ULTRASOUND Messages for May, 2008: Re: ULTRASOUND digest 2786

Re: ULTRASOUND digest 2786

From: DuBose, Terry

DuboseTerryJ@uams.edu

Thu May 22 10:11:30 2008

As to "Is anyone out there working on charts which use volumetric measurements? That will be cool!" Thanks for asking. In 1986 I received the SDMS Kenneth R. Gottesfeld Award for publishing (1985, see below) a fetal cranial volume measurement. I still do not understand why no one picked up on that measurement. The late Frank Hadlock once said from the lectern at a meeting I attended, "Terry, I don't know why we are not using the fetal head volume. I guess we are just lazy." Incidentally, Hadlock was one of the peer-reviewers of that manuscript.

I suspect the reason these volumetric measurements have not been generally picked upon is because they were published in the JDMS, which is not listed in the Index Medicus, even though it is peer-reviewed and is a good sonographic journal. Also there is some bias in the literature toward the larger, better known institutions, rather than community colleges, which is were I was when we did the research.

See:

-- DuBose TJ; Fetal Biometry: Vertical Calvarial Diameter and Calvarial Volume, J Diagn Med Sonography 1985; 1:205-217.

DuBose TJ; FETAL SONOGRAPHY, W. B. Saunders Co. 1996, Chapter 7 Size/Age Analysis, and Chapter 8 Cranial Biometry, p. 157-199.

Featured Article of the Month -- 3D BPD Correction; http://www.obgyn.net/us/cotm/0007/3d-bpd-correction.htm

Three-Dimensional Fetal Head; http://jdm.sagepub.com/cgi/content/abstract/17/2/74

Terry J. DuBose, Loraine Endres, and Leeber Cohen, Three-dimensional Fetal Brain Volumes * Reply; Ultrasound Med., Vol. 21, Issue 6, 709-711, June 1, 2002.

And most recently, Textbook of Diagnostic Ultrasonography, 6th Edition, 2006; By Sandra L. Hagen-Ansert;

Chapter 46 Obstetric Measurements and Gestation age, Table 46-1, p. 1070-1071.

Thanks for the good discussion on a topic dear to my hear.

Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM

Associate Professor & Director Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sonography/ http://www.obgyn.net/us/panel/panel.htm http://www.io.com/~dubose/ ---------------------------------------------------------------

________________________________ ---------------------------------------------------------------

--------------------------------------------------------------- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Beithon, Jill (MED US) Sent: Wednesday, May 21, 2008 11:39 PM To: Multiple recipients of list ULTRASOUND Subject: Re: ULTRASOUND digest 2786

Good evening from Minnesota,

Besides the educated attention to detail by the skilled hands performing the measurements, it is also very important to consider the charts and formulas used to calculate the EFW after we input the numbers. Results based on complicated regression formulas still must have had normal ranges which they were designed from which had to have had taken into account geographic populations. How accurate can any of us be on the EFW of any given fetus considering we, and the authors of the charts we use, come from different parts of the country or the world? And who of us are absolutely positive which formulas our machines use? Hadlock had many different weight formulas. And the formulas vary depending on which parameters we input. Yikes! It's pretty complicated.

With that being said I wholeheartedly agree that proper training and careful scanning certainly improve EFW results. Is anyone out there working on charts which use volumetric measurements? That will be cool!

Jill Beithon RT, RDMS, RDCS, RVT

________________________________

=46rom: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Sue ________________________________ Davies Sent: Wednesday, May 21, 2008 10:46 PM To: Multiple recipients of list ULTRASOUND Subject: Re: ULTRASOUND digest 2786

Hi Guys

I don't often contribute to this forum but here goes, I'll weigh into this one! Many years ago (1979) we did a prospective study on EFW, with very tight guidelines and criteria (too long to go into here). The results showed that, in our hands (well trained, careful sonographers with a strict attention to detail), the EFW by ultrasound was within +/- 50gms. I would imagine that, were the study to be repeated, we would be even better nowadays with modern sensitive equipment at our fingertips.

I'm with you Terry - don't knock something unless you are prepared to do it properly, ultrasound fetal measurement is not a slapdash procedure, it should be undertaken with much care and attention. Those who are properly trained will do the best job.

Cheers

Sue

From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Terry DuBose Sent: Thursday, 22 May 2008 12:29 PM To: Multiple recipients of list ULTRASOUND Subject: Re: ULTRASOUND digest 2786

Art, you are correct, weight is given by a scale, that is difficult with a fetus.

An estimate does have more variance than a measurement by scale; but a good sonographic instrument, in skilled hands can reduce the variance. A sonographic estimate by a skilled operator is more than a guess. IMHO. And as people understand volumetric fetal measurements, the variance will be reduced more.

Peace, Terry

evsono@pipeline.com wrote:

If you want to find out how much you weigh, you get on a scale. You don't measure your waistline. Estimate is just a fancy word for guess. Of course, that's just my opinion. I could be wrong. -----Original Message----- From: ultrasound@obgyn.net Subj: ULTRASOUND digest 2786 Date: Wed May 21, 2008 9:21 pm Size: 25K To: Multiple recipients of list ULTRASOUND ULTRASOUND Digest 2786 Topics covered in this issue include: 1) RE: EFW accuracy by "DuBose, Terry" 2) RE: EFW accuracy by Dave Berck ---------------------------------------------------------------------- Date: Wed, 21 May 2008 09:39:47 -0500 From: "DuBose, Terry" To: ---------------------------------------------------------------------- Date: ultrasound@obgyn.net, "Multiple recipients of list ULTRASOUND" Subject: RE: ---------------------------------------------------------------------- Date: EFW accuracy Message-ID: Content-class: urn:content-classes:message MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----_=_NextPart_001_01C8BB50.85285723" This is a multi-part message in MIME format. ------_=_NextPart_001_01C8BB50.85285723 Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: quoted-printable I suspect the reason sonographic measurements are considered so questionable is that there are so many people using sonography who do not have rigorous training and do not practice precise methods. Many seem to think precise measurement methods are not necessary because "ultra! sound" is not considered accurate, a sort of self-fulfilling problem. In a lawsuit in which I was an expert witness, a case very similar the one under current discussion, the sonographer has attended an unaccredited, = short course of study, was not credentialed by the ARDMS, and was on-call by herself. It was obvious she had measured the abdominal circumference at == the ribs and spine in back, completely excluding the skin, baby fat, and muscles in back. The vaginal delivery also ended up with dystocia and neurological damage in the neonate. It is my opinion that sonography, in the hands of a skilled sonographer, is much more accurate than it is given credit for being. But many simply do not take the time and/or do not have the understanding and skill to use it effectively. I would like to see how the measurements in the case under current = discussion were actually made. We also need to be moving to volumetric measurements, the fetus does not liv! e in "Fla t Land"... and the head molds considerably, especially in the vertical axis due to the sutures and fontanels. Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Associate Professor Director Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sonography/ http://www.obgyn.net/us/panel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- [mailto:ultrasound@obgyn.net] On Behalf Of Dave Berck Sent: Tuesday, May 20, --------------------------------------------------------------- 2008 4:46 PM To: Multiple recipients of list ULTRASOUND Subject: Re: EFW --------------------------------------------------------------- accuracy true David J. Berck, MD, MPH ----- Original Message ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subjec! t: Re: EF W accuracy In a message dated 5/20/08 1:57:45 PM, djberck@yahoo.com writes: comparison was made between U/S EFW, Leopold's , and Maternal estimates of EFW. The maternal estimates were the most accurate. Only mother's who had already had one pregnancy already (I believe). Joe P.

Confidentiality Notice: This e-mail message, including any attachments, is = for the sole use of the intended recipient(s) and may contain confidential= and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please = contact the sender by reply e-mail and destroy all copies of the original = message. ------_=_NextPart_001_01C8BB50.85285723 Content-Type: text/html; charset=us-ascii Content-Transfer-Encoding: quoted-printable ! I suspect the reason sonographic = measurements are considered so questionable is that there are so many people using sonography who do not have rigorous training and do not practice precise methods. Many seem to think precise measurement methods are not necessary because "ultrasound" is not considered accurate, a = sort of self-fulfilling problem. In a lawsuit in which I was an expert witness, a case very similar the one under current discussion, the = sonographer has attended an unaccredited, short course of study, was not credentialed by the ARDMS, and was on-call by herself. It was obvious she had measured the abdominal circumference at the ribs and spine in back, = completely excluding the skin, baby fat, and muscles in back. The vaginal = delivery also ended up with dystocia and neurological damage in the neonate. It is my opinion that sonography, in = the hands of a skilled sonographer, is much more accurate than it is given = credit for being. But many simply do not take the time and/or do not= = have the understanding and skill to use it effectively. I would like to see how the = measurements in the case under current discussion were actually made. = We also need to be moving to volumetric measurements, the fetus does not live = in "Flat Land" and the head molds considerably, especially in the vertical axis due to the= = sutures and fontanels. Terry J. DuBose, M.S., RDMS, FSDMS, = FAIUM Associate Professor & Director Diagnostic Medical Sonography Program University= of Arkansas for Medical Sciences, = CHRP 4301 West Markham = St. Mail Slot #563 Little Rock, = Arkansas, 72205 USA 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sono= graphy/ http://www.obgyn.net/us/pa= nel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- =09 --------------------------------------------------------------- =09 --------------------------------------------------------------- From:= ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Dave Berck Sent: Tuesday, May 20, 2008 = 4:46 PM To: Multiple recipients of = list ULTRASOUND Subject: Re: EFW = accuracy true David J. Berck, MD, MPH

> ----- Original Message ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subject: Re: EFW accuracy In a message dated 5/20/08 1:57:45 PM, djberck@yahoo.com writes: comparison was made between U/S EFW, Leopold's , and Maternal estimates of EFW. The maternal estimates were the most = accurate. Only mother's who had already had one pregnancy already (I believe). Joe P.

(http://food.aol.com/dinner-tonight?NCID=aolfod0003000= 0000001) Confidentiality Notice: This e-mail message, including any= attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized = review, use, disclosure or distribution is prohibited. If you are not = the intended recipient, please contact the sender by reply e-mail = and destroy all copies of the original message. ------_=_NextPart_001_01C8BB50.85285723-- ------------------------------ Date: Wed, 21 May 2008 14:16:17 -0700 (PDT) =46rom: Dave Berck To: ultrasound@obgyn.net Subject: RE: EFW accuracy ------------------------------ Date: Wed, 21 May 2008 14:16:17 -0700 (PDT) Message-ID: MIME-Version: 1.0 Content-Type: text/html; charset=3Dutf-8 ------------------------------ Date: Wed, 21 May 2008 14:16:17 -0700 (PDT) Content-Transfer-Encoding: quoted-printable I agree. This applies to other areas of u/s also. 1st tri= screening works presumably because standards are adhered to. But in = this case, had the birthweight been known exactly, most OBs would still all= ow a vaginal delivery, in which case this is simply a case of an unavoidabl= e shoulder dystocia. David J. Berck, MD, MPH --- On Wed, 5/21/08, DuBose, T= erry wrote: From: DuBose, Terry = Subject: RE: EFW accuracy To: "Multiple recipients of list ULTRASOUND" ultrasound@mail.obgyn.net> Date: Wednesday, May 21, 2008, 10:42 AM I suspect the reason= sonographic measurements are considered so questionable is that there are = so many people using sonography who do not have rigorous training and do no= t practice precise methods. Many seem to think precise measurem= ent methods are not necessary because â€œultrasoundâ€ is not c= onsidered accurate, a sort of self-fulfilling problem. In a lawsuit in whic= h I was an expert witness, a case very similar the one under current discus= sion, the sonographer has attended an unaccredited, short course of study, = was not credentialed by the ARDMS, and was on-call by herself. = It was obvious she had measured the abdominal circumference at the ribs and= spine in back, completely excluding the skin, baby fat, and muscles in bac= k. The vaginal delivery also ended up with dystocia and neurolo= gical damage in the neonate. It is my opinion tha= t sonography, in the hands of a skilled sonographer, is much more accurate = than it is given credit for being. But many simply do not take = the time and/or do not have the understanding and skill to use it effective= ly. I would like to see = how the measurements in the case under current discussion were actually mad= e. We also need to be moving to volumetric measurements, = the fetus does not live in â€œ Flat Land â€â€¦ and the h= ead molds considerably, especially in the vertical axis due to the sutures = and fontanels. Terry J. DuBose, = M.S., RDMS, FSDMS, FAIUM Associate Professor & Director Diagn= ostic Medical Sonography Program University of Arkansas for Medical Scie= nces, CHRP 4301 West Markham St. Mail Slot #563 Little Rock , Arkansa= s , 72205 USA 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sonography/ http://www.obgyn.ne= t/us/panel/panel.htm http://www.io.com/~dubose/ ----------------= ----------------------------------------------- =09 ----------------= ----------------------------------------------- =09 ----------------= ----------------------------------------------- From: ultrasound@obgyn.net [mailto:ultrasound@= obgyn.net] On Behalf Of Dav= e Berck Sent: Tuesday, M= ay 20, 2008 4:46 PM To: = Multiple recipients of list ULTRASOUND Subject: Re: EFW accuracy true David J. Berck, MD, MPH

> ----- Original Message ----From: "DoctorJoe@aol.com" To: Multiple reci= pients of list ULTRASOUND Sent: Tuesda= y, May 20, 2008 4:39:17 PM Subject: Re: EFW accuracy In a message = dated 5/20/08 1:57:45 PM, djberck@yahoo.com writes: comparison was made between U/S EFW, Leopold= 's , and Maternal estimates of EFW. The maternal estimates were the most ac= curate. Only mother's who had already had on= e pregnancy already (I believe). Joe P.

(http://= food.aol.com/dinner-tonight?NCID=aolfod00030000000001) = Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. ------------------------------ End of ULTRASOUND Digest 2786 *****************************=20 ------------------------------ End of ULTRASOUND Digest 2786

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Jill.  You are correct in that, "And who of us are absolutely positive which formulas our machines use? Hadlock had many different weight formulas. And the formulas vary depending on which parameters we input. Yikes! It's pretty complicated."  I wonder how many who wield the transducer even know what Filly's "distal femoral point" is and what influence it will have on Hadlock's 4 parameter weight estimates; and even fewer know about the comparable “proximal humeral point”.   It is also pretty obvious to me that many do not pay attention to which tables/charts/formulas are in the sonographic instruments they are using, and have no idea if they are using Hadlock’s, Jeanty’s, Holer’s, Kurtz & Goldberg’s, or others; or how those specific measurements were documented in the research. <o:p></o:p>

<o:p></o:p>

As to "Is anyone out there working on charts which use volumetric measurements? That will be cool!"   Thanks for asking.   In 1986 I received the SDMS Kenneth R. Gottesfeld Award for publishing (1985, see below) a fetal cranial volume measurement.  I still do not understand why no one picked up on that measurement.  The late Frank Hadlock once said from the lectern at a meeting I attended, "Terry, I don't know why we are not using the fetal head volume.  I guess we are just lazy."   Incidentally, Hadlock was one of the peer-reviewers of that manuscript.  <o:p></o:p>

<o:p> </o:p>

I suspect the reason these volumetric measurements have not been generally picked upon is because they were published in the JDMS, which is not listed in the Index Medicus, even though it is peer-reviewed and is a good sonographic journal.   Also there is some bias in the literature toward the larger, better known institutions, rather than community colleges, which is were I was when we did the research. <o:p></o:p>

<o:p> </o:p>

See: <o:p></o:p>

DuBose TJ; Fetal Biometry: Vertical Calvarial Diameter and Calvarial Volume, J Diagn Med Sonography 1985; 1:205-217. <o:p></o:p>

<o:p> </o:p>

DuBose TJ; FETAL SONOGRAPHY, W. B. Saunders Co. 1996, Chapter 7 Size/Age Analysis, and Chapter 8 Cranial Biometry, p. 157-199. <o:p></o:p>

<o:p> </o:p>

Featured Article of the Month -- 3D BPD Correction; <a href="http://www.obgyn.net/us/cotm/0007/3d-bpd-correction.htm" title="blocked::http://www.obgyn.net/us/cotm/0007/3d-bpd-correction.htm">http://www.obgyn.net/us/cotm/0007/3d-bpd-correction.htm</a><o:p></o:p>

<o:p> </o:p>

Three-Dimensional Fetal Head; <a href="http://jdm.sagepub.com/cgi/content/abstract/17/2/74" title="blocked::http://jdm.sagepub.com/cgi/content/abstract/17/2/74">http://jdm.sagepub.com/cgi/content/abstract/17/2/74</a><o:p></o:p>

<o:p> </o:p>

Terry J. DuBose, Loraine Endres, and Leeber Cohen, Three-dimensional Fetal Brain Volumes • Reply; Ultrasound Med., Vol. 21, Issue 6, 709-711, June 1, 2002. <o:p></o:p>

<o:p> </o:p>

And most recently, Textbook of Diagnostic Ultrasonography, 6th Edition, 2006; By Sandra L. Hagen-Ansert;<o:p></o:p>

Chapter 46 Obstetric Measurements and Gestation age, Table 46-1, p. 1070-1071.<o:p></o:p>

<o:p> </o:p>

Thanks for the good discussion on a topic dear to my hear.    <o:p></o:p>

<div>

Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Associate Professor & Director Diagnostic Medical Sonography Program <st1:place w:st="on"><st1:PlaceType w:st="on">University</st1:PlaceType> of <st1:PlaceName w:st="on">Arkansas</st1:PlaceName></st1:place> for Medical Sciences, CHRP <st1:Street w:st="on"><st1:address w:st="on">4301 West Markham St.</st1:address></st1:Street> Mail Slot #563 <st1:place w:st="on"><st1:City w:st="on">Little Rock</st1:City>, <st1:State w:st="on">Arkansas</st1:State>, <st1:PostalCode w:st="on">72205</st1:PostalCode> <st1:country-region w:st="on">USA</st1:country-region></st1:place> 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu <a href="http://www.uams.edu/chrp/sonography/">http://www.uams.edu/chrp/sonography/</a> <a href="http://www.obgyn.net/us/panel/panel.htm">http://www.obgyn.net/us/panel/panel.htm</a> <a href="http://www.io.com/~dubose/">http://www.io.com/~dubose/</a> ---------------------------------------------------------------</fonsize=3D2><o:p></o:p> ---------------------------------------------------------------</fon </div>

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From: <st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName> [mailto:<st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName>] On Behalf Of Beithon, Jill (MED US) Sent: Wednesday, May 21, 2008 11:39 PM To: Multiple recipients of list ULTRASOUND Subject: RE: ULTRASOUND digest 2786<o:p></o:p>

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<o:p> </o:p>

Good evening from <st1:place w:st="on"><st1:State w:st="on">Minnesota</st1:State></st1:place>,<o:p></o:p>

<o:p></o:p>

Besides the educated attention to detail by the skilled hands performing the measurements, it is also very important to consider the charts and formulas used to calculate the EFW after we input the numbers. Results based on complicated regression formulas still must have had normal ranges which they were designed from which had to have had taken into account geographic populations. How accurate can any of us be on the EFW of any given fetus considering we, and the authors of the charts we use, come from different parts of the country or the world? And who of us are absolutely positive which formulas our machines use? Hadlock had many different weight formulas. And the formulas vary depending on which parameters we input. Yikes! It's pretty complicated.    <o:p></o:p>

<o:p></o:p>

With that being said I wholeheartedly agree that proper training and careful scanning certainly improve EFW results. Is anyone out there working on charts which use volumetric measurements? That will be cool!<o:p></o:p>

<o:p></o:p>

Jill Beithon RT, RDMS, RDCS, RVT<o:p></o:p>

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From: <st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName> [mailto:<st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName>] On Behalf Of Sue Davies Sent: Wednesday, May 21, 2008 10:46 PM To: Multiple recipients of list ULTRASOUND Subject: RE: ULTRASOUND digest 2786<o:p></o:p>

Hi Guys<o:p></o:p>

I don’t often contribute to this forum but here goes, I’ll weigh into this one! Many years ago (1979) we did a prospective study on EFW, with very tight guidelines and criteria (too long to go into here). The results showed that, in our hands (well trained, careful sonographers with a strict attention to detail), the EFW by ultrasound was within +/- 50gms. I would imagine that, were the study to be repeated, we would be even better nowadays with modern sensitive equipment at our fingertips.<o:p></o:p>

<o:p> </o:p>

I’m with you Terry – don’t knock something unless you are prepared to do it properly, ultrasound fetal measurement is not a slapdash procedure, it should be undertaken with much care and attention. Those who are properly trained will do the best job.<o:p></o:p>

Cheers<o:p></o:p>

Sue<o:p></o:p>

<o:p> </o:p>

From: <st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName> [mailto:<st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName>] On Behalf Of <st1:PersonName w:st="on">Terry DuBose</st1:PersonName> Sent: Thursday, 22 May 2008 12:29 PM To: Multiple recipients of list ULTRASOUND Subject: Re: ULTRASOUND digest 2786<o:p></o:p>

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Art, you are correct, weight is given by a scale, that is difficult with a fetus.   <o:p></o:p>

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<o:p></o:p>

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<div>

An estimate does have more variance than a measurement by scale; but a good sonographic instrument, in skilled hands can reduce the variance.  A sonographic estimate by a skilled operator is more than a guess. IMHO. And as people understand volumetric fetal measurements, the variance will be reduced more.  <o:p></o:p>

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<o:p></o:p>

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Peace, Terry evsono@pipeline.com wrote:<o:p></o:p>

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If you want to find out how much you weigh, you get on a scale. You don't measure your waistline. Estimate is just a fancy word for guess. Of course, that's just my opinion. I could be wrong. -----Original Message----- From: <st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName> Subj: ULTRASOUND digest 2786 Date: Wed May 21, 2008 9:21 pm Size: 25K To: Multiple recipients of list ULTRASOUND ULTRASOUND Digest 2786 Topics covered in this issue include: 1) RE: EFW accuracy by "<st1:PersonName w:st="on">DuBose, Terry</st1:PersonName>" 2) RE: EFW accuracy by Dave Berck ---------------------------------------------------------------------- Date: Wed, 21 May 2008 09:39:47 -0500 From: "<st1:PersonName = ---------------------------------------------------------------------- Date: w:st=3D"on">DuBose, ---------------------------------------------------------------------- Date: Terry</st1:PersonName>" To: <st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName>, "Multiple recipients of list ULTRASOUND" Subject: RE: EFW accuracy Message-ID: <Content-class: urn:content-classes:message MIME-Version: 1..net>Content-Type: multipart/alternative; boundary="----_=_NextPart_001_01C8BB50.85285723" This is a multi-part message in MIME format. ------_=_NextPart_001_01C8BB50.85285723 Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: quoted-printable I suspect the reason sonographic measurements are considered so questionable is that there are so many people using sonography who do not have rigorous training and do not practice precise methods. Many seem to think precise measurement methods are not necessary because "ultra! sound" is not considered accurate, a sort of self-fulfilling problem. In a lawsuit in which I was an expert witness, a case very similar the one under current discussion, the sonographer has attended an unaccredited, = short course of study, was not credentialed by the ARDMS, and was on-call by herself. It was obvious she had measured the abdominal circumference at = the ribs and spine in back, completely excluding the skin, baby fat, and muscles in back. The vaginal delivery also ended up with dystocia and neurological damage in the neonate. It is my opinion that sonography, in the hands of a skilled sonographer, is much more accurate than it is given credit for being. But many simply do not take the time and/or do not have the understanding and skill to use it effectively. I would like to see how the measurements in the case under current = discussion were actually made. We also need to be moving to volumetric measurements, the fetus does not liv! e in "<st1:place w:st="on"><st1:State w:st="on">Fla</st1:State></st1:place> t Land"... and the head molds considerably, especially in the vertical axis due to the sutures and fontanels. Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Associate Professor Director Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sonography/ http://www.obgyn.net/us/panel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- w:st=3D"on">ultrasound@obgyn.net</st1:PersonName> --------------------------------------------------------------- [mailto:<st1:PersonName w:st=3D"on">ultrasound@obgyn.net</st1:PersonName>] = --------------------------------------------------------------- On Behalf Of Dave Berck Sent: Tuesday, May 20, 2008 4:46 PM To: Multiple recipients of list ULTRASOUND Subject: Re: EFW accuracy true David

>J. Berck, MD, MPH ----- Original Message ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND Sent: Tuesday, May 20, 2008 4:39:17 PM Subjec! t: Re: EF W accuracy In a message dated 5/20/08 1:57:45 PM, djberck@yahoo.com writes: comparison was made between U/S EFW, Leopold's , and Maternal estimates of EFW. The maternal estimates were the most accurate. Only mother's who had already

(http://food.aol.com/dinner-tonight?NCID=aolfod00030000000001) Confidentiality Notice: This e-mail message, including any attachments, is = for the sole use of the intended recipient(s) and may contain confidentia= land privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please = contact the sender by reply e-mail and destroy all copies of the original = message. ------_=_NextPart_001_01C8BB50.85285723 Content-Type: text/html; charset=us-ascii Content-Transfer-Encoding: quoted-printable ! I suspect the reason sonographic = measurements are considered so questionable is that there are so many people using sonography who do not have rigorous training and do not practice precise methods. Many seem to think precise measurement methods are not necessary because “ultrasound” is not considered accurate, a = sort of self-fulfilling problem. In a lawsuit in which I was an expert witness, a case very similar the one under current discussion, the = sonographer has attended an unaccredited, short course of study, was not credentialed by the ARDMS, and was on-call by herself. It was obvious she had measured the abdominal circumference at the ribs and spine in back, = completely excluding the skin, baby fat, and muscles in back. The vaginal = delivery also ended up with dystocia and neurological damage in the neonate. = It is my opinion that sonography, in = the hands of a skilled sonographer, is much more accurate than it is given = credit for being. But many simply do not take the time and/or do not= = have the understanding and skill to use it effectively. = I would like to see how the = measurements in the case under current discussion were actually made. = We also need to be moving to volumetric measurements, the fetus does not live = in “<st1:place w:st="on"><st1:PlaceName w:st="on">Flat</st1:PlaceName> <st1:PlaceType w:st="on">Land</st1:PlaceType></st1:place>” and the head molds considerably, especially in the vertical axis due to the= = sutures and fontanels. Terry J. DuBose, M.S., RDMS, FSDMS, = FAIUM Associate Professor & Director Diagnostic Medical Sonography Program University= of <st1:place w:st="on"><st1:State w:st="on">Arkansas</st1:State></st1:place> for Medical Sciences, = CHRP 4301 West Markham = <st1:place w:st="on">St.</st1:place> Mail Slot #563 <st1:City w:st="on">Little Rock</st1:City>, = <st1:State w:st="on">Arkansas</st1:State>, 72205 <st1:place w:st="on"><st1:country-region w:st="on">USA</st1:country-region></st1:place> 501-686-6510 or 501-686-5948 DuBoseTerryJ@UAMS.edu http://www.uams.edu/chrp/sono= graphy/ http://www.obgyn.net/us/pa= nel/panel.htm http://www.io.com/~dubose/ --------------------------------------------------------------- --------------------------------------------------------------- --------------------------------------------------------------- From:= <st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName> [mailto:<st1:PersonName w:st="on">ultrasound@obgyn.net</st1:PersonName>] On Behalf Of Dave Berck Sent: Tuesday, May 20, 2008 = 4:46 PM To: Multiple recipients of = list ULTRASOUND Subject: Re: EFW = accuracy true David J. Berck, MD, MPH =

>----- Original Message ---- From: "DoctorJoe@aol.com" To: Multiple recipients of list ULTRASOUND = Sent: Tuesday, May 20, 2008 4:39:17 PM Subject: Re: EFW accuracy In a message dated 5/20/08 1:57:45 PM, djberck@yahoo.com writes: comparison was made between U/S EFW, Leopold's , and Maternal estimates of EFW. The maternal estimates were the most = accurate. Only mother's who had already had one pregnancy already (I believe). Joe P. ************** Wondering what's for Dinner Tonight=3D3F Get new twists on family favorites= =

a= tAOL Food. (http://food.aol.com/dinner-tonight?NCID=aolfod0003000= 0000001) Confidentiality Notice: This e-mail message, including any= = attachments, is for the sole use of the intended recipient(s) and may = contain confidential and privileged information. Any unauthorized = review, use, disclosure or distribution is prohibited. If you are not = the intended recipient, please contact the sender by reply e-mail = and destroy all copies of the original message.

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