Volume 8 Issue 3 - Australasian Society for Ultrasound in Medicine

Editor’s noteThe introduction by ultrasound operators in the USA andAustralia of a purely commercial ‘non-medical 3D ultrasoundimaging service to provide keepsake images of theunborn child has provoked a storm of controversy. TheAmerican Medical Association has weighed into the debatewith the following comments extracted from the article thatfollows.American Medical Association says ultrasoundin-utero ‘portraits’ are bad idea6/22/2005By: Reuters Health‘Recent advances in ultrasound technology, including3D image capacity, have made the ‘pre-birth’ portraitspopular, which prompted the Missouri delegation to theHouse of Delegates to ask the AMA to go public about therisks of the practice . . .The Missouri doctors said the ultrasound portraits areoften done by unqualified technicians in whose handsultrasound, which is generally a safe procedure, may haveunanticipated risks. During a reference committee hearing“testimony was overwhelmingly in support of this resolutioncalling for the responsible use of diagnostic ultrasoundduring pregnancy,” said Dr Daniel van Heeckeren, a thoracicsurgeon at University Hospitals, Cleveland, Ohio whochaired the Reference Committee . . .Dr Van Heeckeren noted that use of diagnostic ultrasoundfor ‘keepsake’ purposes puts the clinician at riskof potential legal liability since this imaging is often performedwithout parents receiving the standard counselingthat normally precedes ultrasound examinations.Editor’s noteASUM members also had plenty to say, including the followingedited comments extracted from various emailsto the Editor. Space precludes full publication of eachcommunication. Readers are invited to submit any furtherviews on this subject. ASUM does not endorse any of thesestatements. They are simply the opinions of individual correspondents.■ “How do bodies such as ASUM justify other non-medicaluses of ultrasound equipment, such as in live company-sponsoreddemonstrations and other ‘non-medical’activities? There is a far wider impact overall fromother non-medical uses compared to the 3D foetal photoscanner in [location omitted].If a 3D photo of the unborn child’s facial featuresduring pregnancy improves bonding (which it probablydoes on the face of it – no pun intended) and reducesthe incidence of postnatal family disruption by makingthe family-to-be appreciate the actuality of a child inthe making, or improves paternal postnatal care-giving(which it might), then a 3D photo has done more for thepregnancy than 99% of morphology scans, which seekto identify any abnormality which might prompt a latemid-trimester termination – an abhorrent 'treatment' inmy view. The reporting of an isolated so called ‘softmarker’ morphology scan finding which alone has nostatistical significance (such as an echogenic focus inthe heart, a choroid plexus cyst or a 5 mm renal pelvis)creates significant anxiety for many pregnant ladies andtheir partners and is arguably far more damaging than afew 3D images of an unborn baby’s face.”■ “Advocates perhaps might produce some evidencefor the statements made about the benefits of 3Dultrasound for families. One of our research Psychstudents has just concluded a randomised studywhich surprised us all by showing that comparedwith 2D scanning there is no difference in bondingas judged by the psychologic testing methodsshe employed. And not all foetal anatomy scans arepart of a search and destroy campaign. But we coulddebate the value of foetal abnormality scans (FAS)ad nauseam. We certainly do create angst but the softmarker chaos was initiated by well meaning groupsmainly in the USA extrapolating from high risk tolow risk groups. What I think worries most peopleabout entertainment scanning is [that] it is demeaningof the profession and the inference that what isgood for the greedy entrepreneurs [offering these 3Dservices] is necessarily good for their customers andtheir babies in utero.”■ “The BMUS guidelines for non-diagnostic uses of diagnosticultrasound provide upper limits to the thermalindex (TI < 0.5) and mechanical index (MI < 0.3). Theseare somewhat restrictive but were chosen to provide alower degree of risk for procedures where there is noobvious clinical benefit.”■ “Medicare is solely a payment system. It has nothingto do with setting standards of practice. There is noMedicare payment involved [in 3D ‘entertainment’ultrasound] so there is little interest [from legislators] incurbing the practice.”■ “ASUM must take the lead here as the peak ultrasoundbody in advising legislators and the publicthat this practice [of 3D ‘entertainment’ ultrasound]is inappropriate. The ALARA [as low as reasonablyachievable] rule applies to ultrasound as it does toother imaging modalities. It should only be performedwhere there is an appropriate medical indicationand exposure should be minimised. Just becausethere is no demonstrated effect to date, it does notmean ultrasound exposure is safe."■ “3D scanning is a commercial contract creating aduty of care. If the mother is warned of material biodangers(of which none are established) and understandsthat the scan is not for medical purposes, theduty of care is discharged. Where the operator doesnot hold themselves out to be providing a medicalservice, the provisions of the various State basedlegislative instruments controlling doctors and otherswho deliver medical care do not apply.”■ “[In relation to the concern of abnormalities either beingfound or missed on these social scans] the operators hadbetter be careful with the way they structure their business,get good legal advice and have good insurance!”■ “What about the right of the foetus to determine itsexposure to unnecessary risk [such as 3D ‘entertainment’ultrasound] for the enjoyment of others [its parentsand grandparents]”.ASUM Ultrasound Bulletin 2005 August; 8 (3)37