Enhancing fetal ultrasound with a visual checklist

Ensuring quality in fetal ultrasound (US) is critical, particularly achieving data completeness evaluation as recommended in the latest guidelines. This study assesses the impact of a visual checklist on the completeness of fetal US exams across the first (T1), second (T2) and third (T3) trimester scans according to the French National Obstetric and Fetal US Conference (CNEOF 2022).

Over six months, three obstetrician-gynecologists from a French women's health institution, used the visual checklist integrated into Sonio Pro (Sonio, Paris, France). The control group included three other physicians (also obstetrician-gynecologists) from the same facility. Exam completeness was measured by comparing the actual images taken during the exam, with views included in the CNEOF 2016 and 2022 recommendations, hypothesizing that the use of the checklist would reduce the number of missing views.

Out of 336 exams (including: 111 T1, 117 T2 and 108 T3) the checklist was used on 206 exams (80 T1, 78 T2 and 48 T3). The use of the visual checklist significantly reduced the number of missing images across all exam types and recommendations, with the number of complete exams increasing notably. Specifically, the completion rate of T2 exams doubled under the CNEOF 2022 protocol, when the visual checklist was used. For the most frequently missed "placenta insertion" and "axial kidneys" views in T2 exams, the use of the visual checklist increased the capture rates from 70% to 87% and 74% to 97%, respectively. Missing views dropped from 0,39 to 0,06 on average for CNEOF 2022 T2 exams after implementing the checklist.

The use of a visual checklist markedly enhanced exam completeness, proving potential benefit for compliance with evolving guidelines and, ultimately, for patient care.