Concerns about biological impacts in nonmedical ultrasounds raised by governments and professional organizations are hypocritical and unjustified. Obstetric ultrasound is a well-known prenatal test that is used to determine and visualize the health of the fetus and her mother. Aside from medical applications, fetal ultrasound equipment are also being used for non-medical purposes by a variety of businesses. Nonmedical fetal ultrasound is defined as the use of ultrasound employing 3D and 4D fetal imaging, in which couples are provided with DVDs, keepsake images, real-time scans, views, pictures, and fetal sex determination without a medical indication (Taylor, 2008). This is usually classified as amusement, elective or fetal-keepsake imaging, and shopping mall or boutique. It happens mostly in Europe and the U.S where 9.4% of pregnant women have admitted having had nonmedical scans. Notwithstanding the warnings and guidelines concerning ultrasound safety issued by professional bodies and governments, the absence of scientifically proven physical harm to fetuses from this procedure creates a path for these businesses with grounds for spontaneous expansion (Fleischer, 2011).
The governments and professional organizations highly oppose the utilization of fetal ultrasound for nonmedical reasons. They mostly cite the risk associated with harmful biological effects. For example, doctors opposed actor Tom Cruise, when he bought an ultrasound system with plans to personally scan his girlfriend, Katie Holmes. They warned that the use of ultrasound poses unnecessary physical risk to the fetus when used for nonmedical reasons. The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) highly disapproves the use of ultrasound for nonmedical purposes. Nevertheless, for over 40 years of extensive use of ultrasound, there have been no reported serious incidents of human fetal harm both in medical and business purposes (Abramowicz, 2009).
The possibility that ultrasound can trigger biological effects in the fetus remain a great concern to people all over the world. According to the study, the majority of individuals under 25 years of age in all western countries was exposed to ultrasounds in utero, mainly during multiple scans. The consequences of any biological effects can be very devastating. However, instead of regarding nonmedical ultrasound as dangerous, the factors that governments and professional organizations should be considering are the power of ultrasound and gestational age, not the indication for a scan and where it was conducted. Therefore, the current arguments using the benefit/risk balance to opposing nonmedical ultrasound during pregnancy fail (Mitchell, 2016).
Entertainment or nonmedical ultrasound and biological effects
Entertainment ultrasound is performed in two forms. Nonmedical ultrasound is done without the recommendation of the doctor, with no diagnostic or therapeutic aim. Also, non medically indicated scan can be performed by sonographers in hospitals within the context of a professional relationship. A good example is a supplement to a diagnostic or therapeutic scan, which can be referred as a medical entertainment ultrasound (MEU). Mostly, all medically indicated scans involve demonstration of fetal images to the parents, and there is no real dividing line to plainly differentiate this from diagnostic segments of the scan (Paladini, 2014).
There is no support for nonmedical ultrasounds among the governments and professional organizations. They claim it is unjustifiable to expose the fetus to ultrasound with no anticipation of medical benefits. The underlying principle is as low as reasonably achievable acoustic output and dwells time. The concern is so serious that the American Food and Drug Administration (FDA) can confiscate machines utilized for nonmedical reasons without a prescription and it encourages state governments to take actions against technicians who conduct nonmedical ultrasound examinations. However, some organizations argue that there is little cause for ethical objection to fetal entertainment imaging of biological effects, especially when time and the intensity of the ultrasound examination is reasonable (Archer, 2009).
Also, there is concern regarding MEU. It is considered that the use of 3D or 2D ultrasound only to obtain a picture or view the fetus and determine the fetus sex without a medical reason is unnecessary and contrary to sound medical practice. Therefore, this shows that we are dealing with a bad unstable technique. Nevertheless, statements are contradictory, whereby the Britain Medical Ultrasound Society claim that research and bonding scans endorsed by a midwife or clinician are acceptable, yet it opposes nonmedical ultrasounds. It is thus unclear concerning how non-diagnostic scans can have differing risks based on who requests them (White, 2012).
Whether nonmedical ultrasound has a higher risk than diagnostic ultrasound
Nonmedical ultrasound is considered risky because untrained commercial operators do not care that there might be some hidden danger of ultrasound. Nevertheless, trained medical operators can be guilty of the same failing. From 1992, it has always been the responsibility of the machine operator to monitor the output displays to guarantee the safe utilization of ultrasound. According to some studies, only 27.8% of regular ultrasound users know where to find the safety indices on the screen of their machines. Out of that only 21.6% knew how to adjust output energy. Machine power displays do not provide the basis for safe scanning. Moreover, there are no recommended limits towards indications of, or number of, diagnostic ultrasound examinations. Physicians mostly conduct numerous scans during each pregnancy; some ultrasounds scan low risk to the mother at every antenatal visit. Guidelines and procedure do not disregard this practice (Fredouille, 2014).
The suggestion that nonmedical ultrasounds during pregnancy are riskier than diagnostic ultrasound is flawed since, given necessary power levels, there is minimal likelihood that it is qualitatively or quantitatively more dangerous than medical ultrasound. Imagine that a 45 years person is found to have suffered harm from ultrasound conducted when she was a fetus. Her mother had medical ultrasound scans, including Doppler, at 6, 8, 12, and 19 weeks, a scan researching aortic flow at 13 weeks and later a nonmedical ultrasound at 26 weeks. It is not crucial to her that one of the scans was for nonmedical reasons. None of them was likely to provide her medical benefit. In fact, they were unlikely to show problems, which would enable her health-enhancing treatments. Essentially, ultrasound biological effects would almost definitely be caused by the diagnostic scans since these were at earlier gestational ages and the power levels somehow higher compared with the nonmedical ultrasound scan. The same thoughts can apply to the MEU. Focusing attention on the scan's indication or where it is being performed is a distraction. However, many professional statements are cautionary concerning the risks of nonmedical ultrasound during pregnancy, and in various instances also MEU, but reassuring regarding the dangers of teaching or diagnostic scans (Mitchell, 2016).
To what extent is the risk too much?
It is not yet clear whether diagnostic or MEU ultrasound causes biological effects, especially using post-1992 power levels. It is crucial to know. Nevertheless, there is a separate question, which also requires being addressed, concerning how we should deal with theoretical or small risks. The method that is sometimes used is to draw on the principle of precautionary or non-maleficence principle to justify avoiding such risks. Nevertheless, the concern is that possible risks apply to almost any medical intervention (for example, gene therapies) or new treatment, and these principles can prevent the evolvement of significant medical advances. A more rational method is to try to balance possible risks with potential benefits (Salvesen, 2009).
Professional organizations have shown a willingness to balance the benefits and potential risks of ultrasound. Many professional statements indicate that the risks of ultrasound to the fetus are profoundly highly or deeply uncertain, that scans should only be conducted when they prove a significant benefit to the mother. They say that diagnostic or MEU ultrasound possesses such advantages, whereas nonmedical ultrasound does not (Salvesen, 2009).
This kind of argument has two problems. First, it seems apparent that many mothers gain benefits from the nonmedical ultrasound that are comparable to those, which they get from the medical ultrasound. For example, consider the case of a mother who undergoes mid trimester medical ultrasound examination even though she would not think about abortion in the case of abnormality. Because it is primarily a test for fetal abnormality, the benefits which this mother gets from the scans are likely to be small, less high than those gained from the nonmedical ultrasound. In fact, some medical scans like those intended to detect threatened miscarriages, mostly have little medical benefits. The benefits can be inform of psychological reassurance - not dissimilar to the benefits of nonmedical ultrasound that is done for entertainment (Fleischer, 2011).
Second, and most crucially, it is unclear whether the 'significant benefits to the mother' test is a necessary one. Is it ethical to cause risks to a fetus so that the mother can gain some important (but less enormous) benefit? For example, it is considered unethical for a pregnant woman to take recreational drugs or drink alcohol since this may cause harm to the fetus, even though that mother may find that the benefits to her are crucial. Many people argue that a pregnant woman has strong, impressive moral reasons to stay away from behavior, which potentially causes the baby to be born in an endangered state and that has less prospect of benefiting it. This kind of reasoning does not presuppose that the fetus is an individual, but is based on prevention of harm to future people and principles of respect for the interests of sentient beings. The argument needs to focus when, if ever, it is appropriate to perform a test that is in the benefit of the parent, but has a risk, regardless of how low, of causing significant morbidity to the future baby (Fredouille, 2014).
Maybe more defensible positions for professional bodies and the governments would be the one holding that the risks of ultrasound to the fetus are profoundly high, or deeply uncertain, that ultrasound scans should only be conducted once the physician conveys important benefits to the fetus. Also, it can be argued that medical ultrasound would typically pass this test, whereas nonmedical ultrasound would not. The first problem is that while some medical ultrasound scans potentially benefit the fetus like those identifying third-trimester fetal compromise, many of them has no such benefits. Scans inherently pose a clear risk to the fetus, quite apart from those of biological effects. Most of them are conducted to avail information that could result in aborting the fetus, which is not in the interest of fetus. For example, Nuchal translucency scans are carried out mainly for risk assessment of chromosomal abnormality. In a situation like this, the fetus risks being aborted if a problem is detected. They primarily provide the parent with a choice if an anomaly is found. Research and teaching scans typically provide no benefits to the fetus, and they equally expose the fetus to all kinds of risks relating to biological effects (Archer, 2009).
The second problem is that nonmedical ultrasound may in various instances pass the 'crucial benefit to the fetus' test. These scans can increase bonding between the woman and fetus and thus reduce a fetus's risk of therapeutic abortion. In fact, some states in the U.S encourage women to have a mandatory pre-abortion ultrasound examination to discourage abortion (Paladini, 2014).
Conclusion
Professional organizations and governments currently discourage nonmedical ultrasound during pregnancy, but not widespread misuse of medical ultrasound. This is inconsistent. Due to its timing and likely low power levels, nonmedical ultrasound is low-risk compared to many medical scans (Mitchell, 2016).
Nonmedical ultrasound may often be unethical since the risks of bio-effects are highly greater than any potential health benefit to the fetus, and because there is no fundamentally great benefit to the parent to outweigh the overall risk imposed to the fetus. The same is equally true of research, teaching, and diagnostic ultrasound scans (Salvesen, 2009).
Criticisms of nonmedical ultrasound by professional organizations and governments reflect their concerns regarding potential biological effects. Other objections also exist, but they are not persuasive. Therefore, these criticisms should stop, or clear guidelines must be availed to discourage research and training scans, scans using higher power Doppler and frequently repeated scans in a low-risk woman (Archer, 2009).
Since it is already believed that fetal ultrasound has non-negligible risks, a position which balances fetal and maternal interests in medical settings should be established. Also, consistent policies should be developed indicating when it is appropriate to perform or prolong nonmedical ultrasound. However, clear biological effect statements are predicated on having improved about the research relating to the potential adverse effects of the ultrasound equipment that are currently being used both for medical or nonmedical purposes (White, 2012).
Statements by professional organizations seem to claim that the purpose of a scan can impact on the risk of biological effects; nevertheless, whether a scan is diagnostic or nonmedical is not essential to its physical risk towards the fetus. The risk of biological effects varies with ultrasound power and gestational age, not the indication. Governments and professional bodies misuse the benefit/risk concept and are hypocritical towards its application (Mitchell, 2016).
If the ultrasound causes adverse biological effects, it is not only nonmedical ultrasound that will pose most harm. It is medical ultrasound. It is the multiple diagnostic scans, mostly including Doppler, usually in the first trimester and often for the minimal clinical benefit. Medical practitioners would be called to account, not entrepreneurs. The focus must be on reducing all fetal exposures, particularly during the embryonic period. We should first deal with the key concern of documenting and reducing fetal diagnostic ultrasound exposure and later address the minor issue of nonmedical ultrasound performed for the purpose of entertainment. Therefore, given the current clinical practice, there are no profound reasons of biological effects for opposing nonmedical ultrasound during pregnancy (Taylor, 2008).
References
Abramowicz J., & Barnett S. (2009). The safe use of non-medical ultrasound: a summary of the proceedings of the joint safety symposium of ISUOG and WFUMB. Ultrasound Obstet Gynecol.
Archer, N., & Manning, N. (2009). Fetal cardiology. Oxford [England: Oxford University Press.
Fleischer, A. C. (2011). Sonography in obstetrics and gynecology: Principles and practice. New York: McGraw-Hill.
Fredouille, C., Develay-Morice, J.-E, & Lombardi, C. (2014). Fetal heart ultrasound: How, why, and when--3 steps and 10 key points.
Mitchell, L. M. (2016). Baby's First Picture: Ultrasound and the Politics of Fetal Subjects. Toronto: University of Toronto Press.
Paladini, D., & Volpe, P. (2014). Ultrasound of congenital fetal anomalies: Differential diagnosis and prognostic indicators.
Salvesen K., & Lees C. (2009). Ultrasound is not unsound, but safety is an issue. Ultrasound Obstet Gynecol.
Taylor, J. S. (2008). The public life of the fetal sonogram: Technology, consumption, and the politics of reproduction.
White, D. (2012). Ultrasound in medicine: Proceedings of the 19th annual meeting of the american institute of ... ultrasound in medicine: Springer.
