title: An Audit of Second-Trimester Fetal Anomaly Scans Based on a Novel Image-Scoring Method in the Southwest Region of the Netherlands.
abstract: OBJECTIVE
  Since 2007 the second-trimester fetal anomaly scan is offered to all pregnant women as part of the national prenatal screening program in the Netherlands. Dutch population-based screening programs generally have a well-described system to achieve quality assurance. Because of the absence of a uniform system to monitor the actual performance of the fetal anomaly scan in 2012, we developed a standardized image-scoring method. The aim of this study was to evaluate the scanning performance of all sonographers in the southwestern region of the Netherlands using this image-scoring method.
  
  
  METHODS
  Each sonographer was requested to set up a digital portfolio. A portfolio consists of five logbooks from five different pregnant women, each containing 25 fetal anatomical structures and six biometric measures of randomly selected fetal anomaly scans.
  
  
  RESULTS
  During the study period, 425 logbooks of 85 sonographers were assessed as part of the audit process. Seventy-three out of 85 sonographers (86%) met the criteria in the primary audit, and 12 sonographers required individual hands-on training. A successful assessment was achieved for 11 sonographers in the re-audit and one sonographer ceased her contract. Moreover, 2.1% of the required images were not digitally stored and therefore could not be reviewed.
  
  
  CONCLUSIONS
  Quality assessment using the image-scoring method demonstrated that most of the sonographers met the expectations of the audit process, but those who had subpar performance met the expectations after retraining.
authors.affiliation: Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands.|Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Nicolette T C
authors.initials: NTC
authors.lastname: Ursem
authors.affiliation: Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands.|Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Peters
authors.affiliation: Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands.
authors.forename: Mieke N
authors.initials: MN
authors.lastname: Kraan-van der Est
authors.affiliation: Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands.
authors.forename: Jacqueline C I Y
authors.initials: JCIY
authors.lastname: Reijerink-Verheij
authors.affiliation: Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands.|Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Maarten F C M
authors.initials: MFCM
authors.lastname: Knapen
authors.affiliation: Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
authors.forename: Titia E
authors.initials: TE
authors.lastname: Cohen-Overbeek
mesh_terms: D000465:Algorithms; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods* / Q000592:standards; D008297:Male; D008485:Medical Audit; D009426:Netherlands / Q000453:epidemiology; D015588:Observer Variation; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D015995:Prevalence; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*
keywords: audit; fetal anomaly scan; quality assessment; training; ultrasound