measurement of fetal modified myocardial performance index. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:158-162. [PMID: 20922780 DOI: 10.1002/uog.7765] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the learning curve for measurement of the fetal modified myocardial performance index (MPI). METHODS Three trainees with the theoretical knowledge of but without prior experience in performing MPI measurement were selected. Each trainee and one experienced examiner measured MPI in a cohort of 90 consecutive fetuses. The average difference between the three trainees and the expert in the MPI measurements was calculated; a difference below 10% was considered to indicate an accurate measurement. Individual and averaged learning curves were delineated using cumulative sum analysis (CUSUM). RESULTS The gestational age at evaluation ranged from 20 + 4 to 41 + 4 (mean, 33 + 3) weeks. The CUSUM plots demonstrated that, on average, competence in performing fetal MPI measurement was achieved by 65 cases. The average number of attempts to achieve competence were 42, 77 and 83 for the ejection time, isovolumetric contraction time and isovolumetric relaxation time, respectively. CONCLUSIONS Evaluation of fetal MPI by an inexperienced trainee requires on average 65 measurements to achieve competence.
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Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine, University of Barcelona, Barcelona, Spain
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Yang XH, Chen M, Leung TY, Wong SM, Lau TK. Use of three-dimensional (3D) sonography to assess the true midsagittal plane of fetal spine. J Matern Fetal Neonatal Med 2010; 24:297-300. [PMID: 20504071 DOI: 10.3109/14767058.2010.487139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To study the angle of the deviation of a presumed midsagittal plane of the fetal spine from the true midsagittal planes by three-dimensional (3D) ultrasound and to investigate whether the experience of operators has an effect on the degree of this deviation. METHODS Eight sonographers, four were trained to perform routine anomaly scan (Trained Group) and four were trained to perform fetal biometric measurement only (Non-trained Group), were asked to use a 3D transducer to obtain a 2D image which they thought to represent the true midsagittal plane of the fetal spine. A 3D volume was then acquired. Stored volumes were analyzed using the multiplanar mode. In the transverse plane, the angle of the deviation of presumed midsagittal planes from the true midsagittal planes was measured. RESULTS The mean angle of deviation of the trained group was significantly lower than that of the non-trained group (7.9 vs. 21.1, p < 0.001). There were no significant variations among the four operators within each group. However, even among the Trained Group, the angle of deviation could be as large as 27.2°. CONCLUSIONS Training improved the ability to obtain a midsagittal plane of the fetal spine. 3D ultrasound might provide potential useful information to guide the acquisition of standard image planes.
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Affiliation(s)
- Xiao Hong Yang
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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