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Equipment Choice can
make a difference

In general, practitioners of fetal ultrasound operate on a Titanic Mentality:  Safety is assured, therefore precautions are unnecessary.  I would be happy to be proven wrong.  Tina Ureten, the operator of a chain of commercial entertainment/bonding fetal ultrasound facilities in Canada (UC Baby), made this point in a spirited response to criticism in the Aug 26, 2003 edition of The Medical Post (Canada): “Ultrasound has been used extensively by Canadian doctors and health practitioners for more than 40 years without any concern.”  This background of indifference has caused difficulties for me in trying to have output intensities given serious weighting in the tendering and selection process for new equipment.  Vendors repeatedly tell me that they have not previously been asked for this information, and without precedent or support from the wider user community it is hard for someone in a small facility to insist on treating acoustic outputs as a priority in the purchase process. 

Equipment choice can make a difference. The General Electric Logiq 9 provides satisfactory fetal imaging for most circumstances with a default Mechanical Index (MI – described in section 3) of about 0.2 using its fundamental frequency.   A recent report (4) gives an MI value of about 1 for second-trimester fetal imaging with the equipment that the authors were using (Philips HDI 5000), which is a similar value to our Toshiba Aplio. While it is not possible to know how much of the rise in acoustic intensities over time was really necessary for essential image improvements and also to satisfy increased penetration requirements in our increasingly obese populations, I have not seen a 1000-fold increase in image quality since 1980.  Comparison with mammography, where there has been intense consumer-driven demand for dose reduction and image improvements, is instructive:  “Standardization of mammography led to a decrease in mean glandular dose from 14 to 1.8 mGy with concurrent improvement in image quality” (5).