Articles
Register for 8th World Congress on Ultrasound in Obstetrics & Gynecology
Setting and Maintaining Standards
Terry
J. DuBose, M.S., RDMS,
Chair, Ultrasound section of OBGYN.net
November 4, 1998, Edinburgh, Scotland
This Round Table covered the need to establish more standard methods of sonic examination, education for sonographers & sonologists, and quality assurance in this new profession. There was general agreement that the current state of affairs is haphazard, leading to excessive costs, and often less effective uses of sonography. There was also agreement that the only solutions are better education and certification of individuals showing competence in the modality.
Pentti Joupplia, Chair:
Overview of Setting and Maintaining Standards
Dr. Joupplia noted that standards of obstetrical and gynecologic sonography were needed for early pregnancy, fetal dating, growth follow-up and fetal weight estimation, among others. Of the other problems were guidelines for clinical actions after Doppler detection of abnormal maternal-fetal hemodynamics, differential criteria for the ovary and neoplasm, cervical findings, OB & other effective screening procedures, and finally, education and quality assurance. It was noted that the standardization of these will not be simple.
Tony Vintzileos
Cost effective analyses of 2nd trimester strategies for prenatal
detection of Downs Syndrome
Greater standardization of education, equipment, and methods were emphasized. Dr. Vintzileos indicated that in his practice 76% of his patients opt for sonographic evaluation over amniocentesis. However, he noted that everyone’s accuracy is not the same with sonography. He demonstrated a method of estimating the cost effectiveness of sonography both nationally and for specific practices using the relative statistics for sensitive and specificity. These econometric methods are common in formulating governmental and corporate strategies. These formulations are complex and require many assumptions, but can allow the relative comparisons of different clinical practices using the same assumptions. If this reviewer recalls correctly, Tony has published these methods in the White Journal (JUOG) in the last year.
Bosky Thilaganathon
10-14 Week Assessment – Quality Assurance
This lecturer also emphasized that adequate training is paramount for the accurate and effective use of sonography. He also advocated regular audit procedure for certain particularly critical areas, the nucal translucency for example. He indicated that scoring standards for 1st trimester exams will be published next month in the White Journal (JUOG). These standards will include a specified course of study, practical examinations, and a logbook of at least 50 examinations. I would be assumed that these kinds of certifications would also be extended to other areas such as the examination of the fetal heart.
Lyn Chitty
Information, support, and choice in counseling
Ms. Chitty discussed the need for patients to have information in a sensitive way so that their decisions can be made with out confusion. She particularly indicated that the patients often have difficulty interpreting the various diagnostic examinations and may need careful explanations, especially when two or more results seem to be in conflict. Again it was emphasized that education is a corner stone of counseling.
Trish Chudleigh
Training standards for United Kingdom Sonographers
Trish started by pointing out several problems in the current sonography profession. The problems in the UK were stated as there is no statutory requirement for training or any sort of certification, and that Sonography is not considered a Profession by the authorities. These problems are compounded because of the growing use of sonography for multiple disciplinary practitioners, including nurses, cardiac specialists, midwives, radiographers, and others using sonar as a component of wider rolls. The accepted UK education is at a post graduate level as a certificate or diploma. An organization for standardizing education was formed 5 years ago, the Consortium for Accreditation of Sonographic Education (CASE). CASE includes all Societies of Sonographers, promotes education and standards, and occupational working standards. In the UK sonographers are independent practitioners who perform sonar examinations, interpret, report, and sign the report. However, the CME program is currently voluntary. Sonography is unregulated in the UK.
These are exactly the problems faced worldwide in this rapidly growing profession. It is very similar to what currently exists in the USA and Canada, except America has the American Registry of Diagnostic Sonographers (ARDMS), a very well respected and rigorous examination with required CME to maintain registration. Perhaps it is time for the ARDMS to go international by dropping the "A" of the ARDMS, and time for the sonographers of America, the European Union, and other countries/nations to lead the way by joining to bring about worldwide standards for this important new medical profession. Who better to define the profession than those who hold the transducer and do the examinations?
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