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Re: One-Hour Fetus PhotoFrom: Terry J DuBose (tjdubose@juno.com)Sat Sep 7 11:23:19 2002
Dr. Berck, Great points... you's are the arguments against non-medical uses of sonography. The liability issue is a major concern. No doubt someone will get sued, but where there is money involved some entrepreneurs will take that risk... and they are. A patient can sign anything and still sue if unhappy, so there is always a risk ... even in mainstream medicine. As to the ALARA principle, yes non-medical use is in violation of ALARA. Yet, it has been the medical profession that has spent the last 25 or more years convincing the public that ultrasound is safe to use extensively during pregnancy (the ubiquitous "dopptone" must be considered also); and it appears that we have done an admirable job of convincing everyone... it appears that not even the FDA is any longer concerned. The FDA did confiscate a couple of machines before 1994, but that was 10 years ago under a completely different administration. The public is demanding this as a part of having a modern pregnancy and "family values". The public is even buying Doppler fetal monitors to use at home. So what do we do? Shake our fingers at them and shout "NO!"? That does not... is not working. Baby sonographic studios are proliferating. The FDA is not doing anything now, they claim to not have the resources, and the corporate culture controlling the current federal administration is not going to support regulation over free enterprise. So it seems we are left with either continuing to stomp and shout "NO!" while the uneducated hands learn to make pretty baby faces, or have RDMS certification demanded by the public. It will take a huge PR campaign to win this one. It has some risks that the uneducated are already making inroads into ultrasound, and that this more "open use sonography" might open a hemorrhage of distasteful uses. That is why I said that I was playing "Devil's Advocate". I like professional sonography and academia... I am dedicated to formal higher education in the profession. However, I don't see many MDs, RNs, or others getting credentialed... thus endorsing the idea that "anyone" who knows anatomy and physiology can use ultrasound. We know this is patently false. Sonography also requires acquiring psychomotor and cybernetic skills for defining anatomy & pathology with a graphics computer within your eye-hand neural loop. These skills are acquired by doing it under the guidance of a sonographer. Sonography is the most operator dependent diagnostic modality that I know of. Skilled Sonographers are quite frustrated by the position we find ourselves. Ethically and professionally we have believed that sonography should always be kept in the mainstream medical hospital/clinic setting. Now we see these folks... many church ladies in the Bible Belt... grabbing the transducer... including many physicians and nurses who can't even recognize when they are scanning twins much less evaluate a fetal heart. At the same time the medical community is saying "Because you know what you are doing, you will be held to a higher standard and liable for wrong or missed diagnoses."; yet these other folks get away with "murder" because they are ignorant! There is something wrong with this picture. I believe that the Professionals of Sonography should have some influence over what happens to us. Sonography can be either a medical procedure or a non-medical one, or both; but it should be in the hands of those who have demonstrated an understanding of the modality. RDMS is the accepted credential and it is time that the public expect that everyone who uses medical ultrasound should have this designation... regardless of the setting in which it is used. RDMS will have to become fashionable. Peace, Terry J DuBose, RDMS ----------------------------------------------
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