An Ultrasound Training Program For Fetal Palate Screening And Design And Application Of Fetal Palate Screening Software Based On The “Sequential Sector Scan Through The Oral Fissure”

Objectives To introduce an ultrasound training program for fetal palate screening by using a “sequential sector scan through the oral fissure” to train less experienced doctors and to investigate its effectiveness.Methods Twenty doctors who were able to independently perform prenatal primary screening before they attended the training,including 10 resident doctors with less than5 years of work experience and 10 attending physicians with more than 5 years of work experience.None of them had previously performed prenatal tertiary screening and had received special training for fetal palate screening.Several women at approximately 20-28 weeks of gestation with singleton pregnancies were also enrolled.All participants who provided informed consent were fully aware of the content and process of this training program.Specialists developed special training plans,designed training procedures and feedback mechanisms based on the difficulties in fetal palate screening,relevant anatomical structures,and acoustic characteristics.The training program consisted of theory and practice training,theory tests,practice tests,self-evaluation,and a questionnaire towards the satisfaction of this training program.The trainees were evaluated on theory,practice,and self-assessment before training,received theory training,practice training,theory and practice tests immediately after training.For the items with a score that were less than 60% of the full score were again used for training with a reconstructed plan.And then the theory,practice tests and self-assessment were conducted after training again.The scores of various assessments and self-assessment before training,immediately after training and after training were statistical analyzed.Finally,a questionnaire survey was conducted to evaluate the practicality,content,scientificity,and effectiveness of the training program.Results No significant difference was found between the resident doctors group and physicians group in the theory scores of the pre-training test,Z=-0.1770,P=0.089,>0.05.The median theory scores increased from 8.00(range 6.00-10.00)to13.00(range 12.00-15.00)to 15.00(range 13.00-17.00),from the pre-training to the immediately after training to the post-training test.The theory scores of the pre-training test and the immediately after training test of all trainees were significantly different,Z=-3.972,P<0.01.The theory scores of the immediately after training test and the posttraining test of all trainees were significantly different,Z=-3.977,P<0.01.The theory scores of the pre-training test and the post-training test of all trainees were significantly different,Z=-3.972,P<0.01.The differences in the pre-training test and the posttraining test theory scores between the resident doctors group and physicians group were not significantly different,Z=-0.762,P=0.481,>0.05.No significant difference was found between the resident doctors group and physicians group in the practice scores of the pre-training test,Z=-0.040,P=0.971,>0.05.The median practice scores increased from 5.00(range 2.00-9.00)to 9.50(range 9.00-11.00)to 14.00(range 11.00-19.00),from the pre-training to the immediately after training to the post-training test.The practice scores of the pre-training test and the immediately after training test of all trainees were significantly different,Z=-3.954,P<0.01.The practice scores of the immediately after training test and the post-training test of all trainees were significantly different,Z=-3.944,P<0.01.The practice scores of the immediately after training test and the post-training test of all trainees were significantly different,Z=-3.935,P<0.01.The differences in the pre-training test and the post-training test practice scores between the resident doctors group and physicians group were not significantly different,Z=-0.500,P=0.631,>0.05.No significant difference was found between the resident doctors group and physicians group in the median completion time for the fetal palate scan of the pre-training test,Z=-0.303,P=0.796,>0.05.The median completion time for the fetal palate scan on the pre-training test,the immediately after training and the posttraining test decreased from 11.33 min(range 7.67-15.00 min)to 9.28 min(range 6.49-15.00 min)to 3.94 min(range 2.50-15.00 min).The completion time for the fetal palate scan of the pre-training test and the immediately after training test of all trainees were significantly different,Z=-1.867,P=0.062,>0.05.The completion time for the fetal palate scan of the immediately after training test and the post-training test of all trainees were significantly different,Z=-3.733,P<0.01.The completion time for the fetal palate scan of the pre-training test and the post-training test of all trainees were significantly different,Z=-3.584,P<0.01.The differences in the pre-training test and the post-training test completion time between the resident doctors group and physicians group were not significantly different,Z=-0.832,P=0.406,>0.05.The median expression scores increased from 2.00(range 1.00-3.00)to 2.50(range 1.50-4.00)to 14.00(range 2.00-5.00),from the pre-training to the immediately after training to the post-training test.For the checklist of practice test,the total scores of the soft palate sections,the hard palate sections,the dynamic scans of the palate,and the upper alveolar bone sections increased from 9.00 to 42.00 to 69.00,from 27.00 to 51.00 to 74.00,from 10.00 to40.00 to 68.00,from 40.00 to 55.00 to 75.00 from the pre-training to the immediately after training to the post-training test.The total completion time for the fetal palate scan decreased from 232.88 min to 197.80 min to 107.35 min from the pre-training to the immediately after training to the post-training test.In the pre-training,immediately after training,post-training practice test,the median scores of the sections of soft palate were0.00(0.00-2.00),2.00(1.00-3.00),3.00(3.00-5.00)respectively.In the pre-training,immediately after training,post-training practice test,the median scores of the sections of hard palate were1.00(0.00-3.00),2.00(2.00-4.00),4.00(3.00-4.00)respectively.In the pre-training,immediately after training,post-training practice test,the median scores of dynamic scans of the palate were 0.00(0.00-2.00),2.00(1.00-3.00),3.00(3.00-5.00)respectively.In the pre-training,immediately after training,post-training practice test,the median scores of the sections of upper alveolar bone were 2.00(1.00-3.00),3.00(2.00-3.00),4.00(3.00-5.00)respectively.The number of trainees whose theory test scores were less than 60% of full scores were 20,0,0 in the pre-training,immediately after training,and pos-training tests respectively.For the practice tests,the number of trainees whose total scores,soft palate section scores,hard palate section scores,dynamic scan scores of the palate and upper alveolar bone section scores were less than60% of full scores were 20,20,16,20,14 respectively in the pre-training test.The number of trainees whose total scores,soft palate section scores,hard palate section scores,dynamic scan scores of the palate and upper alveolar bone section scores were less than 60% of full scores were 20,15,11,16,6 respectively in the immediately after training test.The number of trainees whose total scores,soft palate section scores,hard palate section scores,dynamic scan scores of the palate and upper alveolar bone section scores were less than 60% of full scores were 1,1,0,0,0 respectively in the posttraining test.The median self-assessment scores increased from 2.00(range 1.00-3.00)to 4.00(range 3.00-5.00),from the pre-training test to the post-training test,Z=-4.072,P<0.01.The median questionnaire scores for each item were 5.00(range 3.00-5.00)for pragmatism,4.00(range 3.00-5.00)for content,4.00(range 3.00-5.00)for scientific nature,and 5.00(range 3.00-5.00)for effectiveness.Conclusions The training program for fetal palate screening based on “sequential sector scan through the oral fissure” can effectively standardize and improve doctors’ scans for fetal palates.In addition,the program might also make it feasible to use the scan sequence as a universal methodology for fetal palate screening.Objectives To introduce the development and application of software for fetal palate screening based on the “sequential sector scan though the oral fissure” and to evaluate its feasibility and clinical practicability.Methods Software was developed for fetal palate screening based on the “sequential sector scan though the oral fissure”.The three-dimensional volume data of the fetal face obtained by an ultrasonic machine were imported into the software offline,after which the software automatically displayed the continuous transverse,sagittal,and coronal planes of the fetal face.Then,the values of the X,Y,and Z axes,which correspond to the transverse,sagittal,and coronal planes built in the software,respectively,were adjusted to show the anterior superior edge of the lower alveolar bone on the three planes,based on which the coordinates of the anterior superior edge of the lower alveolar bone were set.On the median sagittal plane,the scanning fulcrum was placed on the anterior superior edge of the lower alveolar bone,and the scanning angle and numbers of layers were set.The sequential sector planes of the lower alveolar bone,pharynx,soft palate,hard palate,and upper alveolar bone were then obtained to display the overall view of the fetal palate,according to which its display integrity was evaluated.The feasibility and accuracy of the software in fetal palate screening and the diagnosis of cleft palate were evaluated by actual clinical cases.Results After the three-dimensional volume data of 10 normal fetal palates and 10 cleft palates were imported into the software,full views of the normal fetal palates and the defective parts of the cleft palates were displayed,and relatively clear sequential tomographic images and continuous dynamic videos were formed.Conclusions The software can display fetal palates more directly after fetal face threedimensional ultrasound data are obtained,which might allow for a new method of fetal palate screening and cleft palate diagnosis.