Our trust is in the minority of 44% that aren’t retaining fetal cardiac views.
Our scan appointment letters advised that we couldn’t film or use our mobile phones. There were signs in the department also that reinforced this.
Concerning general filming on trust premises our trust policy advises; “each ward may have a different protocol – depending on its type of patients and the medical equipment used.” We needed to submit another freedom of information request to dig deeper.
Our trust have now confirmed in writing we were not permitted to film during Molly’s scans, and patients are still currently not permitted to film during their scans. We requested our trust obstetric ultrasound department written policy on this issue. There doesn’t seem to be one. Our trust provided two documents with very limited value;
Document one; The Society of Radiographers (SoR) - NHS Obstetric Ultrasound Examinations. Guidance on Sale of Images, Fetal Sexing, Commercial Considerations and Requests to Record. Fourth edition. (August 2021). This guidance draws distinctions between requests to record for personal and clinical reasons. It advises that requests to record for personal reasons only should be discouraged (such as social media posts). The guidance emphasises that sonographers need to concentrate and privacy of all parties must be respected. Recording by patients could compromise this. This SoR publication is ultimately ambiguous and non-prescriptive.
As patient mobile phones and cameras don’t interfere with ultrasound equipment, the issue of patient recording has necessitated SoR to provide four publications on this issue alone since 2019;
-Recording of images and clinical discussions by patients during diagnostic imaging, interventional procedures and radiotherapy treatment (2019)
-NHS obstetric ultrasound examinations. Guidance on sale of images, fetal sexing, commercial considerations and requests to record (2021 - referenced to us)
-Recording images of sonographers performing NHS obstetric ultrasound examinations: Guidance to support local policy development (2022)
-Guidance and recommendations for running an effective, high-quality obstetric ultrasound service and supporting obstetric sonographer career development (2023)
We’ve commented previously on these four SoR publications (update 20)
It’s interesting that our trust have been selective in which aspects of the SoR guidance to adhere to and which parts to reference to us. As our trust don’t retain images or video clips, they seem to have disregarded the following further relevant SoR guidance;
“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”.
“The compilation of an appropriate number of annotated images that represent the entire ultrasound examination is good practice as it provides the following:.. Evidence that the examination was carried out to a competent standard”
“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” (relevant in the context of 56% of trust sonographers in England retaining records).
Document 2; Standard Operating Procedure For Virtual Attendance in Obstetric Ultrasound During Covid-19 Pandemic. [A publication by our trust]. (May 2020). This document is 3 pages long and over 4 years old. The content appears to have been forged from a range of professional guidelines and views of clinical bodies over patients streaming footage to birthing partners who were not permitted to attend the scan during the pandemic.
We’ve commented previously how in January 2021 charity Birthrights.org instructed leading barrister Shu Shin Luh at Doughty Street Chambers, London. Her practice has a strong human rights, civil liberties, and anti-discrimination focus. Birthrights instructed her as trusts nationally were adopting this same stance and were quoting the same material during the pandemic. Shu Shin Luh advised on the legal position of all trusts (such as ours) refusing patients to record their scans or stream to partners. Shu Shin Luh deconstructed all such guidance and debunked all the material contained within our trust publication through a 17 page legal position assessment.
She concluded; “In my view, by simply adopting the SoR’s recommendation as a hard and fast rule, the NHS will have acted unlawfully in closing its mind to all relevant and available evidence that it is required to address in its policy formulation on streaming / recording during antenatal appointments”.
https://birthrights.org.uk/wp-content/uploads/2021/01/210114-Birthrights.Advice-filming-at-scans.pdf
We’re disappointed. We don’t feel these two ambiguous and outdated publications provided to us constitute a trust policy.
Some really interesting extracts from our own trust’s publication provided to us are;
“The option of storing a cineloop [sequential series of ultrasound images] to PACS [picture archiving and communication system] for the patient to record is not possible due to the impact that would have on the PACS storage and capacity. This would also be an additional function to the medical examination and would extend the examination time. If anyone is allowing cine loops to be filmed they will have to be stored on PACS for governance reasons – anyone could manipulate someone’s personal video and use it for litigation purposes. There is a cost associated with storing the huge dynamic files on PACS. Cost of additional PACS storage – approx. £2K per terabyte = approx. 86 patients, storage of the original recording is vital as copies can be manipulated and used as evidence in a court of law.”
“Extended scan times to enable the capture a 10-30 second Cineloop would introduce the risk to the fetus of mechanical tissue heating due to unnecessary and medically unjustifiable prolonged exposure of the fetus to the ultrasound beam”.
“Mobile phone photography or video recording on any device is not permitted at any time. Sonographers must be able to concentrate fully on performing the scan, adhering to ALARA [As Low As Reasonably Achievable] guidelines. Scans times must not be extended to obtain pictures/cine loops to protect the safety and wellbeing of the unborn fetus, patient or staff.”
The scans are performed. We feel they could be captured whilst they are performed. We feel these extracts are illogical and re-enforce our suspicion that this debate centres around cost and fear of litigation alone. It’s interesting that around 10% of trusts are retaining video / cineloops (predominantly in London) which doesn’t appear to have introduced “mechanical tissue heating”, triggered ALARA considerations or compromised the safety and well being of the fetus.
56% of trusts in England retaining views (images or video) supports the proposition there is a clinical need to retain fetal cardiac views. If trusts aren't capturing images or video - we'd suggest patients have every right to.