P08.05: Cardiac screening based on 3D imaging of the fetal heart: feasibility and reproducibility for remote telemedicine consultation

Abstract

To assess whether 3D cardiac imaging can be obtained by a non-expert and whether extended heart evaluation can be performed via telemedicine, providing a remote and reproducible diagnosis. 3D volume datasets (VD) from 206 fetuses (19–29 weeks) were obtained through standardized methods within a 30-minute period by 3 operators performing routine ultrasound in Guayaquil, Ecuador and analyzed independently by 2 reviewers located remotely in Chile. Two of the operators (Op1 & Op2) were given 2 days' theoretical and practical training by FV. The third (Op3) received the imaging instructions by email. A checklist of 15 structures and views was used to evaluate most of the cardiac connections. A mean of 3 VD (range 1–4) per patient were acquired and compressed. Neither reviewer evidenced a statistical difference between Op1 and Op2 for the four-chamber view (mean 82%) and outflow tract view (OutF) (mean 79%) (Table 1). However, statistical differences were detected between these two operators and Op3, in terms of the success of the imaging of these structures. The reviewers showed different results when analyzing OutF from Op3. There was good inter-reviewer concordance (Kappa > 0.60). 3D VD, acquired by a properly trained operator, enabled the reviewers to recognize most of the cardiac connections. The average-quality 3D ultrasound system required for this study is widely accessible globally, even in many undeveloped countries. This fact, along with the use of email-based diagnosis, makes the technique a viable low-cost alternative for isolated locations or those with limited access to a tertiary centre. The study demonstrates that 3D, performed within certain standards, enables remote and reproducible extended cardiac analysis.

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