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Although we are unaware of the existence of a recognized fetal MRI qualification, individuals who perform fetal MRI should have undergone specialized training in collaboration with a teaching center, enabling them to perform a state-of-the-art fetal MRI examination after exposure to a sufficient number of cases. Introduction Fetal magnetic resonance imaging (MRI) is an important diagnostic imaging adjunct to ultrasonography[1], especially for evaluation of the fetal brain, lungs and bowel[2] and the placenta[3]. Factors influencing the decision to perform fetal MRI include, but are not limited to: experience/equipment of the ultrasound and MRI facilities, accessibility to MRI, maternal conditions such as obesity, abdominal scarring and oligohydramnios, gestational age, safety concerns, legal considerations regarding termination of pregnancy (TOP) and parental wishes after appropriate counseling[8]. [Extracted from the article]

Objective: The Nuchal Translucency Quality Review (NTQR) program has provided standardized education, credentialing and epidemiological monitoring of nuchal translucency (NT) measurements since 2005. Our aim was to review the effect on NT measurement of provider characteristics since the program's inception.Methods: We evaluated the distribution of NT measurements performed between January 2005 and December 2019, for each of the three primary performance indicators of NT measurement (NT median multiples of the median (MoM), SD of log10 NT MoM and slope of NT with respect to crown-rump length (CRL)) for all providers within the NTQR program with more than 30 paired NT/CRL results. Provider characteristics explored as potential sources of variability included: number of NT ultrasound examinations performed annually (annual scan volume of the provider), duration of participation in the NTQR program, initial credentialing by an alternative pathway, provider type (physician vs sonographer) and number of NT-credentialed providers within the practice (size of practice). Each of these provider characteristics was evaluated for its effect on NT median MoM and geometric mean of the NT median MoM weighted for the number of ultrasound scans, and multiple regression was performed across all variables to control for potential confounders.Results: Of 5 216 663 NT measurements from 9340 providers at 3319 sites, the majority (75%) of providers had an NT median MoM within the acceptable range of 0.9-1.1 and 85.5% had NT median MoM not statistically significantly outside this range. Provider characteristics associated with measurement within the expected range of performance included higher volume of NT scans performed annually, practice at a site with larger numbers of other NT-credentialed providers, longer duration of participation in the NTQR program and alternative initial credentialing pathway.Conclusions: Annual scan volume, duration of participation in the NTQR program, alternative initial credentialing pathway and number of other NT-credentialed providers within the practice are all associated with outcome metrics indicating quality of performance. It is critical that providers participate in ongoing quality assessment of NT measurement to maintain consistency and precision. Ongoing assessment programs with continuous feedback and education are necessary to maintain quality care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

An editorial is presented in which the author discusses three-dimensional imaging of bony structures of the fetal head and face. Topics discussed include conduction of imaging for fetal development by using methods including, three-dimensional-ultrasound (3D-US) multiplanar imaging, and tomographic imaging.

ABSTRACT Objective To evaluate the performance of first-trimester nuchal translucency ( NT) measurement by providers (physician-sonologists and sonographers) within the Nuchal Translucency Quality Review ( NTQR) program. Methods After training and credentialing providers, the NTQR monitored performance of NT measurement by the extent to which an individual's median multiple of the normal median ( MoM) for crown-rump length ( CRL) was within the range 0.9-1.1 MoM of a published normal median curve. The SD of log10 MoM and regression slope of NT on CRL were also evaluated. We report the distribution between providers of these performance indicators and evaluate potential sources of variation. Results Among the first 1.5 million scans in the NTQR program, performed between 2005 and 2011, there were 1 485 944 with CRL in the range 41-84 mm, from 4710 providers at 2150 ultrasound units. Among the 3463 providers with at least 30 scans in total, the median of the providers' median NT-MoMs was 0.913. Only 1901 (55%) had a median NT-MoM within the expected range; there were 89 above 1.1 MoM, 1046 at 0.8-0.9 MoM, 344 at 0.7-0.8 MoM and 83 below 0.7 MoM. There was a small increase in the median NT-MoM according to providers' length of time in the NTQR program and number of scans entered annually. On average, physician-sonologists had a higher median NT-MoM than did sonographers, as did those already credentialed before joining the program. The median provider SD was 0.093 and the median slope was 13.5%. SD correlated negatively with the median NT-MoM ( r = −0.34) and positively with the slope ( r = 0.22). Conclusion Even with extensive training, credentialing and monitoring, there remains considerable variability between NT providers. There was a general tendency towards under-measurement of NT compared with expected values, although more experienced providers had performance closer to that expected. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background and Objective: The prenatal detection of congenital heart defects remains one of the most difficult challenges for the sonologist/sonographer when performing the second- or third-trimester screening examination. The four-chamber view has been used for a number of years as the primary screening image for detection of heart defects, but the inclusion of the right and left outflow tracts increases the detection of cardiac malformations. One of the difficulties, however, is obtaining and interpreting two-dimensional images of the outflow tracts. This paper reviews a new technique using three-dimensional (3D) multiplanar imaging that allows the examiner to identify the outflow tracts within a few minutes of acquiring the 3D volume dataset by rotating the volume dataset around the x- and y-axes. Methods: 3D multiplanar imaging of the fetal heart using static 3D or spatio-temporal image correlation (STIC) imaging allows the examiner to obtain a volume of data that can be manipulated along the x- and y-axes using reference points from the four-chamber view, five-chamber view, three-vessel view at the level of the bifurcation of the pulmonary arteries, and three-vessel view at the level of the transverse aortic arch and trachea. Results: The full length of the main pulmonary artery, ductus arteriosus, aortic arch and superior vena cava could be identified easily in the normal fetus by rotating the volume dataset along the x- and y-axes. The vessels were identified using the four-chamber view, the five-chamber view, and the two three-vessel views. The technique was useful in identification of d-transposition of the great vessels and evaluation of the outflow tracts in hypoplastic left heart syndrome. Conclusion: 3D multiplanar evaluation of the fetal heart allows the examiner to identify the outflow tracts using a simple technique that requires only rotation around x- and y-axes from reference images obtained in a transverse sweep through the fetal chest. [ABSTRACT FROM AUTHOR]

Editorial. Highlights developments in three-dimensional (3D) ultrasound as of September 2000. Application of obstetric and gynecologic imaging in breast and ovarian pathology; Sources of artifacts observed in 3D sonography; Monitoring of follicular response during ovarian stimulation; Techniques used in the evaluation of needle position during breast biopsy.

This study assesses two methods used to define relatively short femur in screening for trisomy 21 and examines changes in performance of screening with gestational age. Retrospective analysis of data on menstrual age, femur length (FL) and biparietal diameter (BPD) in 49 trisomy 21 pregnancies and 6069 normal controls. Reference ranges were derived for BPD/FL versus menstrual age and for FL versus BPD. Two methods of defining short femur (BPD/FL and observed-to-expected FL ratio) were examined for false-positive rates and detection rates for trisomy 21 at different gestational ages. In the control group the BPD/FL ratio and its standard deviation decreased with menstrual age. Trisomy 21 was associated with a significantly higher BPD/FL ratio (P < 0.001) and the deviation increased significantly with menstrual age (P < 0.05). Eleven percent of 28 fetuses examined at 15–17 weeks had a BPD/FL above the 95th centile compared with 24% of 21 fetuses examined at 18–20 weeks (P = 0.40). The median observed-to-expected FL ratio in the control group was 1.0 throughout the gestational age range but the standard deviation decreased significantly with menstrual age (P < 0.01). Trisomy 21 was associated with a significantly reduced observed-to-expected FL ratio (P < 0.001) and the deviation increased significantly with menstrual age (P < 0.05). A fixed cut-off of 0.91 for observed-to-expected FL ratio provided a false-positive rate of 12% at 15–17 weeks compared with 6% at 18–20 weeks of gestation (P < 0.001) with detection rates of 29 and 38%, respectively (P = 0.73). Irrespective of the definition used to define the condition, relatively short femur is a poor marker for trisomy 21 particularly when the assessment takes place before 18 weeks of gestation. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Visualization of the fetal three vessel view, aortic arch, and ductal arch views: A comparison of 2-D and 3-D rapid acquisition at 18-22 weeks gestation," by L. Cohen and colleagues is presented.

An abstract of the research paper "Satisfactory Visualization Rates of Standard Cardiac Views at 18-22 Weeks Gestation: A Comparison of Static 2-D and Spatial Temporal Image Correlation (STIC 4-D)," by L. Cohen and colleagues is presented.

The author reflects on the growth of the International Society of Ultrasound in Obstetrics and Gynecology, the publisher of the journal "Ultrasound in Obstetrics and Gynecology." He said that while the organization's journal has been in its 13th anniversary, it has served its purpose which is to provide information related to the field since in its first issue. Meanwhile, the author believes that the society have realized all its goals and have continued serving people as it promised.

Deals with the challenge faced by the editors of `Ultrasound in Obstetrics and Gynecology' journal in the publication of papers on the use of color and pulsed Doppler ultrasound in the first trimester of pregnancy. Information on the theoretical risks of Doppler examination for the fetus in the early first trimester of pregnancy; Policy adopted by the journal on Doppler studies in the first trimester.

An abstract of the article "The impact of fetal renal pelvic diameter on postnatal outcome," by A. A. Shamshirsaz and colleagues is presented.

An abstract of the conference paper "Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis," by M. R. Torloni, and colleagues is presented.

An abstract of the conference paper "Change in hCG in twin gestations during sequential independent screening," byD. A. Kahn and colleagues is presented.

An abstract of the article "Basic as well as detailed neurosonogram can be performed by an off-line analysis of 3D fetal brain volumes," by E. Bornstein and colleagues, is presented.

An abstract of the article "Integrated second trimester risk assessment in twin gestations previously screened in the first trimester," by D. A. Kahn and colleagues, is presented.

An abstract of the article "Median view obtained by an off-line analysis of 3D fetal brain volume can provide easy and reliable measurements of the cerebellar vermis, cisterna magna and nuchal fold," by E. Bornstein and colleagues, is presented.