New FASP guidelines – what do they mean for sonographers?

Written by Sharon Cook, Tiny Tickers’ Head of Training, October 2016

Being a sonographer in 2016 is interesting, instructive, educational and informative, even awe inspiring.

I know from nearly 30 years in the NHS and performing ultrasound for nearly 15 years, the gratification you can get from diagnosing a problem; the emotional challenge you feel when you need to report a concern; the joyous elation of giving good news. We are at the forefront of this discipline and are key to addressing the issues within.

Fetal Cardiac Ultrasound has come far from its humble beginning in the early 1980’s, where the four chamber view was the only view used picking up 60% of severe cardiac abnormalities (1). Adding ventricular outlet views has been found to be the most effective technique to improve this detection prenatally (2).

Since then we have seen, and been part of, big changes within obstetric screening and scanning practices, with a huge improvement and advancement in technology and expertise in this field. Tiny Tickers has been a part of this ongoing improvement since 2002, delivering hands-on training to sonographers to improve their skills and confidence in diagnosing cardiac defects.

The success of such a programme depends on a commitment to continuous in house training of obstetric ultra-sonographers. FASP have recently improved this training aspect by introducing a 5th view to their screening protocol. 3VT (3 vessel trachea) view was added earlier this year. This extended part of the screening examination looks at the ductal and transverse aortic arch as they meet and their relationship with the trachea. Research suggests this addition to the heart views further increases the diagnoses of fetal heart defect within the upper mediastinum and efficiently identifies an important group of critical heart defects involving the outflow tracts and the aortic arch (3).

A nationwide programme has been established with sonographers being trained in this scanning technique. FASP have instilled that this 5th view be compulsory, training ‘cardiac champions’ within hospital setting to continue the competency of sonographers in their unit with obtaining this scanning heart section. The positives of this national programme and continued mandatory training will ensure that we, as sonographers, can reflect on what we are doing, why we are doing it and the benefit we will achieve from this.  By answering these questions, we can understand and feel confident about what we are doing – i.e.  Having a deep knowledge of the normal appearances of the heart so that the abnormal can be detected. The reasons behind why we are doing the scan – to improve detection rates and ultimately the benefit of improving the baby’s chance of survival. Through our team of highly specialised trainers at Tiny Tickers, we will instil values of care, commitment, compassion and communication to deliver the best possible training to sonographers. It’s up to them to reflect on that training and with compassion and courage of conviction to continue the excellent work in improving the detection rate of CHD.


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1) Allan,LD. Crawford, DC. Chita, SK, and Tynan, MJ. (1986)Prenatal screening for congenital heart disease. BMJ, 292 (8), 1717-9.

2 Carvalho, JS.  Mavrides, E., S Campbell, EA, and Thilaganathan, B. (2002). Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart, 88 (4), 387–391.

3) Viñals,F. Heredia,A. Giuliano,V. (2003) The role of the three vessels and trachea view (3VT) in the diagnosis of congenital heart defects. Ultrasound of Obstetrics and Gynecology. 22 (4), 358 – 367.