Can we justify 'entertainment' ultrasound scans?

This past week, two Canadian medical associations--the Society of Obstetricians and Gynaecologists of Canada  (SOGC) and the Canadian Association of Radiologists (CAR)--issued a joint policy statement in the Journal of Obstetrics and Gynaecology Canada opposing the nonmedical use of fetal ultrasound.

These associations are particularly concerned about the rise of nonmedical ultrasound centers that provide "entertainment scans," or keepsake images that are provided to expectant parents.

For more than a decade now, the Food and Drug Administration has cautioned against ultrasound "keepsake imaging," pointing out that while ultrasound has been around for many years, "expectant women and their families need to know that the long-term effects of repeated ultrasound exposures on the fetus are not fully known."

That continues to be a major concern for these two Canadian associations. In their joint statement, SOGC and CAR said that while there is no evidence that diagnostic ultrasound can be linked to any fetal abnormalities or harmful biological effects, the targeted energy exposure involved in the scans provides a "theoretical" risk to fetal development.

Furthermore, the associations argue, "With the nonmedical use of fetal ultrasound, the maintenance of technical safeguards, operator training, qualifications, expertise, standards for infection control and governing competency are no longer ensured. As a result, fetal energy exposure may not be appropriately monitored, and operators of the equipment may not be adequately trained to recognize fetal and placental abnormalities that may adversely affect fetal and maternal outcomes."

This isn't to say that expectant parents shouldn't be able to get a nice 3-D ultrasound keepsake image of their baby. But, as Deborah Levine, co-chief of ultrasound and director of obstetric and gynecologic ultrasound in the department of radiology at Beth Israel Deaconess Medical Center in Boston puts it in this May 2013 RSNA News article, it's something that radiologists should only provide after they've performed a whole diagnostic study of the technique.

In the same article, Wesley Lee, co-director of the Texas Children's Fetal Center at the Texas Pavilion for Women in Houston, said that while in general, there is minimal risk involved with ultrasound if used properly, there is a question of whether the fetus is at risk when a scan is "performed by a person not properly trained who is putting that transducer over the mother for hours and hours."

In the end, when we think about the wisdom of allowing this practice to continue with what appears to be a minimal amount of regulation, shouldn't we remember that when it comes to imaging, providers must always try to balance the diagnostic benefit that comes from the scan and the risk to the patient?

And, if that's so, how can we justify these "keepsake" scans if they have no diagnostic benefit at all? - Mike (@FierceHealthIT)

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