PowerPoint Presentation

Image Quality Review Second and Third Quarters 2013Special Report : Incomplete OB 2/3 Screening ExamsMonday October 14th 2013 5:30-7:00 PM IIBC Lower Level Conference RoomsJohn Crowley, RDMS-RVT

Screening Obstetrical Ultrasound: What Cant We See ?How often do we have incomplete screening OB exams?

Is there an association with BMI?

Most frequently not seen structures?

What can we do moving forward to make things better?3 Benchmark

Benchmark MethodsRetrospective cohort study of singleton pregnancies 18-24 weeks.

Five year period that included 10,112 patients.

Evaluated ten anatomic components according to AIUM guidelines.

Calculated percentages of complete exams based on BMI. BMI range calculation slightly different than Inlands group.

Benchmark ResultsVisualization of fetal anatomy decreased significantly with increasing patient BMI. Most difficult components to see were the midline face and four chamber heart.

Outflow tracts were not included in this study or any pregnancy outside of 18-24 weeks.

Inland Imaging: MethodsRetrospective review from May 1st to July 31st 2013.

Included all first time screening 2/3 trimester exams. (benchmark only 18-24 weeks)

335 total patients.

BMI and exam impression as complete or incomplete were documented, as well as what anatomical part was not seen.

Over all percentages were calculated for incomplete exams by BMI.Inland Results335 total patients; 232 complete; 103 incomplete.Average BMI 27. (range 17-58)

Challenging Images ( Inland)Nose/ Lips 39%

Spine 32%

Outflow Tracts 19% ( Not included in Benchmark study) Source of StrugglesObesity

Gestational Age ( before 18 weeks and after 24 weeks)

Position

Individual skill level

Examples of Incomplete Exams

BMI 41BMI 42 Nose/Lips

BMI 24 Nose/Lips

Nose/ Lips BMI 42

BMI 33 Nose/Lips

Spine BMI 33

Spine BMI 22

Spine BMI 18 / No sagittal images

Good Examples

Good Examples

Poor Heart Images

Poor Heart Cine

Poor Heart Images

Good heart Examples

Good Heart exampleLVAOGood Heart Example

RVPABad Femur ! Really Bad.

Femur Length

How do we Improve ? Show all incomplete Screening exams to a Radiologist.

The use of good cine sweeps helps with the nose/lips image.

Refine techniquecystic structures need to look cysticproperly frame the image.use the appropriate probefocal zones properly placedreposition the patient and or the transducer.

Steady continuous sweep in ONE direction.

Thank You !