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Re: Level three sonogramFrom: roger sanders (sanders87529@yahoo.com)Sun Jul 21 08:57:47 2002
I dont disagree that MOST anomalies will be ruled out but as you rightly point out outflow tracts, distal limbs and face are not part of a basic scan and exhaustive efforts to examine the spine are not required. My point is that efforts to validate the competence and completeness of referral, targeted, or level 2 scans are currently only being monitored by legal means and judging by the large number of law suits related to fetal anomalies and the dismal results of surveys such as the RADIUS study better means of ensuring quality are desirable. Karen Roersma <kroersmardms@netscape.net> wrote: At Fri, 19 Jul 2002, roger sanders wrote: >The level one standard refers to the standard obstetrical sonogram as defined by ACR,AIUM, ACOG guidelines which we all know is the minimum legally acceptable level. We know this is not a sufficiently detailed study to rule out anomalies and that greater detail and skill is required for an anomaly scan.< I beg to disagree. If a comprehensive scan is performed, MOST anomalies should be ruled out. I believe that both AIUM and ACR standards indicate that second and third trimester fetal anatomy should be documented, including, but not limited to, "cerebral ventricles, choroid plexus, posterior fossa (including cerebellar hemisphere and cisterna magna,), four-chamber view of the heart(including its position within the thorax), spine (longitudinal and transverse), stomach, urinary bladder, fetal umbilical cord insertion site and intactness of abdominal wall, and the kidneys." (ACR standards, rev. 1999) If all of the above mentioned anatomy is displayed, then most anomalies (but not all) could be ruled out. I always go one step further, and examine outflow tracts, hands and feet, as well as all extremeties. In my opinion, this should cover a "screening" scan quite well. Karen Roersma, RDMS Yahoo! Health - Feel better, live better
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