Why aren't views retained? These are the reasons or justifications we've heard over the last 12 months. We thought it would be responsible to list them. If there are any more you are aware of, please let us know.
Non-prescriptive national guidance. The FASP guidance doesn’t direct it.
Autonomy of trusts. Trusts can set their own policy and must only consider guidelines.
Size. At 20 weeks the heart is very small and is challenging to assess. It is the size of an acorn and is moving quickly.
Difficulty with later scans. The 20 week scan is the optimum time to perform the scan. In later pregnancy calcification of bones and more restricted space in the uterus makes assessment even more difficult.
Body habitus. The size and weight of mums present challenges. Amounts of maternal tissue, scaring tissue or amniotic fluid can also make visualisation of the heart more difficult.
Fetal position. The way a baby is positioned can present challenges to gain optimum images.
Evolving structure. CHD can evolve, it isn’t static. Heart issues can develop and issues can emerge or resolve pre and post scans.
Type of condition. Not all conditions are equally visible on ultrasound. Some are easier to detect than others.
False Positives. Sometimes, scans may show abnormalities that are later found to be normal or not significant.
Views over structure. Some suggest sonographers should be more concerned with assessing form and structure in real time, rather than trying to capture a perfect image.
Value of an image. Some suggest still images have limited value when assessing a rapidly moving 3D heart structure.
No evidence. We've heard there is no evidence to suggest retaining images would improve detection rates.
Data storage cost. We understand specialist systems are used to perform the scans. There is seemingly a significant associated data storage cost of these specialist systems. In material provided by our trust, it was suggested if cineloops for each patient were stored, this may cost in the region of £23 per patient.
Minority of affected families. Some have suggested the standardised storage of images for all patients wouldn’t be reasonable or proportionate when such small numbers are ultimately adversely affected.
Time constraints. Sonographers need time for; room preparation, assessing the ultrasound request, introductions and explanations, obtaining valid consent and supporting to get on and off the examination couch. Further time is needed to discuss the findings, write the report, archive the images and attend to the aftercare of the patient, including making arrangements for further appointments and/or further investigations. Equipment may need to be cleaned or disinfected post-examination.
Fear of legal action. Claims against the NHS are already spiralling and some have suggested if views are retained this may expose the NHS further.
National shortage of sonographers. The UK is already experiencing a significant and sustained shortage of sonographers. We understand this is placing clinical services under considerable pressure already. Some have suggested that the possibility sonographers and their images could be drawn into the claims process may make matters worse.
Our stance remains the same and we feel that majority practice throughout trusts in England carries significant weight.