Improving the Detection Rate of Congenital Heart Defects Using a Real-Time Cardiac Assessment Technique in Routine Obstetrical Screening. Using a Real-Time Cardiac Assessment Technique in Routine Obstetrical Screening

Donald Scott

Research output: ThesisDoctoral Thesis

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Abstract

Screening the fetal heart for the presence of congenital heart disease (CHD) during routine obstetrical sonography has not translated to early identification of CHD for the majority of patients (Friedberg et al., 2009; Poole et al., 2013). Limitations have been identified in the methods used to assess the fetal heart. A number of leading experts have identified the need for a real-time assessment of the fetal heart compared with the convention of relying on static images only for interpretation (Mcgahan, Moon-grady, & Pahwa, 2007; Sklansky, 2007). In addition, a deep need has been identified for education to improve the examiner''s and interpreting physician''s understanding of the sonographic features of CHD (Friedberg et al., 2009; McBrien, Sands, Craig, Dornan, & Casey, 2010).Imaging the fetal heart is a challenging element of a routine obstetrical sonogram. The fetal heart is a very small, complex and highly dynamic structure with a normal heart rate ranging from 120-160 bpm (Fredouille, 2007). The expression of CHD varies considerably, depending on the specific congenital anomaly and the time at which the exam is performed. (Cook, Yates, & Anderson, 2004). Some severe forms of CHD including Transposition of the Great Arteries (TGA) can only be detected through visualization of the outflow tracts, while other forms such as Hypoplastic Left Heart Syndrome (HLHS) can be seen in the four chamber view (Chaoui, 2003).Although the practice guidelines for obstetric ultrasound imaging explicitly identify the anatomic structure that should be examined during screening, considerable variation in how these structures are assessed exists (ACR Guidelines and Standards Committee, American Institute of Ultrasound in Medicine, 2003)(American Institute of Ultrasound in Medicine, 2013). The majority of screening centers rely on a few static images to demonstrate the normalcy of fetal heart including a four chamber view and both outflow tracts. Alternative approaches have been identified and these include the use of cine-loops, Doppler imaging, and three dimensional imaging, as well as detailed anatomic planes (Chaoui & Heling, 2005; Chaoui & McEwing, 2003; Mcgahan et al., 2007).This PhD thesis includes three projects that have been completed to address potentially increasing the rate of CHD detection. The first project assessed the feasibility and efficacy of using cine-loop sweeps, grey-scale cine-loop sweeps and colour Doppler cine sweeps compared with static images only. The use of cine-loop sweeps was found to be the most effective and practical technique. The second project assessed the practicality of using cine-loop sweeps and a standardized assessment technique compared with static images only and demonstrated an increased detection rate of CHD. The third project assessed the efficacy of an online, tutorial-based tool for learning the standardized assessment technique of cine-loop sweeps used in the first two projects.Improving the detection rate of CHD during routine obstetrical sonography can be achieved with the use of a standardized assessment of cine-loop sweeps. The translation of this technique to clinical practice can be achieved using an online learning tool.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Charles Sturt University
Award date01 Jul 2014
Place of PublicationAustralia
Publisher
Publication statusPublished - 2015

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Congenital Heart Defects
Fetal Heart
Heart Diseases
Ultrasonography
Medicine
Learning
Hypoplastic Left Heart Syndrome
Transposition of Great Vessels
Three-Dimensional Imaging
Practice Guidelines
Obstetrics
Color
Heart Rate
Guidelines
Physicians
Education

Cite this

@phdthesis{ea251c1a0699424da188dea8eb1e260c,
title = "Improving the Detection Rate of Congenital Heart Defects Using a Real-Time Cardiac Assessment Technique in Routine Obstetrical Screening.: Using a Real-Time Cardiac Assessment Technique in Routine Obstetrical Screening",
abstract = "Screening the fetal heart for the presence of congenital heart disease (CHD) during routine obstetrical sonography has not translated to early identification of CHD for the majority of patients (Friedberg et al., 2009; Poole et al., 2013). Limitations have been identified in the methods used to assess the fetal heart. A number of leading experts have identified the need for a real-time assessment of the fetal heart compared with the convention of relying on static images only for interpretation (Mcgahan, Moon-grady, & Pahwa, 2007; Sklansky, 2007). In addition, a deep need has been identified for education to improve the examiner''s and interpreting physician''s understanding of the sonographic features of CHD (Friedberg et al., 2009; McBrien, Sands, Craig, Dornan, & Casey, 2010).Imaging the fetal heart is a challenging element of a routine obstetrical sonogram. The fetal heart is a very small, complex and highly dynamic structure with a normal heart rate ranging from 120-160 bpm (Fredouille, 2007). The expression of CHD varies considerably, depending on the specific congenital anomaly and the time at which the exam is performed. (Cook, Yates, & Anderson, 2004). Some severe forms of CHD including Transposition of the Great Arteries (TGA) can only be detected through visualization of the outflow tracts, while other forms such as Hypoplastic Left Heart Syndrome (HLHS) can be seen in the four chamber view (Chaoui, 2003).Although the practice guidelines for obstetric ultrasound imaging explicitly identify the anatomic structure that should be examined during screening, considerable variation in how these structures are assessed exists (ACR Guidelines and Standards Committee, American Institute of Ultrasound in Medicine, 2003)(American Institute of Ultrasound in Medicine, 2013). The majority of screening centers rely on a few static images to demonstrate the normalcy of fetal heart including a four chamber view and both outflow tracts. Alternative approaches have been identified and these include the use of cine-loops, Doppler imaging, and three dimensional imaging, as well as detailed anatomic planes (Chaoui & Heling, 2005; Chaoui & McEwing, 2003; Mcgahan et al., 2007).This PhD thesis includes three projects that have been completed to address potentially increasing the rate of CHD detection. The first project assessed the feasibility and efficacy of using cine-loop sweeps, grey-scale cine-loop sweeps and colour Doppler cine sweeps compared with static images only. The use of cine-loop sweeps was found to be the most effective and practical technique. The second project assessed the practicality of using cine-loop sweeps and a standardized assessment technique compared with static images only and demonstrated an increased detection rate of CHD. The third project assessed the efficacy of an online, tutorial-based tool for learning the standardized assessment technique of cine-loop sweeps used in the first two projects.Improving the detection rate of CHD during routine obstetrical sonography can be achieved with the use of a standardized assessment of cine-loop sweeps. The translation of this technique to clinical practice can be achieved using an online learning tool.",
author = "Donald Scott",
year = "2015",
language = "English",
publisher = "Charles Sturt University",
address = "Australia",
school = "Charles Sturt University",

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T1 - Improving the Detection Rate of Congenital Heart Defects Using a Real-Time Cardiac Assessment Technique in Routine Obstetrical Screening.

T2 - Using a Real-Time Cardiac Assessment Technique in Routine Obstetrical Screening

AU - Scott, Donald

PY - 2015

Y1 - 2015

N2 - Screening the fetal heart for the presence of congenital heart disease (CHD) during routine obstetrical sonography has not translated to early identification of CHD for the majority of patients (Friedberg et al., 2009; Poole et al., 2013). Limitations have been identified in the methods used to assess the fetal heart. A number of leading experts have identified the need for a real-time assessment of the fetal heart compared with the convention of relying on static images only for interpretation (Mcgahan, Moon-grady, & Pahwa, 2007; Sklansky, 2007). In addition, a deep need has been identified for education to improve the examiner''s and interpreting physician''s understanding of the sonographic features of CHD (Friedberg et al., 2009; McBrien, Sands, Craig, Dornan, & Casey, 2010).Imaging the fetal heart is a challenging element of a routine obstetrical sonogram. The fetal heart is a very small, complex and highly dynamic structure with a normal heart rate ranging from 120-160 bpm (Fredouille, 2007). The expression of CHD varies considerably, depending on the specific congenital anomaly and the time at which the exam is performed. (Cook, Yates, & Anderson, 2004). Some severe forms of CHD including Transposition of the Great Arteries (TGA) can only be detected through visualization of the outflow tracts, while other forms such as Hypoplastic Left Heart Syndrome (HLHS) can be seen in the four chamber view (Chaoui, 2003).Although the practice guidelines for obstetric ultrasound imaging explicitly identify the anatomic structure that should be examined during screening, considerable variation in how these structures are assessed exists (ACR Guidelines and Standards Committee, American Institute of Ultrasound in Medicine, 2003)(American Institute of Ultrasound in Medicine, 2013). The majority of screening centers rely on a few static images to demonstrate the normalcy of fetal heart including a four chamber view and both outflow tracts. Alternative approaches have been identified and these include the use of cine-loops, Doppler imaging, and three dimensional imaging, as well as detailed anatomic planes (Chaoui & Heling, 2005; Chaoui & McEwing, 2003; Mcgahan et al., 2007).This PhD thesis includes three projects that have been completed to address potentially increasing the rate of CHD detection. The first project assessed the feasibility and efficacy of using cine-loop sweeps, grey-scale cine-loop sweeps and colour Doppler cine sweeps compared with static images only. The use of cine-loop sweeps was found to be the most effective and practical technique. The second project assessed the practicality of using cine-loop sweeps and a standardized assessment technique compared with static images only and demonstrated an increased detection rate of CHD. The third project assessed the efficacy of an online, tutorial-based tool for learning the standardized assessment technique of cine-loop sweeps used in the first two projects.Improving the detection rate of CHD during routine obstetrical sonography can be achieved with the use of a standardized assessment of cine-loop sweeps. The translation of this technique to clinical practice can be achieved using an online learning tool.

AB - Screening the fetal heart for the presence of congenital heart disease (CHD) during routine obstetrical sonography has not translated to early identification of CHD for the majority of patients (Friedberg et al., 2009; Poole et al., 2013). Limitations have been identified in the methods used to assess the fetal heart. A number of leading experts have identified the need for a real-time assessment of the fetal heart compared with the convention of relying on static images only for interpretation (Mcgahan, Moon-grady, & Pahwa, 2007; Sklansky, 2007). In addition, a deep need has been identified for education to improve the examiner''s and interpreting physician''s understanding of the sonographic features of CHD (Friedberg et al., 2009; McBrien, Sands, Craig, Dornan, & Casey, 2010).Imaging the fetal heart is a challenging element of a routine obstetrical sonogram. The fetal heart is a very small, complex and highly dynamic structure with a normal heart rate ranging from 120-160 bpm (Fredouille, 2007). The expression of CHD varies considerably, depending on the specific congenital anomaly and the time at which the exam is performed. (Cook, Yates, & Anderson, 2004). Some severe forms of CHD including Transposition of the Great Arteries (TGA) can only be detected through visualization of the outflow tracts, while other forms such as Hypoplastic Left Heart Syndrome (HLHS) can be seen in the four chamber view (Chaoui, 2003).Although the practice guidelines for obstetric ultrasound imaging explicitly identify the anatomic structure that should be examined during screening, considerable variation in how these structures are assessed exists (ACR Guidelines and Standards Committee, American Institute of Ultrasound in Medicine, 2003)(American Institute of Ultrasound in Medicine, 2013). The majority of screening centers rely on a few static images to demonstrate the normalcy of fetal heart including a four chamber view and both outflow tracts. Alternative approaches have been identified and these include the use of cine-loops, Doppler imaging, and three dimensional imaging, as well as detailed anatomic planes (Chaoui & Heling, 2005; Chaoui & McEwing, 2003; Mcgahan et al., 2007).This PhD thesis includes three projects that have been completed to address potentially increasing the rate of CHD detection. The first project assessed the feasibility and efficacy of using cine-loop sweeps, grey-scale cine-loop sweeps and colour Doppler cine sweeps compared with static images only. The use of cine-loop sweeps was found to be the most effective and practical technique. The second project assessed the practicality of using cine-loop sweeps and a standardized assessment technique compared with static images only and demonstrated an increased detection rate of CHD. The third project assessed the efficacy of an online, tutorial-based tool for learning the standardized assessment technique of cine-loop sweeps used in the first two projects.Improving the detection rate of CHD during routine obstetrical sonography can be achieved with the use of a standardized assessment of cine-loop sweeps. The translation of this technique to clinical practice can be achieved using an online learning tool.

M3 - Doctoral Thesis

PB - Charles Sturt University

CY - Australia

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