Survey Of Ultrasound Community Regarding The Use Of Obstetrical Ultrasound

Over the past 10 years controversy has surrounded the practice of ultrasound for entertainment purposes. In 1994, the ARDMS held and published a readership poll on this very subject. For our paper we decided to hold a similar poll to see if the opinion has changed over the last 5 years. We posted our survey on the Ultrasound section of OBGYN.net on the WWWeb from February 8, 1999 to February 20, 1999 under the ultrasound topic. The questions we asked were as follows:

• What is your position on conducting fetal videotaping for nondiagnostic purposes such as entertainment value?
• Do you feel that there are any inherent risks associated with ultrasound technology for non-diagnostic purposes?
• Do you believe that entertainment fetal videotaping reduces the professionalism of sonography?
• Do you feel that businesses practicing entertainment fetal videotaping should be shut down?
• Do you feel that entertainment fetal videotaping, done by a registered medical sonographer under the guidelines established by the FDA, could provide a positive public relations tool for the medical community?
• Are you currently registered with the American Registry of Diagnostic Medical Sonographers?
• What city and state do you live in?

We received 57 responses to our survey. Forty three respondents were registered by the ARDMS. Of the registrants that responded to our poll, 75% opposed the use of ultrasound for entertainment purposes, down from the ARDMS 92% in 1994. Fourteen respondents were in favor of this practice but only under certain guidelines (see attached comment sheet). Seven respondents have no opposition to the use of ultrasound for entertainment.

The majority of our respondents did think there are inherent risks associated with ultrasound for a non-diagnostic purpose. Almost 80% feel that this practice reduces the professionalism of sonography and as one ARDMS registered sonographer commented "There are days when I feel like a cinematographer instead of a sonographer and my 'patients' want to be the director." In the 1994 ARDMS survey 92.1% of respondents felt that the businesses performing fetal videotaping should be shut down, compared to 68.4% in our survey. Twenty respondents feel that entertainment fetal ultrasound could provide a positive public relations tool for the medical community. Overall, the attitude is against any non-medical use of ultrasound, and most think this practice should not continue.

What is your position on conducting fetal videotaping for nondiagnostic purposes such as entertainment value?

Do you feel that there are any inherent risks associated with ultrasound technology for non-diagnostic purposes?

Do you believe that entertainment fetal videotaping reduces the professionalism of sonography?

Do you feel that businesses practicing entertainment fetal videotaping should be shut down?

Do you feel that entertainment fetal videotaping, done by a registered medical sonographer under the guidelines established by the FDA, could provide a positive public relations tool for the medical community?

Are you currently registered with the American Registry of Diagnostic Medical Sonographers?

SURVEY RESPONSES:

QUESTION:
WHAT IS YOUR POSITION ON CONDUCTING FETAL VIDEOTAPING FOR NONDIAGNOSTIC PURPOSES, SUCH AS ENTERTAINMENT VALUE?

COMMENTS:

• I oppose non-medical uses of ultrasound on humans. Little Rock, AR

• I do not feel it is an appropriate use of US. This is a medical instrument for use under supervision. Paradise, CA

• In general, I do not agree with any ultrasound done for entertainment purposes. However, because I work in the homebirth field and often times the women I work with are not under the care of a physician, our local "entertainment" ultrasound place (run by someone who is ARDMS registered), is of benefit to us when we have questions about EDD, multiple gestation, or breech lie (the last 2 things we need to know for sure because we do not continue care in the situation). If we did not have the "entertainment" ultrasonographer, it would make it more difficult to properly care for our patients. Atlanta, GA

• I don’t think that fetal ultrasounds should be used for entertainment. Richmond, VA

• I am against entertainment use of ultrasound. On our intro/hx paper to patients it states that the ultrasound is a medical procedure your doctor has determined to be necessary for the care of you and your baby. The exam is performed by highly skilled sonographers, and only on observer over the age of 10 will be allowed in the room. To many patients forget that we are there to look for anomalies, not to have a party. Rochester, NH

• I am against it. However, I have to add that I would guess that many pregnant nurses, medical secretaries, sonographers and perhaps even students in sonographer programs who work with and know doctors and sonographers, have entertainment prenatal ultrasounds, performed by their colleagues off the record. I consider this "OK" and entirely different than a store front or mall operation.

• Since you did not proved space for remarks in question 2: it depends on who is doing the sonography: if the entertainment business sonographer is a well-trained and experienced prenatal sonographer, it is possible that the exam done in the mall is the same exam the sonographer does at work in the clinic or hospital. But overall I would guess the mall exam is of lesser quality.

• Regarding question 5… most patients who want a prenatal sonogram and who are willing to pay for it probably can get one done in a medical facility, to include a short video tape. I think labs that will not do a short (3-5 minute) video tape for the patient at the conclusion of the formal exam is not doing much for our medical image. Fairbanks, AK

• With a complete high risk ultrasound assessment and with the patients well educated regarding the intent (to survey and acquire diagnostic information necessary to provide optimal management) a short tape isn’t a tragedy. A video is no worse than performing a study and receiving medical insurance reimbursement for that service when the KNOWN intent was to identify fetal gender. Charleston, WV

• Should not be done… The safety of ultrasound hasn’t been proven. Anomalies could be missed…focus is on fun, not diagnosis. Putting a fetus at possible risk (missed anomalies, unknown/future bio-effects) is not an acceptable way to promote the medical community. Ortonville, MI

• We don’t participate in this. We do however give them one photo of the baby. Clovis, CA

• It’s fine as long as offices aren’t billing medicaid for it, that’s a question you need to ask. Atlanta, GA

• I am against the use of ultrasound for this purpose. San Diego, CA

• Disapprove, unless: 1) video is captured during formal diagnostic study AND 2) copy of the video is filed as part of patient’s medical record. Hamilton, New Zealand

• Just about every expectant parent EXPECTS the opportunity to video at least ONE ultrasound and if the OB-GYN MD or obstetrical care provider doesn’t provide this (or doesn’t spend and unacceptable amount of time explaining why not), the parents get very hostile and angry and will seek out another provider who will comply with their wishes. Parents are also VERY unhappy when a non-MD does the scan and TURNS THE SCREEN AWAY from them and won’t comment on ANYTHING. This does more harm than the "strip-mall U/S" shops! Northern California, CA

• If it is not for a diagnostic purpose, then it is unnecessary. Would these same people go out and get skull x-rays to frame and hang on the wall after birth? I feel it reduces the profession of the sonographer to a Sears Studio photographer, not to mention the legal problems it presents. Davenport, IA

• I am against this practice. New Orleans, LA

• I believe that fetal videotaping is providing a valuable bonding tool to families. There of course should be regulations in place to monitor the quality of the sonograpers/equipment ECT. There should also be requirements that only "certified" or "medically scanned" pregnancies be allowed to go to these services. Columbus, OH

• It is an inappropriate use of the technology. I have no qualms with an ultrasound exam that is ordered by a physician, to verify fetal growth, well being, etc. And a videotape is generated during part of this exam. In fact, this situation is actually a great opportunity to educate the patient about realistic expectations of medical sonography and our abilities. I do believe that these individuals put themselves at risk for lawsuits down the road. They also give the parents a false sense of security as to the baby’s well being. And I am certain that the individual doing the scanning in an entertainment only situation is not looking for physical and growth anomalies. It truly cheapens our abilities as participants of the health care team in the parent’s eyes. Boise, ID

• Opposed. Santa Barbara CA

• I think it is OK as an adjunct to a medical sonogram. The mother should obtain a medical sonogram from a registered sonographer and then could obtain a videotape, either in that office, or in a separate office dedicated to entertainment ultrasound videos only. With the appropriate disclaimers explained and signed. The risk of problems to the mother and fetus are so minimal, that, as long as these risks are presented to the patient, I think it is perfectly OK. New York NY

• Ultrasounds are to be used to find problems with the baby or the surrounding areas, not for entertainment. Huntsville, MO

• Ultrasound examinations of fetuses are a very serious medical exam, possibly the most comprehensive exam anyone will have in their entire life. They should by undertaken only by qualified, certified persons, with the special training needed to accurately evaluate the pregnancy and fetus. These exams just happen to be fun for the parents, sonographer, and observers. This does not give license to keep the exam records as entertainment. I do not make videos of fetuses but I do give photos. Facial features, feet, and hands are common photos and not add to my exam time as I routinely evaluate these. Tacoma, WA

• I think it is a poor use of medical imaging technology. I think it degrades the sonography profession. I think it has the potential to leave the parents and video tape provider in an unfortunate situation if some abnormality is found, not found or if a normal structure is mistaken for pathology. I think ultrasound, a medical imaging device, should not be used in this fashion. I can think of other imaging devices which could make "neat pictures" of the baby with relatively low risk, MRI for example, but they are not used. Why, because they are expensive – ultrasound is cheap and unregulated. Iowa City, IO

• I feel that if it is a trained professional administering the ultrasound then it is ok. However, I do feel the patient should have one done by a trained and certified professional before seeking out solely for entertainment purposes. (To make sure there are no abnormalities. Braintree, MA

• I am against entertainment videos. Sonography is a diagnostic testing tool. It lowers our ‘profession’. Do I say I do entertainment sono not diagnostic. The pictures I take are for entertainment only. Oh well, I did not notice that the baby had only one leg. I was only trying to entertain you. New York, NY

• Ultrasound is a medical tool and should be handled as such. Use of ultrasound by diagnostic sonographers for entertainment is unprofessional and unethical. Valparaiso, IN

• I do not believe that fetal videotaping for non-diagnostic purposes should EVER be allowed…it undermines the integrity of the ultrasound profession itself…and cheapens our reputation to a public that loves to find fault…and dwell on it. Hapmden, MA

• Speaking only for myself, I would prefer not to have to video. There are days when I feel like a cinematographer instead of a sonographer and my "patients" want to be the director. All those years of study and work invalidated in just a few minutes! It is a large pain. Baton Rouge, LA

• I oppose it! Jackson, MI

• I know that the entire content of any sonographic examination is the patient’s property, and make provision for the patient to have an archival tape at her own expense. I know that sonography has been shown to promote maternal infant bonding, which is in the best interest of the fetus. I believe that the patient may use this record for any purpose without risk. I know that the embryo is subject to teratogenic risk by heat. I know that all sonography heats the object of study. I know that the teratogenic risk is not large. I know that the teratogenic risk has not been shown to be zero. I know that the fetal brain undergoes primary organogenesis during the entire pregnancy. I know that the use of any medical equipment or procedure is justified only if the foreseeable benefit of use justifies the foreseeable risk. I do not believe that ultrasonography for purely entertainment value is justified. Atlanta, GA

• I myself do not like to videotape scans, as no one knows what I am having to do to obtain images on a MOVING fetus! I will not do videotaping for entertainment purposes, but I am forced to do them when I am at work. (I understand the patients wanting them though as it is a very special time in their lives.) The reason is, that many other practices offer them to their patients, and the patients WANT them to show their families. The Doctors that I work for feel obligated to offer the SERVICE. I tape for only a couple of minutes and do my best to not show any in-depth views that will hopefully not come back to haunt me! I notice that in the later questions you ask if videotaping regulated by the FDA would be ok. Were would the line be drawn. We as sonographers are only human. I know I pride myself on doing the BEST job possible, but have been known to miss a ! Trisomy baby. It hurts, but we are only human and somewhere along the LEGAL lines there are NO HUMAN LINES. Only black and white. It is a shame that you cannot offer a fun side of this job, but the facts are, it is for MEDICAL purposes not entertainment. St. Louis, MO

• I am against this and feel that there should be no fetal videotaping for non diagnostic purposes. New York, NY

• Centers that only perform non-diagnostic fetal videotaping should not be allowed. The purpose of fetal sonography is to evaluate that fetus for anomalies, not for the relative’s entertainment, and also not solely for sex determination, as many of our patients’s seem to feel. Although I can understand parents wanting a prenatal peek at their baby, and a video of the experience, I often feel it demeans the ultrasound profession. Many days I feel more like a "kiddie" photographer than a medical professional. I often remind parents that we are there first and foremost to make sue baby is healthy. We will videotape for a few minutes at the conclusion of our routine fetal ultrasound for parents that provide a tape, but this is in addition to (not in place of) a complete fetal survey. Our perinatologist believes very strongly in the bonding benefit of prenatal sonography. Although ultrasound is safe, the danger in non-diagnostic use is that of missing anomalies that a medical sonographer would not miss. It is a medical technology and its use should be limited to such. La Crosse, WI

• It's kinda in a middle situation because this shouldn't be for entertainment, but for education. Broussard, LA

• I don't believe in videotaping as a stand alone service nor as part of a routine obstetric scan. We often have pts arrive with tape in hand and have to inform them we don't videotape. We provide a wall mounted monitor for the pt to view and allow family in the room. We also give them a few thermal pictures to take home. Albquerque, NM

• I think if the parents are paying for it out of pocket, and it is done by an RDMS, it is ok. I see no serious risk to it. I think the scan should be for 30-60 minutes max and done only once during the pregnancy. Portage, MI

• I refuse to use the ultrasound machine as a toy. I think it distorts the view of the parents. They get almost angry when we find a choroid plexus cyst or an echogenic cardiac focus. We're ruining their good time. I think it would be a good idea to keep it business only. Bridgeport, CT

• No. Taunton, MA
• I am completely against this practice. xxx, LA

• Entertainment use is not justified with any diagnostic method since the risk is not zero and the benefit is. I believe the risks to be very small but not zero. Some risk exists with any technology and with it's application. Risks for nondiagnostic ultrasound are ( I think order):

• Missing a medical condition, I consider this likely because such procedures are considered unprofessional by a wide variety of medical practitioners which increases the chance that the practitioner is not qualified. That is qualified practitioners will not be willing to participate.

• It costs money for this procedure, that is not covered by health insurance, and the loss of this resource is negative on the health of the mother and child.

• Electrical shock. Extremely unlikely but more likely than the ultrasound hurting the mother or fetus.

• Unknown risks associated with ultrasound. Although a rich variety of studies show pulsed diagnostic ultrasound to be free of known risks this is not the same thing as zero risk. Proving a negative is impossible, so I believe no diagnostic technique should be used for entertainment purposes.

• Some have argued that the imaging of the unborn changes the bonding with the mother and this is assumed to be positive. ACOG is currently studying this issue and others associated with the impact on pregnancy and birth of imaging methods and I'm sure we will all gain new insight. The assumption that these effects are positive is not currently justified. Results of studies in the future might change that assessment but right now no demonstrated benefit exists. If such a benefit should be demonstrated then routine diagnostic ultrasound would be justified as part of prenatal care (some already do so) but never solely to entertain the parents. San Francisco, CA

• I believe that, if done during an ordered and required ultrasound, videotaping/image giving is appropriate. It should only be performed by those registered by the ARDMS, or by appropriately qualified physicians. Ultrasound is NOT a toy, but a diagnostic tool. This is not to say that we are not to add to the happiness and enjoyment of the pregnancy, but in a professional manner! Hamilton Ontario, Canada

• We disagree with the use of ultrasound for entertainment reasons. Wellington, New Zealand

• I believe that patients should be allowed to obtain an ultrasound and fetal videotaping at their own expense of they wish. There are so many things that people are allowed to do that carry risk, yet ultrasound appears to carry little if any risk. We should certainly encourage, however, that fetal ultrasound be done by people adequately trained and experienced. Raleigh, NC

• That it is misuse of a diagnostic tool. Hamilton, New Zealand

• I think it is good PR, and is almost expected in many parts of the country. Dover, DE

• I think it should not be done. Ultrasound is a very serious exam to be performed. Looking for congenital anomalies is not a joke or a media affair. Burlington, VT

• I am opposed to conducting fetal videotaping for nondiagnostic purposes. Englewood, NJ

• Absolutely against. Lufkin, TX

• Absolutely no! This is a medical diagnostic test, not a family portrait. It also opens you up for medicolegal liability. Media, PA

• As every sonographer knows, an obstetric sonogram is a source of great joy to patient and family. A non-diagnostic sonogram is not morally or professionally wrong. There is not a sonographer or physician who objects to these who, if they or a loved one were pregnant, would not immediately use their machine after hours for a personal keepsake (unless, of course, a sonogram were already requested by their physician). The only potential difficulty would lie in the case where an anomaly were detected. This, however, would be a management problem for the service and not necessarily a reason why this is wrong. In fact, many otherwise undetected anomalies might be picked up this way. As far as the issue of use by unqualified personnel, the market would eventually sort this out the way it sorts out bad auto mechanics, bad lawyers, and bad airlines. In fact, the display of an ARDMS credential would offer heightened significance to the value of the credential. Currently, patients select the sonographer's credentials as a secondary or tertiary consideration, if at all. If such services were to flourish, customers would seek out the ARDMS credential as the primary criteria. New York, NY

• I am against videotaping for entertainment when done by an inexperienced person. If it is done I would hope an ARDMS sonographer would be doing the scanning. I do think the exam should be more than just videotape. Documentation guidelines for a limited exam could be set up. I feel that all pregnancies should have an exam in mid 2nd trimester. If the parents are willing to pay for a tape or gender only exam, then I see no reason why we can't provide that service and check out the fetal condition and environment at the same time. Mehama, OR

• I train students in ULS and it is difficult to stress the professionalism of the field, then students witness "entertainment ultrasound" during OB studies. Phoenix, AZ

• I believe that this is a way for people to make money off of parents excitement, but should not be done. Ultrasound is a diagnostic tool and can be harmful if something is missed in the wrong, untrained hands. Denver, CO

• I consider ultrasound a diagnostic medical test. Therefore I am against videotaping. One would not even think of handing out a video of a patient's upper GI x-ray. Sandusky, OH

• I think videotaping should be absolutely excluded and showing the screen and providing still pictures should be done at the discretion of the professional sonographer based on his or her schedule and general rapport with the patient. Arlington, TX

• At first I was very much against the idea of fun videos. Now I have to take a second look at this idea. Why can not the diagnostic exam be used as the entertainment video. Why can not the reading physician offer a entertainment video upon completion of the exam. If that is the case then I think that may be I would agree in them. Otherwise I do not believe that anyone regardless of the ability to perform the exam has the right to offer what is used as a diagnostic exam for entertainment. Where will the limits be drawn. We currently know the ultrasound in general is a safe exam if used without the Doppler etc. What will stop the examiner from using such applications. The use of the heart beat in sync with music. Boston, MA

• WE HAVE THE TOOL TO SEE THE FUTURE OF PEOPLE'S LIVES AND WELL BEING OF A LIVING BEING. ULTRASOUND SHOULD ALWAYS BE PUT IN A PROFESSIONAL LIGHT. DIAGNOSTIC ULTRASOUND IS AND SHOULD ASWAYS BE USED FOR THE PURPOSE OF EVALUATING FETAL WELL BEING IN A MEDICAL ASPECT AND NOT A LOW BUDGET SHOW. A COUPLE PICTURES FOR THE PARENTS GIVES THEM SOMETHING FOR THE PHOTO ALBUM AND LEAVE OUR PROFESSION WITH TRUE PURPOSE AND CREDIBILITY. TACOMA, WA

• "Entertainment" ultrasound is not what the profession of sonography is about. An ultrasound exam is a diagnostic exam and should be considered medically necessary for the exam to be performed. Fetal videotaping for nondiagnostic purposes such as in entertainment ultrasound is not medically necessary and should not be performed. La Crosse, WI

References:

Citation: Lane J, Marvin CD: Survey of Ultrasound Community Regarding the Use of Obstetrical Ultrasound for Non-diagnostic Purposes; October 1999