Objective. Diagnosis of cleft lip and palate remains a challenge with 2‐dimensional ultrasonography, particularly when clefting involves only the secondary palate. The utility of 3‐dimensional ultrasonography (3DUS) has enhanced our ability to detect clefts. We report our experience with a modification of the flipped face technique to aid in the diagnosis of clefting of the secondary palate. Methods. Ninety‐two volumes of 92 fetal faces were evaluated. Thirty‐six volumes were acquired prospectively. Fifty‐six volumes had previously been acquired and included 8 with clefting of the secondary palate. Volumes were obtained on 3DUS systems and reviewed by 4 blinded readers on personal computer workstations. Volumes were manipulated so that an upright profile was visualized. The palate was then rendered using a thin, curved render box. Statistical analysis was performed using the Fisher exact test for categorical data. Intraclass correlations were computed to assess inter‐rater agreement. Results. The mean gestational age at image acquisition ± SD was 22 ± 5 weeks. Image quality of the secondary palate was obtained and rated as adequate by at least 2 reviewers in 34% (31 of 92) of volumes. The sensitivity of cleft detection ranged from 33% to 63%, and the specificity ranged from 84% to 95%. The low sensitivity was mainly due to artifacts/shadowing. The inter‐rater reliability was 0.62 (95% confidence interval, 0.47–0.76). Conclusions. Three‐dimensional ultrasonography can be used to diagnose clefts of the secondary palate. This evaluation is limited by the fetal position and artifacts from shadowing of adjoining structures. Pseudoclefts can be created, and optimal imaging cannot be obtained in all fetuses.

The MCYLS is 19% greater for CAD added to screening versus screening mammography alone but is still within the accepted range for cost-effectiveness.

Multislice 3DUS evaluation of the fetal face can be performed successfully with high image quality. This technique can be used to consistently and accurately differentiate the fetal primary palate and mandible. Fetuses with cleft lip with or without cleft palate can be identified with confidence.

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Mammography is the principal method of screening for breast cancer in the United States, however there is variability among radiologists in their interpretations of screening mammograms. This variability may cause differences in cost-effectiveness. The aim of this research was to evaluate the effect of different radiologists' practice patterns on the cost-effectiveness of screening mammography. The initial step of this analysis was an extensive literature search of published screening mammography audit results from radiology practices (five different practices were used in the final analysis). From these data, relevant parameters were selected, including screening recall rate, positive predictive value of biopsies based on mammographic findings and the Stage distribution of breast cancers diagnosed by mammography. These parameters were then inserted into a Markov model, which compares two hypothetical groups of women: the first undergoing annual mammographic screening beginning at age 40 and the second undergoing observation without screening. The model (developed using a commercial software product) is based on previously published data and calculates all of the costs and benefits accrued by each of the groups over a 39 year period. The cost-effectiveness of screening mammography (measured as marginal cost per year life saved) was calculated by comparing each of the five different practices to the observed group. The cost-effectiveness varied greatly. The most cost-effective practice had the lowest recall rate (5.20%), a high positive predictive value of biopsy (38%) and a high percentage of Stage 0 and 1 cancers (89.3%), resulting in a marginal cost per year life saved of $6,587.63 compared to the observed group. However, another practice in this study, with a recall rate of 13%, a positive predictive value of biopsy of 19% and stage 0 and 1 cancers totaling 72.1% was considerably less cost-effective. In this case, the marginal cost per year life saved of screening mammography was $21,052.67. The results suggest that the different practice patterns of individual radiologists have a profound effect on the overall cost-effectiveness of screening mammography.