Canadian ob/gyns, rads target entertainment ultrasound

Canadian ob/gyns, rads target entertainment ultrasound
By Erik L. Ridley, AuntMinnie staff writer

February 20, 2014 -- The growing use of fetal ultrasound for nonmedical purposes has prompted two Canadian medical societies to issue a statement against the scans, which have been linked to gender-specific abortion in the country.


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 indicating their strong opposition to the nonmedical use of fetal ultrasound. The statement encouraged governments to join with them "to find appropriate means to deal with this public health issue."

Sex-selective abortion as a result of fetal ultrasound scans has long been a problem in developing countries such as India and China, where it has resulted in lopsided male-to-female ratios among the general population. But the problem is believed to be spreading to some developed countries such as Canada and the U.S. that have large immigrant communities.

The problem has been exacerbated by the rise of nonmedical ultrasound centers that offer "entertainment" scans, such as keepsake ultrasound images provided to expecting parents. Recent media coverage has highlighted the role of first-trimester gender determination by these centers in contributing to gender-specific abortion.

As a result, SOGC and CAR updated their individual policy statements on this issue with a new joint policy statement. The joint statement was prepared by the SOGC Diagnostic Imaging Committee and the CAR Point of Care Ultrasound Working Group, and it was approved by SOGC's executive council and CAR's board of directors (J Obstet Gynaecol Can, February 2014, Vol. 36:2, pp. 184-185).

While there is no definitive evidence that diagnostic ultrasound produces fetal abnormalities or harmful effects, studies of the biological effects of ultrasound in humans and in animal models indicate a theoretical risk, according to the organizations. For example, recent studies in animal models reported subtle effects on fetal brain physiology and development.

Nonmedical fetal ultrasound raises a number of safety concerns, according to the organizations.

"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," they said in the statement. "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."

Other potential harms include false-positive diagnoses that lead to unnecessary investigations and anxiety, as well as false reassurance to the patient that everything is "normal," according to the organizations. Physical harm could also result if unsafe levels of abdominal pressure and fetal maneuvering are applied to obtain a suitable commercial product.

"The fetus should not be exposed to ultrasound for commercial and entertainment purposes, and it could be considered unethical to perform these scans," they wrote.

SOGC and CAR noted that both Health Canada and the U.S. Food and Drug Administration have recommended against the practice of commercial or entertainment ultrasound studies. Specifically, Health Canada recommends that ultrasound should not be performed in the following circumstances:

To take a picture of the fetus solely for nonmedical reasons
To learn the sex of the fetus solely for nonmedical reasons
For commercial purposes, such as the display of pictures or videos of a fetus at trade shows
"SOGC and CAR support the Health Canada recommendations and recommend that ultrasound be used prudently and only by qualified health professionals and that energy exposure be limited to the minimum that is medically necessary," according to the statement. "This technology should not be used for the sole purpose of determining fetal gender without a medical indication for that scan."

Related Reading
Report ties keepsake ultrasound to fetal gender tests in Canada, June 15, 2012

Toronto Star: Hospitals won't reveal baby's gender on US, April 18, 2012

AIUM: Keepsake US tied to low birth-gender ratios in Calif., April 3, 2012

Does keepsake ultrasound lead to gender abortions in Calif.?, March 30, 2010

Fetal entertainment ultrasounds draw patient interest, March 20, 2007


Copyright © 2014 AuntMinnie.com

Last Updated np 2/20/2014 11:45:14 AM
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MRElastography for Liver Diseae

Clinical Applications of Magnetic Resonance Elastography Growing

By Rob Goodier

 February 12, 2014

 

NEW YORK (Reuters Health) - Physicians have used Magnetic Resonance Elastography (MRE) to evaluate liver disease for the past five years, but a lengthening list of other applications for the imaging technology are coming on line, researchers say.

"I believe that the most likely application to be adopted next in clinical practice will be to use MRE to evaluate brain tumors preoperatively," Dr. Richard Ehman, a radiologist at Mayo Clinic and president and CEO of Resoundant Inc. in Rochester, Minnesota, told Reuters Health by email.

"Our preliminary experience is that MRE provides a reliable preoperative assessment of meningioma stiffness, which is extremely valuable information for surgical planning," Dr. Ehman said.

Dr. Ehman presented data from his work with MRE on February 4 at the American Society of Mechanical Engineering's third annual conference on Nanoengineering for Medicine and Biology in San Francisco, California.

Based on MR imaging, MRE gathers data from acoustic shear waves as they pass through and interact with the body. The result is maps showing the mechanical characteristics of the tissue - properties such as stiffness, viscosity, and anisotropy - or how its properties change from different angles.

Data from 4000 patients suggest that MRE is at least as accurate as liver biopsy for diagnosis of liver fibrosis, and it may be safer, more comfortable, and less expensive, Dr. Ehman wrote in conference materials.

Other applications under study include preoperative brain tumor analysis, analysis of the skeletal muscle, heart, and lungs, and diagnosis of breast and prostate cancer.

The findings are "very exceptional," said Dr. Jerry Lee, health sciences director at the U.S. National Cancer Institute, who attended the conference but is not involved in MRE research.

"I think it is a real life demonstration of how mechanical engineering theories are being applied to human disease right now," Dr. Lee told Reuters Health.