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

3. Screening Obstetrical Ultrasound: What Can’t 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?

4. BENCHMARK

5. Benchmark Methods Retrospective 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.

6. Benchmark Results Visualization 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.

8. Inland Imaging: Methods Retrospective review from May 1 st to July 31 st 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.

9. Inland Results 335 total patients; 232 complete; 103 incomplete. Average BMI 27. (range 17-58)

10. Standard Ultrasound (Inland Imaging) n=335 BMI 25 or less n=177 (53%) All components Visualized n=138 (78%) (72%) BMI 26-30 n=65 (19%) All components Visualized n=48 (74%) (68%) BMI 31-35 n=51 (15%) All components visualized n=32 (63%) (57%) BMI 36-41 n= 18 (5%) All components visualized n=7 (39%) (41%) BMI 41+ n=24 (7%) All components visualized n=7 (29%) (30%)

11. Challenging Images ( Inland) Nose/ Lips 39% Spine 32% Outflow Tracts 19% ( Not included in Benchmark study)

12. Source of Struggles Obesity Gestational Age ( before 18 weeks and after 24 weeks) Position Individual skill level

14. Examples of Incomplete Exams BMI 41

15. BMI 42 Nose/Lips

16. BMI 24 Nose/Lips

17. Nose/ Lips BMI 42

18. BMI 33 Nose/Lips

19. Spine BMI 33

20. Spine BMI 22

21. Spine BMI 18 / No sagittal images

23. Good Examples

25. Poor Heart Images

26. Poor Heart Cine

27. Poor Heart Images

28. Good heart Examples

29. Good Heart example LV AO

30. Good Heart Example RV PA

32. Femur Length

33. Show all incomplete Screening exams to a Radiologist. The use of good cine sweeps helps with the nose/lips image. Refine technique…cystic structures need to look cystic…properly frame the image….use the appropriate probe…focal zones properly placed…reposition the patient and or the transducer. Steady continuous sweep in ONE direction.

34. Thank You !