Image Scoring Method CFEF/CNRS

1 : Sagittal planeThis item concerns the head and the thorax. The sagittal nature of the plane may

be satisfactory for NT measurement but unsatisfactory for CRL

4 = good : section passing through the frontal bone, the fetal nose bone, the hard palate, the central part of the mandible and the cervico-dorsal spinal column

3 = acceptable : passing more or less through the foetal nose bone, but only partially informative for the spinal column

2 = insufficient : passing through an orbit and the zy-gomatic bone, without pas-sing through the hard palate (oblique section)

1 = unacceptable : does not pass through the markers (frontal section in this case)

2 : Calipers positionThis item concerns: i) the placement of the cursors with respect to the interfa-ces (see figure below) and ii) their positioning with respect to the nuchal space (measuring the greatest thickness, strictly at the nuchal level and not at the re-

tro-thoracic or retro-occiptal level).

4 = good : the two calipers are well positioned in a re-trocervical location (accor-ding to Nicolaïdes)

3 = acceptable : one of the two calipers is not perfectly positioned

2 = insufficient : neither of the calipers is perfectly posi-tioned

1 = unacceptable : one or both of the calipers are clearly poorly positioned or situated retro-occipitally or retro-dorsally

Image Scoring Method CFEF/CNRS

3 : Differentiation of the amnion and skin

4 = good : the amnion and the skin can be clearly dif-ferentiated

3 = acceptable : the amnion is not clearly visible, but the-re is little doubt about the continuity of the cervico-dor-sal plane

2 = insufficient : possible confusion between the am-nion and the skin, and no continuity of the cervico-dor-sal plane

1 = unacceptable : very high level of doubt or inclu-sion of the amnion in the measurement

Image Scoring Method CFEF/CNRS

4 : Position of the headThis must be determined by the liquid space beneath the chin, at the posterior

cervico-cranial limit.

4 = good : intermediate po-sition (liquid space beneath the chin head and slight posterior roundness)

3 = acceptable : a little bent or deflected (small liquid space or posterior straight-ness)

2 = insufficient : chin stuck to the thorax or too large a liquid space beneath the chin

1 = unacceptable : fetus curled in a ball or hyper-ex-tended

Image Scoring Method CFEF/CNRS

5 : Image magnification

4 = good : image includes the head and the entire tho-rax (between half and two-thirds of the fetus on the image)

3 = acceptable : image in-cludes between the top two-thirds and the entire fetus

2 = insufficient : the fetus occupies less than two-thirds of the image

1 = unacceptable : magnifi-cation too low (the fetus, amniotic cavity and uterus are on the screen) or too high (image shows less than half of the top of the fetus)

Image Scoring Method CFEF/CNRS

6 : Orthogonal access to the cutaneous plane (skin visualisation)

4 = good : access strictly or-thogonal (skin is essentially horizontal to the screen)

3 = acceptable : the inci-dent beam is between 0° and 20° to the orthogonal

2 = insufficient : the inci-dent beam is between 20° and 30° to the orthogonal

1 = unacceptable : the inci-dent beam is more than 30° to orthogonal

Image Scoring Method CFEF/CNRS

4 = good : focus and gain well adjusted

3 = acceptable : focus and/or gain not well adjusted

2 = insufficient : focus and/or gain poorly adjusted

1 = unacceptable : focus and/or gain unacceptable

7 : Focus and gainThis item concerns the focus settings (appropriateness to the zone of interest) and the gain settings (saturation making the image too pale or underexposure

making the image too dark)

Image Scoring Method CFEF/CNRS

Image Scoring Method CFEF/CNRS

8 : CRL measurementThis item concerns three criteria: the sagittal nature of the section, the cursor

position, and the degree of foetal flexion

4 = good : sagittal plane passing strictly through the genital tubercle, calipers well positioned and the head in an intermediate position

3 = acceptable : the plane is slightly parasagittal (the thigh or orbit can just be seen) and/or one or both ca-lipers are not well positioned and the head in an interme-diate position

2 = insufficient : the section is not sagittal (more or less frontal or oblique) or the cranio-caudal limit is unclear and/or there is a clearly er-roneous placement of one or both calipers and/or the head is bent or extended

1 = unacceptable : frontal or oblique section, cranio-caudal limit imprecise, the calipers are poorly placed and/or the head is bent or extended.