title: Learning Curve for Intrapulmonary Artery Doppler in Fetuses with Congenital Diaphragmatic Hernia.
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.
  
  
  CONCLUSIONS
  Competence in Doppler evaluation of the intrapulmonary artery in CDH fetuses is achieved only after intensive continuous training.
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Cruz-Martínez
authors.forename: Monica
authors.initials: M
authors.lastname: Cruz-Lemini
authors.forename: Antonio
authors.initials: A
authors.lastname: Mendez
authors.forename: Miriam
authors.initials: M
authors.lastname: Illa
authors.forename: Víctor
authors.initials: V
authors.lastname: García-Baeza
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Martinez
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D015331:Cohort Studies; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D059032:Learning Curve; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000196:embryology; D012039:Regional Blood Flow; D013337:Students, Medical; D016216:Ultrasonography, Prenatal