We understand fetal cardiac view retention has been the subject of debate for many years. Debated amongst the CHD clinical community.
Our understanding is that the debate surrounds the quality and value of a still image when assessing a rapidly moving 3D structure. Video clips are considered the gold standard. However, most trusts will not allow the storage of clips due to file volume and storage cost.
Another reason suggested to us is that trusts don't save images because they want their sonographers to focus on assessing structure rather than trying to obtain a perfect image and perhaps overlooking structure in the process.
From our FOI requests received so far, we have established that only 11 trusts in England retain video clips. That is around 9.7% of trusts, predominantly in London and the South East;
Mid and South Essex NHS Foundation Trust (MSEFT)
Kings College Hospital NHS Foundation Trust
Chelsea and Westminster Hospital NHS Foundation Trust
London North West University Healthcare NHS Trust
Epsom and St Helier University Hospitals NHS Trust
Medway Foundation NHS Trust
Birmingham Women’s and Children’s NHS Foundation Trust
East Sussex Healthcare NHS Trust
Barts Health NHS Trust
Buckinghamshire Healthcare NHS Trust
Royal Berkshire Hospital Foundation Trust
We feel the most important people have been excluded from this debate - the CHD families who are ultimately affected. These are our scans, our views, our data and our children. We feel these issues and the discrepancy in national practice appears to have almost been kept a secret from us.
We understand the fetal heart is the size of an acorn and it is a moving structure. The fine structures at 20 weeks are incredibly difficult to visualise and capture through an ultrasound image as a result. We understand there will be cases where it is impossible to detect antenatally. As an affected family, we just can't accept these are valid reasons not to retain our records.
Data storage in trusts should be addressed or patients should be allowed to make a record in some form of their scan. Trust practice should be disclosed and the option given if trusts aren't keeping records. Phones don't interfere with ultrasound. Complacency can surely creep and families can slip through the net if there is no audit trail for review and future learning. It's interesting the majority practice is to retain views and these 56% of trusts have interpreted the range of professional guidance in existence accordingly.
“The standard of care provided by a competent ultrasound practitioner is that which the majority of similar individuals would provide and/or which a significant body of similar individuals would provide in similar and contemporaneous circumstances".
"Images that accompany an ultrasound examination carried out by a competent ultrasound practitioner evidence the assumption that the necessary standard of care has been delivered”.
(Above extracts taken from Society of Radiographers and British Medical Ultrasound Society).