P Viossat1, Y Ville1, R Bessis1, R Jeny1, I Nisand1, F Teurnier1, P Coquel1, J Lansac2. 1. Commission nationale d'échographie obstétricale et fœtale (CNEOF), ministère du travail, de l'emploi et de la santé, 14, avenue Duquesne, 75007 Paris, France. 2. Commission nationale d'échographie obstétricale et fœtale (CNEOF), ministère du travail, de l'emploi et de la santé, 14, avenue Duquesne, 75007 Paris, France. Electronic address: jacques.lansac@orange.fr.
Abstract
OBJECTIVES: The committee has among its functions, to promote a quality assurance policy for obstetrics and foetal ultrasound scans by participating in the development of an information strategy for the professionals and the public on the interest and limits of these techniques, and in the development of rules for good practice. Thus, the committee produced in 2005 a good practice's recommendations report concerning the screening ultrasound scans. It pursued its work with a similar report concerning this time the "diagnostic" prenatal ultrasound or second line prenatal ultrasound. The present report has set its objective to define as precisely as possible the content of a "diagnostic" ultrasound scan and what should be expected from it. MATERIALS AND METHODS: A group of experts from the committee members has functioned as a task team that met on a regular basis. First, in the context of a professional consensus and a review of the literature, it determined the clinical goals in regard to the indication of the "diagnostic" ultrasound scan. After discussing different formats of the scan test procedure, some intuitive hypotheses on the content of the test were developed. Each criteria was validated by the group of experts with a statistics' definition and a diagnosis' capacity. The hypotheses were finally validated or discarded after confrontation with the data of the literature. Finally, the content of the report was discussed during the plenary sessions of the CNTEDP, the National Committee on the Technical aspect for PreNatal Ultrasound Screening. All the items validated in format document have been the subject of a consensus with a right to veto. The preliminary report was reviewed by a group of six readers not members of the CNTEPD. RESULTS: The "diagnostic" ultrasound scan test is organized in two parts: one common part made of the content of the screening test, to which is added the study of the anatomic structures and taking some additional pictures. The sonologist must then do a specific scan study for the organ suspected or diagnosed with an anomaly. Subsequently, a series of ten format documents per anomaly is proposed to guide the examiner (i.e., abdomen, chest, heart, genitourinary, cerebrospinal, skeletal and limbs, IUGR, polyhydramnios, infection, twin pregnancy). These documents suggest a check-list of items to study during the scan, specific pictures to take, and, give some comments on the management plan. DISCUSSION AND CONCLUSION: The CPDPN, the Multidisciplinary Committee for PreNatal Diagnosis, since it was established in 1994, has contributed to structure most of the activity of the prenatal diagnosis, but did not answer the question of the quality of the second line prenatal ultrasound. Screening ultrasound, and focused ultrasound scan are not "levels" in the scan procedure, but different and supplementary studies contributing to the quality of the mother and her foetus follow-up. This report of the CNTEDP, in defining the content of this scan test, clarifies the objectives of the diagnostic test compared to the screening test, and subsequently gives the public a better understanding of what is expected or due in regard to our prenatal screening strategy. A reliable second level scan, affordable and consistent, is a label of good quality for our prenatal strategy. The recommendations of the committee should be understood in a large perspective of quality assurance, that includes an initial and a continuous medical education, a quality control system for the echograph, and a procedure to inform the public.
OBJECTIVES: The committee has among its functions, to promote a quality assurance policy for obstetrics and foetal ultrasound scans by participating in the development of an information strategy for the professionals and the public on the interest and limits of these techniques, and in the development of rules for good practice. Thus, the committee produced in 2005 a good practice's recommendations report concerning the screening ultrasound scans. It pursued its work with a similar report concerning this time the "diagnostic" prenatal ultrasound or second line prenatal ultrasound. The present report has set its objective to define as precisely as possible the content of a "diagnostic" ultrasound scan and what should be expected from it. MATERIALS AND METHODS: A group of experts from the committee members has functioned as a task team that met on a regular basis. First, in the context of a professional consensus and a review of the literature, it determined the clinical goals in regard to the indication of the "diagnostic" ultrasound scan. After discussing different formats of the scan test procedure, some intuitive hypotheses on the content of the test were developed. Each criteria was validated by the group of experts with a statistics' definition and a diagnosis' capacity. The hypotheses were finally validated or discarded after confrontation with the data of the literature. Finally, the content of the report was discussed during the plenary sessions of the CNTEDP, the National Committee on the Technical aspect for PreNatal Ultrasound Screening. All the items validated in format document have been the subject of a consensus with a right to veto. The preliminary report was reviewed by a group of six readers not members of the CNTEPD. RESULTS: The "diagnostic" ultrasound scan test is organized in two parts: one common part made of the content of the screening test, to which is added the study of the anatomic structures and taking some additional pictures. The sonologist must then do a specific scan study for the organ suspected or diagnosed with an anomaly. Subsequently, a series of ten format documents per anomaly is proposed to guide the examiner (i.e., abdomen, chest, heart, genitourinary, cerebrospinal, skeletal and limbs, IUGR, polyhydramnios, infection, twin pregnancy). These documents suggest a check-list of items to study during the scan, specific pictures to take, and, give some comments on the management plan. DISCUSSION AND CONCLUSION: The CPDPN, the Multidisciplinary Committee for PreNatal Diagnosis, since it was established in 1994, has contributed to structure most of the activity of the prenatal diagnosis, but did not answer the question of the quality of the second line prenatal ultrasound. Screening ultrasound, and focused ultrasound scan are not "levels" in the scan procedure, but different and supplementary studies contributing to the quality of the mother and her foetus follow-up. This report of the CNTEDP, in defining the content of this scan test, clarifies the objectives of the diagnostic test compared to the screening test, and subsequently gives the public a better understanding of what is expected or due in regard to our prenatal screening strategy. A reliable second level scan, affordable and consistent, is a label of good quality for our prenatal strategy. The recommendations of the committee should be understood in a large perspective of quality assurance, that includes an initial and a continuous medical education, a quality control system for the echograph, and a procedure to inform the public.