title: Continuous independent quality control for fetal nuchal translucency measurements provided by the cumulative summation technique.
abstract: OBJECTIVE
  The cumulative summation technique (CUSUM) is an innovative method for the quality control of nuchal translucency (NT) measurements. CUSUM allows immediate corrective intervention as soon as an unacceptable tendency is noted. The aim of this study was to implement an objective and dynamic quality control method based on the CUSUM technique for prompt analysis of fetal NT measurement which would be compatible with different standards in routine clinical practice. The findings were compared to the standard NT quality control methods currently in use.
  
  
  METHODS
  Three sets of fetal NT measurements performed by three experienced examiners (I, II and III) were selected for retrospective evaluation. One additional set of NT measurements performed by examiner IV was prospectively assessed to approve the practicability of the method. NT measurements were conducted according to the recommendations of Fetal Medical Foundation (FMF) Germany and London. NT values were converted to Z-scores. For quality and accuracy evaluation, data were fed into the Digisono CUSUM software to create double CUSUM charts of Z-scores. In addition, histograms were composed from the Z-scores of each set of measurements and plotted against a normal Gaussian distribution.
  
  
  RESULTS
  Three different patterns of retrospective performance and one set of NT measurements that was evaluated prospectively are presented. The full alignment of Z-scores using CUSUM curves reflected exact periods of under- and overestimation of NT measurements. The CUSUM chart of the prospective data set reveals that prompt corrective intervention of poor performance resulted in reconstitution of optimal results and provided sufficient control. In contrast, histograms of NT Z-scores only showed a minor positive or negative shift as compared to the expected values on the basis of Gaussian distribution, but could not identify poor performance.
  
  
  CONCLUSIONS
  Use of the CUSUM technique analysing the quality of sonographic NT measurements provides the possibility to prospectively observe the development of the examiner's skills, to maintain competence and to promptly define the time when inaccurate measurements start to occur.
authors.affiliation: Frauenheilkunde, UniversitätsSpital Zürich, Zürich. dalia.balsyte@usz.ch
authors.forename: D
authors.initials: D
authors.lastname: Balsyte
authors.forename: L
authors.initials: L
authors.lastname: Schäffer
authors.forename: T
authors.initials: T
authors.lastname: Burkhardt
authors.forename: J
authors.initials: J
authors.lastname: Wisser
authors.forename: A
authors.initials: A
authors.lastname: Krafft
authors.forename: J
authors.initials: J
authors.lastname: Kurmanavicius
mesh_terms: D000465:Algorithms; D000782:Aneuploidy; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008432:Mathematical Computing; D048208:Nuchal Translucency Measurement / Q000379:methods / Q000592:standards*; D015588:Observer Variation; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D011786:Quality Control; D012189:Retrospective Studies; D012984:Software; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards