{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:29:30Z","timestamp":1760956170158,"version":"3.40.5"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T00:00:00Z","timestamp":1675296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>First-trimester anatomical screening (FTAS) by ultrasound has been introduced in many countries as screening for aneuploidies, but also as early screening for fetal structural abnormalities. While a lot of emphasis has been put on the detection rates of FTAS, little is known about the performance of quality control programs and the sonographers\u2019 learning curve for FTAS. The aims of the study were to evaluate the performance of a score-based quality control system for the FTAS and to assess the learning curves of sonographers by evaluating the images of the anatomical planes that were part of the FTAS protocol.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Between 2012\u20132015, pregnant women opting for the combined test in the North-Netherlands were also invited to participate in a prospective cohort study extending the ultrasound investigation to include a first-trimester ultrasound performed according to a protocol. All anatomical planes included in the protocol were documented by pictures stored for each examination in logbooks. The logbooks of six sonographers were independently assessed by two fetal medicine experts. For each sonographer, logbooks of examination 25-50-75 and 100 plus four additional randomly selected logbooks were scored for correct visualization of 12 organ-system planes. A plane specific score of at least 70% was considered sufficient. The intra-class correlation coefficient (ICC), was used to measure inter-assessor agreement for the cut-off scores. Organ-specific learning curves were defined by single-cumulative sum (CUSUM) analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Sixty-four logbooks were assessed. Mean duration of the scan was 22 \u00b1 6 minutes and mean gestational age was 12+6 weeks. In total 57% of the logbooks graded as sufficient. Most sufficient scores were obtained for the fetal skull (88%) and brain (70%), while the lowest scores were for the face (29%) and spine (38%). Five sonographers showed a learning curve for the skull and the stomach, four for the brain and limbs, three for the bladder and kidneys, two for the diaphragm and abdominal wall and one for the heart and spine and none for the face and neck.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Learning curves for FTAS differ per organ system and per sonographer. Although score-based evaluation can validly assess image quality, more dynamic approaches may better reflect clinical performance.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0279770","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T19:35:45Z","timestamp":1675366545000},"page":"e0279770","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Organ-specific learning curves of sonographers performing first-trimester anatomical screening and impact of score-based evaluation on ultrasound image quality"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5311-2207","authenticated-orcid":true,"given":"Francesca","family":"Bardi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merel","family":"Bakker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayten","family":"Elvan-Ta\u015fp\u0131nar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique J. A.","family":"Kenkhuis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeske","family":"Fridrichs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marian K.","family":"Bakker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erwin","family":"Birnie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina M.","family":"Bilardo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"key":"pone.0279770.ref001","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1002\/uog.20844","article-title":"Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11\u201313 weeks\u2019 gestation","volume":"54","author":"A Syngelaki","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0279770.ref002","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1002\/uog.17487","article-title":"Effectiveness of a 12\u201313 week scan for the early diagnosis of fetal congenital anomalies in the cell-free DNA era","volume":"51","author":"MJA Kenkhuis","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0279770.ref003","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1002\/uog.12489","article-title":"Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol","volume":"42","author":"D Iliescu","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0279770.ref004","first-page":"1","article-title":"Early Detection of Structural Anomalies in a Primary Care Setting in the Netherlands","author":"F Bardi","year":"2018","journal-title":"Fetal Diagn Ther"},{"key":"pone.0279770.ref005","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/uog.17246","article-title":"Systematic review of first trimester ultrasound screening in detecting fetal structural anomalies and factors affecting screening performance","volume":"50","author":"JN Karim","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0279770.ref006","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1002\/uog.1775","article-title":"Assessment of fetal anatomy at the 11-14-week ultrasound examination","volume":"24","author":"AP Souka","year":"2004","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0279770.ref007","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/uog.7444","article-title":"13-14-Week Fetal Anatomy Scan: a 5-Year Prospective Study","volume":"35","author":"A Ebrashy","year":"2010","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0279770.ref008","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1002\/uog.12342","article-title":"ISUOG practice guidelines: Performance of first-trimester fetal ultrasound scan","volume":"41","author":"Committee CS","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"key":"pone.0279770.ref009","first-page":"28","volume":"1","author":"V V. 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