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Entertainment Ultrasound.
Medical User Attitudes

Like others involved in fetal sonography, I and the technologists who work with me are already involved in entertainment/bonding ultrasound, as patients and their families expect to be shown the fetus following the diagnostic aspects of the examination.  The current question is: can extension of this established limited practice be justified for more lengthy 3D and real-time 3D (4D) fetal viewing?  Prominent academics who have examined this can be quite enthusiastic (25), and there is information to suggest increased bonding and possibly improvement in undesirable maternal behaviors such as smoking and alcohol consumption.  An obstetric intervention of unproven safety should be of proven benefit; we need accumulated data from careful randomized studies with extended follow-up documenting real benefits before this practice can be justified on a wider basis.  Until there is such a body of scientific data confirming the benefits of 3D/4D entertainment/bonding ultrasound in unselected patients, its dissemination into commercial facilities should be strongly discouraged.

Now for the tough part.  In section 2 I noted the general absence of interest in fetal ultrasound safety issues amongst relevant medical professionals.  Actually, I have the feeling of having just committed a social indiscretion in a crowded elevator when I take discussions with them beyond pious platitudes into practical measures.  The limited number of those interested in bioeffects has been noted elsewhere (20).  I do not recall ever seeing the issue of safety as part of the program of obstetrical ultrasound courses directed at obstetricians/radiologists/sonographers which I receive by mail or e-mail.  It was not part of the October 2006 Advanced Sonography Symposium in Ob/Gyn presented by the Brigham and Women’s Hospital Department of Radiology and Harvard Medical School that I attended in Boston.  It is not part of the proposed program for an obstetric ultrasound course in February 2007 to be presented by the Mount Sinai Hospital and the University of Toronto.   

Over the years I have had considerable correspondence with our Canadian federal regulators about fetal ultrasound safety issues.  I have been impressed by their responses, but not favorably.  They have not yet provided me with a promised (over a year ago) expert answer to the problem of inconsistency of fetal versus postnatal regulatory limits for eye exposure.  Twenty years later I am still dismayed by the response from the Canadian Association of Radiologists to an attempt to interest them in acoustic outputs.

The following is painful to relate.  In December 2005 an article was published in the Journal of Ultrasound in Medicine on   “Acoustic output as measured by mechanical and thermal indices during routine obstetric ultrasound examinations” (4).  To my knowledge and that of the authors, this is the first time that acoustic outputs in real-world obstetrical settings have been addressed and I felt that encouragement and commentary was warranted.  I therefore submitted a letter to the editor with a couple of questions and further material largely representing a condensed version of some of the matters discussed in this website (21).  I included the observation about the 1000-fold increase in ISPTA intensities from around 1980 to the late 1990’s described in section 1.  In order to keep the letter brief and readable I did not give the numbers but did give the references.  Apparently the authors did not read the references, as their response (22) disputed this assertion: “We find the comments in paragraph 4 surprising, to say the least.  A 1000-fold increase in ISPTA?”  They then went on to a discussion of the mere 7.5 to 15-fold increase in regulatory limits over the same timeframe.  The senior author, Dr. Jacques Abramowicz, is the Chair of the Bioeffects Committee of the American Institute of Ultrasound in Medicine, which he points out in his reply.  I sent him an e-mail asking him to submit a correction for publication in the JUM; I received no reply for rebuttal and have not seen any correction in print.  Since their published response was framed as a question I subsequently submitted another letter to the editor with the relevant Ispta values and page citations to answer this point, but the letter was rejected for publication.