Intra‐ and interobserver variability in fetal ultrasound measurements
Open accessAbstract
Objective: To assess intra‐ and interobserver variability of fetal biometry measurements throughout pregnancy. Methods: A total of 175 scans (of 140 fetuses) were prospectively performed at 14–41 weeks of gestation ensuring an even distribution throughout gestation. From among three experienced sonographers, a pair of observers independently acquired a duplicate set of seven standard measurements for each fetus. Differences between and within observers were expressed in measurement units (mm), as a percentage of fetal dimensions and as gestational age‐specific Z‐scores. For all comparisons, Bland–Altman plots were used to quantify limits of agreement. Results: When using measurement units (mm) to express differences, both intra‐ and interobserver variability increased with gestational age. However, when measurement of variability took into account the increasing fetal size and was expressed as a percentage or Z‐score, it remained constant throughout gestation. When expressed as a percentage or Z‐score, the 95% limits of agreement for intraobserver difference for head circumference (HC) were ± 3.0% or 0.67; they were ± 5.3% or 0.90 and ± 6.6% or 0.94 for abdominal circumference (AC) and femur length (FL), respectively. The corresponding values for interobserver differences were ± 4.9% or 0.99 for HC, ± 8.8% or 1.35 for AC and ± 11.1% or 1.43 for FL. Conclusions: Although intra‐ and interobserver variability increases with advancing gestation when expressed in millimeters, both are constant as a percentage of the fetal dimensions or when reported as a Z‐score. Thus, measurement variability should be considered when interpreting fetal growth rates. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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Ultrasound examination results are highly dependent on the training, experience and skill of the sonographer.
“Thus ultrasound examination results are highly dependent on the training, experience and skill of the sonographer [23].”
From Deep Learning Strategies for Ultrasound in Pregnancy (2020) · cites this paper as [23]
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- Authors
- Sarris, I., Ioannou, C., Chamberlain, P., Ohuma, E., Roseman, F., Hoch, L., Altman, D. G., Papageorghiou, A. T., & for the International Fetal and Newborn Growth Consortium for the 21 Century (INTERGROWTH‐21)
- Affiliations
- John Radcliffe Hospital (GB)
- University of Oxford (GB)
- Corresponding author
- Papageorghiou, A. T.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2012-02-27
- Volume
- 39
- Issue
- 3
- Pages
- 266-273
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W2013364878
- Cited by
- 195
- References
- 30
- Citations by year
- 2026: 27 · 2025: 12 · 2024: 14 · 2023: 18 · 2022: 21 · 2021: 10 · 2020: 17 · 2019: 7 · 2018: 27 · 2017: 12 · 2016: 7 · 2015: 8 · 2014: 7 · 2013: 6 · 2012: 1
- FWCI
- 5.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bill and Melinda Gates Foundation (Grant ID# 49038, 49038)
- National Institute for Health and Care Research
- University of Oxford
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Ultrasound in Clinical Applications
- Keywords
- fetal biometry, intraobserver variability, interobserver variability, fetal ultrasound measurement, gestational age, head circumference, abdominal circumference, femur length, Z-score, fetal growth assessment, measurement agreement
- MeSH terms
- Adult, Biometry, Female, Gestational Age, Humans, Pregnancy, Prospective Studies, Sensitivity and Specificity, Reproducibility of Results, Observer Variation, Ultrasonography, Prenatal, Fetal Development
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