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Re: Level three sonogramFrom: Allen Worrall (jworrall@alaska.net)Sun Jul 21 12:35:51 2002
> ----- Original Message ----- From: Terry J DuBose To: Multiple recipients of list ULTRASOUND Sent: Sunday, July 21, 2002 7:10 AM Subject: Re: Level three sonogram This discussion raises an important issue... that of sonographic education and recognition of experience. Not only does the public want to have good sonography, they tend to want "perfect" children. Even though sonography does not cause birth defects, it is expected to ALWAYS find the problem when there is one. Yet, there are few ways, other than asking the individual holding the transducer, "What is your experience in this modality and this particular examination?" At that point, it is usually too late to do anything about it without being obnoxious and saying, "Well, I want someone who has more experience." It is also a problem that seems to be transnational, though it is particularly in the USA, as Dr. Sanders pointed to the RADIUS. This is the same problem that exists in mammography, and other important area with dubious success in reaching its goals, as pointed out in the literature recently. The ACOG, AIUM & ACR have made an attempt at rectifying through guidelines laboratory accreditation, with mixed success. As Dr. Sanders correctly points out, "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." While laboratory accreditation does address the general efficacy of a lab, there are some loopholes when it comes to who is actually holding the transducer. The SDMS & ARDMS have been at the forefront of trying to assure that individuals know how to scan, and more recently some the various medical specialties have added sonography to their curricula. Dr. Filly, in a JUM editorial, pointed out that the ARDMS has taken the leadership in the area of individual certifications in the USA. "It is embarrassing to me as a sonologist and greatly to the credit of sonographers that they have taken the lead on qualifying examinations. The American Registry of Diagnostic Medical Sonographers conducts a comprehensive examination that, in my opinion, would be failed dismally by many physicians who "practice" sonology." Filly R; Letter: "It's Not My Fault Because...."; JUM, March 1998; 17:156. The attempts to certify individuals in specific areas such as "nuchal translucency" are also applaudeable, but seem to be much too specific an approach. The ARDMS specialty approach seems more realistic, but still only indicates entry level knowledge and no longer tests the psychomotor sonographic skills. The SDMS has tried to recognize those with more than entry level skills through the Advanced Practice Sonographer designation. The APS requires a minimum of 5 years clinical experience after becoming ARDMS certified, peer-review publication, and a 4 year college degree. There are other details that can be found at: http://www.sdms.org/membership/aps.asp . However, are only about 125 who have actually become recognized as APS. We are still a long way from establishing a satisfactory system for the public (& medical community) to find a skilled sonographer when they need one. As Art Fougner, MD said here, it isn't the alphabetical soup behind one's name that indicates these skills. Having an MD, RN, or RT certainly does not give much indication . at least for now. Peace, Terry J. DuBose, M.S., RDMS, APS (inactive) ---------------------------------------------- On Sun, 21 Jul 2002 08:58:24 -0500 roger sanders <sanders87529@yahoo.com> ---------------------------------------------- writes:
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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.
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