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Risks of Obstetric Ultrasound
Title:Obstetric ultrasonography: a biophysical consideration of patient safety - the "rules" have changed
Author: M. Miller et al.
Source: American Journal of Obstetrics and Gynecology 179: 241-254 (July) 1998
Summary:Greater responsibility for patient safety is now placed on the diagnostician using ultrasonography as a diagnostic tool. This article provides some guidance to the obstetrician in the interpretation of the new FDA 2 on-screen indexes and for a look at the current status of ultrasonography biophysics as it relates to ultrasonography as a diagnostic office procedure for obstetrics. No deleterious outcomes or "side effects" have been reported with ultrasound. However, most major epidemiologic investigations were undertaken before the amendment of 501(k) Guide- a time when output levels were substantially lower than current output levels. It is now suspected that undesirable bioeffects may occur in vivo in patients exposed to the acoustic fields of todayıs modern ultrasonography. This potential is even higher if a microbubble contrast agent is used during the exam. All ultrasound technicians should be aware of on screen labels concerning thermal and mechanical perturbations. In third trimester pregnancies, it is recommended that ultrasound induced temperature increase be limited to .5 degrees celsius since fetal temperature is slightly higher than the mother's core temperature. This is within keeping with the National Council on Radiation Protection and Measurements recommendation of allowing up to 1 degree celsius in an afebrile patient. There are no prescribed obstetric uses for contrast agents. If a use should become apparent, the understanding of a mechanical index to that use would become relevant. The authors recommend that the obstetrician use the lowest signal output level and the shortest duration of exam time to gather diagnostic information
Comment:Virtually everyone feels that ultrasound is safe. But, the authors have brought up a possibly important issue as to whether this issue needs to be revisited, since ultrasound scans are operating at much higher power. The authors do not reach conclusions and issue only warning's. Perhaps, the greatest value of this report is that it is a comprehensive review of this area, although I have to admit, one must work to understand all of the concepts presented .
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