 |
I grew up with the revolution in ultrasonic medical imaging. In 1968, I began work on my doctoral dissertation, using ultrasound for measuring blood flow. Back then, ultrasound images were fuzzy and offered very little diagnostic information. A physician at the National Institutes of Health was conducting an experimental study using ultrasound to predict the sex of the fetus. The day before the birth of my daughter in 1974, he hooked my wife up to his machine, took a look and proudly announced that she was going to deliver a baby boy!
Over the next 30 years, however, the quality of the images improved. The techniques for measuring blood flow that I could barely imagine ever having practical applications in 1968 are now routine.
In fact, ultrasound imaging has become so good that it has given birth to a fledgling new industry: the prenatal photoshop. The new three- and four-dimensional ultrasound technology means you can take a strikingly lifelike photo or video of your little bundle of joy weeks before delivery. Perhaps not surprisingly, fetal portrait studios are springing up across the land, some conveniently located in your local shopping mall. The newspapers report that there are at least 120 of these shops open now—and more are on the way.
It reminds me of another cottage industry, one from my youth. Many in my generation can recall going to the shoe store, trying on a new pair of shoes, and then putting their feet into an X-ray fluoroscope so that the salesperson—but more importantly their mother—could see that the shoe was large enough that they wouldn't be back in two months buying another pair. However, these machines quickly disappeared after studies documented the risk of radiation exposure.
Dazzling pictures can blind us to important issues of safety and radiation exposure. Physicians trained in the art and science of diagnostic imaging have long employed a standard to use the minimum dose practicable in order to solve a diagnostic problem. This is true whether the exam is using X-rays, gamma rays, magnetic resonance imaging or ultrasound for prenatal evaluation.
Unfortunately, the dose of high-frequency sound waves used to create the beautiful pictures of a mother's fetus require considerably more energy than the simpler but less pretty photos you'll get in your obstetrician's office. And although many studies have failed to document any risk to the mother or fetus by exposure to ultrasound, we do know from animal studies that, at some higher levels of exposure, ultrasound can cause tissue or chromosomal damage. Many of the critical fetal organs are being formed during the time that ultrasound exams are being performed, which is why prudent physicians restrict their use to diagnostic purposes only and perform the minimal exam necessary.
Parents expect perfect babies. Often, when a child is born with a deformity, they are inclined to sue their obstetrician for the imperfect outcome, even when it is uncertain what caused the problem in the first place. As a result, malpractice rates for obstetricians amount to several thousand dollars per baby delivered. But many factors influence the outcome of pregnancy, from the health of the mother to diet and nutrition, genetic factors, infections and yes, exposure to radiation. When a problem develops, it is very difficult to know which among the many factors might have caused the problem. Therefore, however minimal the risk, we should not tolerate any intervention that has the potential to harm the fetus unless there is a clear medical benefit.
Unfortunately, the FDA cannot regulate these new fetal photoshops. By law, the FDA is not allowed to regulate so-called off-label uses of medical devices and pharmaceuticals. Therefore, we must educate mothers, fathers and grandparents not to get shutter happy before the birth of their precious arrival. This is a revolution that should not be televised.
I grew up with the revolution in ultrasonic medical imaging. In 1968, I began work on my doctoral dissertation, using ultrasound for measuring blood flow. Back then, ultrasound images were fuzzy and offered very little diagnostic information. A physician at the National Institutes of Health was conducting an experimental study using ultrasound to predict the sex of the fetus. The day before the birth of my daughter in 1974, he hooked my wife up to his machine, took a look and proudly announced that she was going to deliver a baby boy!
Over the next 30 years, however, the quality of the images improved. The techniques for measuring blood flow that I could barely imagine ever having practical applications in 1968 are now routine.
In fact, ultrasound imaging has become so good that it has given birth to a fledgling new industry: the prenatal photoshop. The new three- and four-dimensional ultrasound technology means you can take a strikingly lifelike photo or video of your little bundle of joy weeks before delivery. Perhaps not surprisingly, fetal portrait studios are springing up across the land, some conveniently located in your local shopping mall. The newspapers report that there are at least 120 of these shops open now—and more are on the way.
It reminds me of another cottage industry, one from my youth. Many in my generation can recall going to the shoe store, trying on a new pair of shoes, and then putting their feet into an X-ray fluoroscope so that the salesperson—but more importantly their mother—could see that the shoe was large enough that they wouldn't be back in two months buying another pair. However, these machines quickly disappeared after studies documented the risk of radiation exposure.
Dazzling pictures can blind us to important issues of safety and radiation exposure. Physicians trained in the art and science of diagnostic imaging have long employed a standard to use the minimum dose practicable in order to solve a diagnostic problem. This is true whether the exam is using X-rays, gamma rays, magnetic resonance imaging or ultrasound for prenatal evaluation.
Unfortunately, the dose of high-frequency sound waves used to create the beautiful pictures of a mother's fetus require considerably more energy than the simpler but less pretty photos you'll get in your obstetrician's office. And although many studies have failed to document any risk to the mother or fetus by exposure to ultrasound, we do know from animal studies that, at some higher levels of exposure, ultrasound can cause tissue or chromosomal damage. Many of the critical fetal organs are being formed during the time that ultrasound exams are being performed, which is why prudent physicians restrict their use to diagnostic purposes only and perform the minimal exam necessary.
Parents expect perfect babies. Often, when a child is born with a deformity, they are inclined to sue their obstetrician for the imperfect outcome, even when it is uncertain what caused the problem in the first place. As a result, malpractice rates for obstetricians amount to several thousand dollars per baby delivered. But many factors influence the outcome of pregnancy, from the health of the mother to diet and nutrition, genetic factors, infections and yes, exposure to radiation. When a problem develops, it is very difficult to know which among the many factors might have caused the problem. Therefore, however minimal the risk, we should not tolerate any intervention that has the potential to harm the fetus unless there is a clear medical benefit.
Unfortunately, the FDA cannot regulate these new fetal photoshops. By law, the FDA is not allowed to regulate so-called off-label uses of medical devices and pharmaceuticals. Therefore, we must educate mothers, fathers and grandparents not to get shutter happy before the birth of their precious arrival. This is a revolution that should not be televised.
