ULTRASOUND Messages for July, 2002: Re: Level three sonogram

Re: Level three sonogram

From: art fougner, md

evsono@pipeline.com

Sun Jul 21 21:37:40 2002

just my opinion - i could be wrong.

art

At Sun, 21 Jul 2002, Terry J DuBose wrote: >
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>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:
>----------------------------------------------
>
>--
>----------------------------------------------
>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 inse! rtion 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
>
>writes:
><BLOCKQUOTE dir=ltr
>style="PADDING-LEFT: 10px; MARGIN-LEFT: 10px; BORDER-LEFT: #000000 2px solid">
> 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:
>
> <BLOCKQUOTE
> style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">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 thi 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<BR should be
> ruled out. I believe that both AIUM and ACR standardsindicate tha
> second and third trimester fetal anatomy should bedocumented, including,
> but not limited to, "cerebral ventricles, choroidplexus, posterior fossa
> (including cerebellar hemisphere and cisternamagna,), four-chamber view
> of the heart(including its position withinthe thorax), spine
> (longitudinal and transverse), stomach, urinarybladder, fetal umbilical
> cord inse! rtion site and intactness of abdominalwall, and the kidneys."
> (ACR standards, rev. 1999)If all of the above mentioned anatom is
> displayed, then most anomalies(but not all) could be ruled out. I always
> go one step further, andexamine outflow tracts, hands and feet, as well
> as all extremeties. Inmy opinion, this should cover a "screening" scan
> quite well.Karen Roersma, RDMS
>

Terry, this is a fantastic thing you have done, to ferret this information out. You really do amaze me. How do you find time for all the sonography things that you do???? You are a true leader of our community, and I am proud to be in a field led by people like you. Truly! I have been saying "Wow"! all day! I am so tremendously excited about this new technology, I can't tell you. Do you think you could let me know how I might contact Sergeant Vance? I want to find out about training for this technology!!! That is the most wonderful stuff!!! Light years away from what I started with in this field!!!! Let's see them do THAT with a CAT scanner or MRI!!!!! Diana Terry J DuBose <tjdubose@juno.com> wrote: Want to see the future of sonography? Take at look at this explanation of the first "wearable ultrasound" machine, read the lesions learned and how soon you too may become a Cyborg, or Zybog, or SonoCyborg!

and see the three articles near the top of the page: Portable Ultrasound - A Peek at the Future Master Sgt. Cheryl Vance, a diagnostic sonography instructor assigned to the 382nd Training Squadron at Sheppard Air Force Base, Texas, may well be the first Sonographic Cyborg on Earth... Portable Ultrasound - An Interview with MSgt. Vance Terry J. DuBose, M.S., RDMS, OBGYN.net Editorial Advisor interviews Master Sgt. Cheryl Vance, RDMS Air Force Tests Wearable Ultrasound Technology By Master Sgt. Cheryl Vance, RDMS This is great stuff! Enjoy, Terry J DuBose Little Rock, Arkansas USA

DIV> <BLOCKQUOTE dir=ltr style="PADDING-LEFT: 10px; MARGIN-LEFT: 10px; BORDER-LEFT: #000000 2px solid"> <P>Terry, this is a fantastic thing you have done, to ferret this information out.  You really do amaze me.  How do you find time for all the sonography things that you do????   You are a true leader of our community, and I am proud to be in a field led by people like you.  Truly!  I have been saying "Wow"! all day! <P>I am so tremendously excited about this new technology, I can't tell you.  Do you think you could let me know how I might contact Sergeant Vance?  I want to find out about training for this technology!!!   That is the most wonderful stuff!!!   Light years away from what I started with in this field!!!!  Let's see them do THAT with a CAT scanner or MRI!!!!! <P>Diana <P>  <B><I>Terry J DuBose <tjdubose@juno.com></I></B> wrote: <BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid"> <META content="MSHTML 6.00.2716.2200" name=GENERATOR> <DIV>Want to see the future of sonography?  Take at look at this explanation of the first "wearable ultrasound" machine, read the lesions learned and how soon you too may become a Cyborg, or Zybog, or SonoCyborg!</DIV> <DIV> </DIV> <DIV>Go to: </DIV> <DIV><A href="http://www.obgyn.net/us/us.asp">http://www.obgyn.net/us/us.asp</A></DIV> <DIV> </DIV> <DIV>and see the three articles near the top of the page:</DIV> <P align=left><B><A href="http://www.obgyn.net/us/us.asp?page=/us/feature/nco_mobile_ultrasound/nco_mobile_ultrasound">Portable Ultrasound - A Peek at the Future</A></B>  <BR>Master Sgt. Cheryl Vance, a diagnostic sonography instructor assigned to the 382nd Training Squadron at Sheppard Air Force Base, Texas, may well be the first Sonographic Cyborg on Earth...</P> <P align=left><B><A href="http://www.obgyn.net/displayarticle.asp?page=/us/feature/nco_mobile_ultrasound/DuBose_Vance">Portable Ultrasound - An Interview with MSgt. Vance</A></B><BR><B><FONT color=#cc0000><A href="http://www.obgyn.net/meet.asp?page=/bibliography/dubose">Terry J. DuBose,</A></FONT><A href="http://www.obgyn.net/meet.asp?page=/bibliography/dubose"> M.S., RDMS</A>, <FONT color=#cc0000>OBGYN.net</FONT></B> <B>Editorial Advisor</B> interviews <B><A href="mailto:cheryl.vance@sheppard.af.mil">Master Sgt. Cheryl Vance, RDMS</A></B> </P> <P align=left><A href="http://www.obgyn.net/us/us.asp?page=/us/feature/nco_mobile_ultrasound/vance_mobileultra"><B>Air Force Tests Wearable Ultrasound Technology</B></A><BR>By <B><A href="mailto:cheryl.vance@sheppard.af.mil">Master Sgt. Cheryl Vance, RDMS</A></B> </P> <P align=left>This is great stuff!</P> <P align=left>Enjoy, Terry J DuBose</P> <P align=left>Little Rock, Arkansas USA</P></BLOCKQUOTE><BR><BR><IMG Inbox&MsgIdA50_868131_6817_997_11639_0_17665&bodyPart=2&filename=dianapen.gif&YY‘22&order=up&sortÚte">

<P><BR> <HR SIZE=1> Health</A> - Feel better, live better <DIV> </DIV></BLOCKQUOTE></BODY></HTML>

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