--
Jeanette Burlbaw BS RDMS FSDMS
Prenatal Imaging Center
--- On Mon, 7/13/09, DuBose, Terry <DuboseTerryJ@uams.edu> wrote:
From: DuBose, Terry <DuboseTerryJ@uams.edu>
Subject: Re: safety of ultrasound in pregnancy
To: "Multiple recipients of list ULTRASOUND" <ultrasound@mail.obgyn.net>
Date: Monday, July 13, 2009, 9:59 PM
repost by bruce in plain readable text...
> From: "DuBose, Terry" <DuboseTerryJ@uams.edu>
> To: "'ob-gyn-l@obgyn.net'" <ob-gyn-l@obgyn.net>
> CC: "'ultrasound@obgyn.net'" <ultrasound@obgyn.net>
> Date: Mon, 13 Jul 2009 10:44:06 -0500
> Subject: Re: safety of ultrasound in pregnancy
I just cannot ignore this one. I could not find the original message
to which Gail Neuman is replying, so I don't know exactly how the
question was phrased. But from Gail's and other's responses the
question is about risk of ultrasound to the fetus. That being the
issue, one of the main risks to the fetus, and especially during
embryogenesis is from heating. Ultrasound does heat the tissues, so
it depends upon the intensity of the ultrasonic energy, and the time
of insonation.
If you are talking about the ultrasound a Chiropractor or Physical
Therapist is using to heat tissues, then there is obviously a risk
(please see quote below). However, if you are talking about
sonography or ultrasonic imaging (ultrasound is a noun meaning high
frequency sound, not an adverb or adjective) at diagnostic
intensities, then no real, reproducible effects have been found in the
last 30 years. But that does not mean they will not be found.
The real risk is from folks using ultrasonic energy when they do not
have proper education and do not understand the procedure or risks.
The best application of ALARA is to have a properly educated
sonographer who can get the diagnostic information and end the exam
before much insonation has occurred. A large risk is the uneducated
and unwashed looking around, trying to figure out what they are seeing
or not seeing. This is particularly true of the newer sonographic
instruments, as mentioned here before, that can apply acoustic energy
above the MI 1.0 or TI 1.0 factors, and the operator does not
understand these intensity measurements and spends a lot of time with
a focused endovaginal transducer very near the embryo. Embryonic
bones start to calcify by 8 LMP weeks, and sonic energy creates more
heat in bone.
The greatest risk is the newly pregnant parent(s), excited about their
pregnancy, and "Daddy Warbucks" buys them a sonographic instrument
(ala Tom Cruise) or even just a Doptone and the parents spend hours
(days?) at 4-6 weeks searching for the embryonic heart rate. I am
sure that Gail Neuman would agree that it may not be easy to locate
the embryonic heart beat at this early time, even with a real
sonographic instrument. If they can't find the heart beat in two
weeks, the anxiety and systemic catecholamines released alone could
have a deleterious effect.
The World Federation of Ultrasound in Medicine and Biology's 1992
Symposium on Safety and Standardization in Medical Ultrasound
indicated that a rise up to 1.5 degrees Celsius could be used in
clinical examination. However, any temperature rise to or above 41
degrees Celsius (105.8O F) should be considered hazardous in embryonic
or fetal exposures. World Federation of Ultrasound in Medicine and
Biology, Symposium on Safety and Standardization in Medical
Ultrasound: Issues and Recommendations regarding thermal mechanisms
for Biological Effects. World Federation of Ultrasound in Medicine and
Biology, 1992.
I know this is not news to those here - you already know to tell your
patients to stay out of HotTubs.
Just my 2 cents. Peace, Terry
--
Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM
Associate Professor & Director
Diagnostic Medical Sonography Program
University of Arkansas for Medical Sciences, CHRP
4301 West Markham St. Mail Slot #563
Little Rock, Arkansas, 72205 USA
501-686-6510 or 501-686-5948
DuBoseTerryJ@UAMS.edu
http://www.uams.edu/chrp/sonography/
http://www.obgyn.net/us/panel/panel.htm
http://www.io.com/~dubose/
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]
Sent: Saturday, July 11, 2009 8:29 AM
To: Multiple recipients of list OB-GYN-L
Subject: OB-GYN-L digest 7068
OB-GYN-L Digest 7068
Topics covered in this issue include:
1) Re: safety of ultrasound in pregnancy
by evsono@pipeline.com (art fougner, md)
2) Re: safety of ultrasound in pregnancy
by DoctorJoe@aol.com
3) Re: safety of ultrasound in pregnancy
by Robert Berg <robert.berg@nyu.edu>
4) Re: safety of ultrasound in pregnancy
by DoctorJoe@aol.com
5) Re: safety of ultrasound in pregnancy
by Robert Berg <robert.berg@nyu.edu>
7) Re: safety of ultrasound in pregnancy
by islesannie@gmail.com (Joanne Bulley, MD)
17) Re: safety of ultrasound in pregnancy
by Dr Eberhard W Lisse <el@lisse.na>
----------------------------------------------------------------------
Date: Fri, 10 Jul 2009 08:35:32 -0500 (CDT)
----------------------------------------------------------------------
From: evsono@pipeline.com (art fougner, md)
--
----------------------------------------------------------------------
Subject: Re: safety of ultrasound in pregnancy
Perhaps we could consult with the Bene Gesserit instead? Or simply use
The Force?
Art
------------------------------
Date: Fri, 10 Jul 2009 09:40:25 EDT
------------------------------
From: DoctorJoe@aol.com
------------------------------
Subject: Re: safety of ultrasound in pregnancy
>
> Perhaps we could consult with the Bene Gesserit instead? Or simply use
> The Force?
Either way. The former would probably add more spice to the discussion . .
Joe P.
------------------------------
Date: Fri, 10 Jul 2009 09:45:20 -0400
------------------------------
From: Robert Berg <robert.berg@nyu.edu>
------------------------------
Subject: Re: safety of ultrasound in pregnancy
Symbiotic??? Don't you mean parasitic?
On Fri, Jul 10, 2009 at 9:28 AM, <DoctorJoe@aol.com> wrote:
>
> Alright, I'll bite. I read---safe but new equipment means no long term
> studies have been done so don't really know. I also read--safe if used
> prudently by medical professionals. What constitutes prudent use? U/S done
> at every prenatal visit? As with EFM-has the increased usage of prenatal
> U/S scanning improved our infant mortality rate or other measurable
> outcomes? And with the ever present ways physicians are working on
> increasing reimbursement are we sure U/S is being used "correctly" and
> "prudently" or is it being used to increase income and CYA?
>
> Sorry, but my philosophy from the MFM standpoint is that U/S is the best
> available method of physical examination of the unborn baby. If you consider
> that you have TWO patients in obstetrics -- the mother and the baby -- and
> don't just feel as I do that there is only one patient -- the mother, who
> happens to have a symbiotic organism temporarily living in her uterus --
> then I think U/S is really the only way to do a complete examination of both
> of your patients.
>
> Joe P.
>
>Robert E. Berg, MD, FACOG, FACS
>And this affects me, how?
------------------------------
Date: Fri, 10 Jul 2009 10:08:17 EDT
------------------------------
From: DoctorJoe@aol.com
------------------------------
Subject: Re: safety of ultrasound in pregnancy
In a message dated 7/10/09 8:47:55 AM, robert.berg@nyu.edu writes:
>
> Symbiotic??? Don't you mean parasitic?
>
Not really.
The mother derives actual benefits from the arrangement.
Some benefits are subtle, like a feeling of well-being at times or
heightened attactiveness to the male of the species. Others are more
longterm, like protection from various cancers in later life and some
sociologic advantages like security (e.g. "I'm gonna use my signing
bonus to buy a house for my Momma!").
Joe P.
------------------------------
Date: Fri, 10 Jul 2009 11:10:20 -0400
------------------------------
From: Robert Berg <robert.berg@nyu.edu>
------------------------------
Subject: Re: safety of ultrasound in pregnancy
Try telling my mother that.
I think the benefit from protection against say ovarian ca pales in
comparison to the number of times I heard "I was worried sick since
you went out - do you know how many years you took off my life
tonight?"
And, I never got a signing bonus. I did offer to buy her the house
though. And in typical Jewish mother fashion, she said "No, no.
Don't worry about me. My small apartment is better."
On Fri, Jul 10, 2009 at 10:11 AM, <DoctorJoe@aol.com> wrote:
>
> In a message dated 7/10/09 8:47:55 AM, robert.berg@nyu.edu writes:
>
> Symbiotic??? Don't you mean parasitic?
>
> Not really.
>
> The mother derives actual benefits from the arrangement.
>
> Some benefits are subtle, like a feeling of well-being at times or
> heightened attactiveness to the male of the species. Others are more long
> term, like protection from various cancers in later life and some sociologic
> advantages like security (e.g. "I'm gonna use my signing bonus to buy a
> house for my Momma!").
>
> Joe P.
------------------------------
Date: Fri, 10 Jul 2009 16:46:31 -0500 (CDT)
------------------------------
From: islesannie@gmail.com (Joanne Bulley, MD)
------------------------------
Subject: Re: safety of ultrasound in pregnancy
I like that salvo!
At times I think there is so much focus on "evidence" that bad evidence
is accepted as truth - even when it makes no sense - sometimes gut level
/ gestalt / "art" of medicine is indeed best.
JB
At Fri, 10 Jul 2009, Bernard Cristalli wrote:
>
>You know what?
>No randomized, double blind study has ever showed that only women get
>pregnant naturally.
>But nobody needs EBM to know.
>B
>
>GIN11153@aol.com a écrit :
>> Louana,
>>
>> I respectfully disagree. Hundreds of studies have been done, with
>> millions of fetuses exposed each year and no problems have been
>> correlated to an ultrasound during pregnancy to make sure there are no
>> problems:
>>
>> http://www.google.com/search?hl=en&ie=ISO-8859-1&q=Is+ultrasound+in+pregnancy+safe%3F&aq=f&oq=&aqi
>> Gail Neuman RNC BSN CPHW
>> Administrator/student midwife
>> Orange County Maternity Center
>> 1210 S. State College Blvd.
>> Suite D
>> Anaheim, CA 92806
>>
Joanne Bulley, MD
solo gyn
Keene, NH
------------------------------
Date: Sat, 11 Jul 2009 07:57:58 +0100
------------------------------
From: Dr Eberhard W Lisse <el@lisse.na>
------------------------------
Subject: Re: safety of ultrasound in pregnancy
Nonsense.
BTW, "bad evidence" means, something doesn't fit your narrow view?
el
Joanne Bulley, MD wrote:
>
> At times I think there is so much focus on "evidence" that bad evidence
> is accepted as truth - even when it makes no sense - sometimes gut level
> / gestalt / "art" of medicine is indeed best.
--
Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist
el@lisse.NA / * | Telephone: +264 81 124 6733 (cell)
PO Box 8421 \ / Please do NOT email to this address
Bachbrecht, Namibia ;____/ if it is DNS related in ANY way
