Posted on July 18th, 2017 by wombwithaviewblog.com

Is ultrasound radiation?! After 25 years in the biz, it would be news to me – and to every other physician, engineer, and manufacturing company in relation to the technology. Not to mention those who have conducted biohazard testing in the field since the early 1900s…

What Exactly is Ultrasound? (Since It Isn’t Radiation)

Ultrasound is just that. Ultra Sound, or sound waves that work at a frequency far beyond human hearing. Like a fish-finder one might use on a boat. Or sonar used by the military. Human hearing ranges from about 20Hz (Hertz) to 20,000Hz (or 20kHz). When it comes to creating an ultrasound image, we work in the MHz range or millions of Hertz. An OB probe ranges from about 2MHz – 13MHz.

Ultrasound is a department of Radiology within a hospital, but it does not emit radiation.

So, Who Thinks Ultrasound is Radiation?!

Apparently, someone who hasn’t done her homework. I was floored recently while doing research for my book when I came across an author of a very popular pregnancy book (who will remain nameless…for now) who actually wrote that ultrasound is radiation.

She also claims that the Doppler used by physicians to obtain heart tones emits more radiation than scanning equipment! Wrong again, Doppler is ultrasound.

How does this happen? After all, she supposedly had the help of “knowledgeable” medical resources to write the book. Are they the only healthcare providers on the planet who don’t know Ultrasound is not X-Ray? And if not, why not?

I have no idea if this author has recanted this falsehood. I tried to Google it with no confirmation. If she did, I give her credit. If not, she owes an explanation and apology to her faithful readers and social media followers. She is incorrectly influencing millions of parents-to-be with this misinformation, and it’s not okay. She is adding needless fuel to the fire, and moms worry about enough as it is.

Additionally, she then goes on to advise moms to only have an ultrasound if they really want one, but to not have more than they need. To me, this begs the question…is it radiation or is it okay?

I would like to think she did not intentionally mislead her readership. But as a published author, ignorance is no excuse.

What is Radiation?

It is a transfer of energy that also travels in waves. For example, radiation is found in light from the sun, microwaves, and X-Rays. But not sound waves. And, yes, exposure to radiation can cause cancer. One example is skin cancer from too much sun exposure.

Consider this. When you go to the dentist, what is the first thing asked of any woman? “Is it possible you might be pregnant?” If the answer is “Yes” or “I’m not sure,” they shield your belly to protect Baby from the minuscule dose of radiation from a one-second X-Ray of your teeth.

If an obstetrician’s job is to manage the health and care of Mother and Baby, and it is, why then would docs expose their patients directly to radiation? And what about sonographers? We all would be directly exposed numerous times a day, every week for the duration of our careers. None of us, patients nor sonographers times decades, have died from cancer due to ultrasound exposure.

Is Ultrasound Safe?

Biohazard testing over decades has shown cavitation, the development of bubbles, over many consecutive hours of scanning in one area. So far, there have been no known effects for the very short-term use as needed by your doctor for your diagnostic scans. Therefore, it’s been the feeling of the medical community that the benefits far outweigh any risk, and they justify the use of ultrasound only for diagnostic purposes. So, no, they are not an advocate of the private entertainment ultrasound scan in the strip mall near you. And neither am I, but this is another post altogether. It’s also the responsibility of the sonographer to use as low a power setting as needed to obtain an adequate image.

***

One of the reasons I started this blog five years ago is because patients were misinformed – by Dr. Google, family, or friends. I expect as much from a random non-medical blogger, and I was even more enraged to find misinformation being doled out on popular pregnancy sites. But this took the cake.

It’s one thing to express one’s opinion. But when you’re making tons of money by persuading expectant moms to adopt your line of thinking, you have the responsibility to get your info right. No one says anyone has to be a fan of ultrasound. And as a mom, you have the right to decline. Before you do so, speak with your provider. You need only to understand your choice. Any mom who ever delivered a baby with serious problems was happy to know about it in advance for planning and educational, emotional, and delivery purposes. This, in fact, is the purpose of obstetric ultrasound.

And if you’re all about moms and choices, and those choices are power? The power only comes from a parent who makes an informed choice, not one based on misinformation. It is my wish and goal to simply and accurately explain ultrasound for moms-to-be and stamp out the misconceptions. Understanding is also power:)

Here’s to a happy, healthy, and informed pregnancy!

wwavblogger, RDMS

wwavblogger, RDMS

***

As always, thanks for reading! Please feel free to email your comments or questions to me at wombviewerblog@gmail.com. And please subscribe to the right>>>to receive automatic posts (of course, you can always opt out!)

PS Readers! Finally! In preparation of publishing my book, I will very soon be introducing myself! Real name, real face. I’ll be happy to meet you all! Stay tuned!

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Posted on July 6th, 2017 by wombwithaviewblog.com
I’ve received questions lately regarding where to find fetal sex or gender in an ultrasound report. Can you always find this information in a report?
The short answer? No, not always.
Actually, we mostly do not record fetal sex, and it’s mostly not important to your doc. Typically, fetal sex is not pertinent information to the examination. Though parents may desire it, physicians don’t need this determination to manage your care and that of your baby if both are healthy. The above is true for most general OB practitioners in the US. However, every physician practices a little differently, and one can certainly dictate if he or she wants this info on all patient reports (if possible to determine). The case may be different if you are seeing a high-risk OB doc, aka a perinatologist. Their reports consist of much greater detail and may possibly include a fetal sex/gender guess.

Example of a Blank Report

In the images of a sample report taken from a monitor, you’ll notice there is a whole host of blanks to fill, but fetal sex is not one of them. On the first page where you see Sex: Other, this refers to the patient. Patient demographics were not entered here, so the Sex option defaulted to Other. We always include your LMP or EDC/EDD – aka baby due date. The larger blue space would be filled with fetal measurements, estimates of gestational age, and fetal weight as they are obtained.

OB ultrasound report

OB ultrasound report
In the pages above, you’ll note the list of fetal organs and structures we attempt to document on a mid-pregnancy anatomy screen. We only fill out the section called BPP in the 3rd Trimester when your doc orders this particular examination. And the CVP is usually only filled out when performing a Fetal Echo or detailed heart examination.

Exception to the Rule

There always seems to be at least one exception to every rule. Because the responsibility of a sonographer is to search out structural malformations, we also have to report suspicions of abnormal external genitalia. In other circumstances, we may see particular abnormalities that we might group together, as in the case of certain syndromes. Sometimes, knowing fetal sex helps physicians either support or rule out a particular chromosomal or structural problem. Some of these are gender specific. In the pic below, we have a designated space on a Comments page to expound on our findings. We can add fetal sex here if we feel it is pertinent information to the findings.
OB ultrasound report
In some countries, fetal sex is neither reported nor discussed with parents due to the cultural preference of one sex over another. And some facilities are beginning to incorporate policies against providing parents with this news due to litigious reasons. Unfortunately, such is life in the good ol’ US. Facilities want to limit their liability for guessing incorrectly by simply not allowing their sonographers to guess at all.
So, if you don’t want to know your baby’s sex (or even if you do!), don’t expect your ultrasound report to disclose that information. Your sonographer creates the images and report. We only include what is needed and leave out what is not!
Best wishes for happy and healthy!
wwavblogger, RDMS
PS ~
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As a thanks, you’ll receive a little something special when I publish my first book on 1st Trimester ultrasound! 🙂
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Posted on February 18th, 2015 by wombwithaviewblog.com

Yes, the title deserves a post all its own and screaming toddlers in OB practices around the country today are getting their due.

I think it’s no secret from prior posts how I feel about this situation.  Babies are precious and I can’t keep my hands off of them.  I want to smother them with sugar as much as the next person..only NOT when I am working.  Like most things in life, there is a time and place for everything (including your kids).  The GYN office is one of them.  The OB office, unassisted, is another.  Taking a toddler to an ultrasound is simply not a fabulous concept.  Today’s events were a perfect example of just that!

As I am minding my own business between patients and uploading exam reports and images for my docs, I become fretfully aware of a toddler in distress.  It continues.  And continues.  I realize the incessant, fever-pitched screams are coming from the room next door where my co-worker was performing an ultrasound and I couldn’t help but feel sorry for her knowing she was trying terribly to concentrate and failing miserably.

When another co-worker walked by my room and widened her eyes at me, I knew it was time to step in.  I called her extension and asked if she needed anything.  She said she could handle it.  At this point, I didn’t know if there was someone else with the patient besides the beyond-pissed child in tow.  I guess Dad got the picture because about a minute later, he stepped out with the red-faced, tear-soaked little dumpling.  All I could think in that moment was what in the world made that father stay put while his child freaked out for ten solid minutes like that?  Poor baby!  Who in their right minds think this is okay during an examination..or anywhere??  Mom.  She was upset they had to leave.  My co-worker apologized and explained she just couldn’t concentrate which, in my opinion, needed absolutely no explanation at all.  I know this probably happens 100,000 times per day at offices all around the country but the real question is ‘should it?’

This really should be a no-brainer for parents of any age.  We all know children are temperamental.  We carry diaper bags with us that hold everything but the kitchen sink in an effort to plan for any and every event we can imagine.  And when we have an important meeting, we hire a sitter or take Baby to Auntie’s house.  We don’t put Baby in a papoose for romantic date night, do we?  No.  This is because we want to focus on our spouse instead of spending the entire candle-lit dinner picking up the sippie cup off the floor or wiping a snotty nose with our linen napkin or silk sleeve of our favorite new blouse.  I am always amazed when parents don’t understand why a two-year-old won’t just “sit still” or why “he’s so fussy” when they scheduled their appointment right in the middle of his nap time…the very same nap time he has taken every single day at this hour his entire little life.

Most every woman knows to leave Baby home for a special evening with Daddy and Daddy is totally on-board with this idea.  Your ultrasound examination of the next member of your family is pretty special, too.  We know you want to relish this experience in every way possible and you totally should, too!  The only way to ensure you won’t be distracted from the most amazing movie you’ve ever seen is to let Little Princess crawl or run or fuss or eat or sleep as much as she wants…at home…just like date night;)

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Posted on December 23rd, 2014 by wombwithaviewblog.com

I’m a little Italian. Well, half. The other half is a Heinz 57 mix of German and Scotch with a little splash of Cherokee Indian. How about that concoction, huh? Most of us Americans are a jumbled gumbo of ancestry. So if you don’t understand the title of this post, you really do! Or you may comprehend “no comprende”. They both mean the same thing. “I don’t understand”. I know this of some of my patients without their saying these words..or a word.

The majority of this lack of understanding primarily comes from my really young patients..those under 20.  Sometimes it’s a blank stare (believe me, I get those from people over 20, as well) or sometimes it’s in the form of a series of inquiries which may begin with “huh?”. I reply with essentially the same answer phrased a little differently each time with an effort to break it down just a little further with each subsequent, unending series of the same question over and over and over.  See if you can follow the following conversation:

(I will preface this by stating that when I typically take a patient back for an Anatomy Screen, I will make their entourage remain in the waiting room initially so I can have some quiet while performing the examination. I say this to the patient as I walk her back for the test. Some don’t get it.)

***

“I’m going to take you and your spouse or one other person back first for the medical portion of the examination then you can bring in the rest of your family.”

“Medical examination.” (You know the questions that are asked more like a statement than a question?)

“Yes, I need to get the medical portion of the exam done first, then I’ll be happy to let your family back.”

“Medical portion?”

“Yes, I need some time to perform the diagnostic test on the baby first.”

“Test. What test? I’m not supposed to be having a test today.”

“Your ultrasound. It’s a diagnostic evaluation on your baby. I have measurements to take and lots of things to document first.”

“Oh. So they can’t come in now?”

O M G

***

Welcome to my career. Granted it’s not every day I have to attempt to impart wisdom in such a way and I can only jest because I was almost as ignorant at that age. However, it’s a  l i t t l e scary sometimes that certain people will be called “Mom” in a very short amount of time. I suppose it takes time to become a woman of the world!

Just a cute pic before I peace-out for the morning;)

11wks waving

 

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Posted on August 8th, 2014 by wombwithaviewblog.com

When a patient told me today she worried about her follow-up ultrasound scan for an entire month I knew I needed to address this issue.

This scan was ordered by her doctor 4 wks after her anatomy screening ultrasound and the patient thought something was wrong with her baby.  When she revealed this, I tried to ease her anxiety by explaining the protocol of these examinations.  On the anatomy screen we have a whole checklist of maternal and fetal anatomy to measure and document.  When parts on our list are limited, and oftentimes they are, most doctors will typically bring the patient back a month or so later for a second attempt to complete the checklist.  Adequate visualization of all these structures relies on so many variables, especially fetal position.  Most of you already know that if Baby is facing your back, we just can’t obtain that portrait for which you’ve been so desperately waiting.  It also means we can’t document all the facial structures we’d  like to see.  Another example is when Baby is lying on her back; in this position, we cannot evaluate the spine adequately.

Limited visualization is very different from questioning an abnormality.  When this happens, your doctor discusses the problem in question at your very next visit, answers any questions you have and refers you to a Perinatologist, a high-risk OB doc, for an evaluation of the suspected problem and recommendation for treatment.  Every doctor manages their patients a little differently, but this is how our docs handle this issue in our practice. There are many things we see on a regular basis that are quite minor that we follow-up and manage ourselves but your doctor knows when you need a high-risk assessment.

So, if you’ve gone in for your anatomy screen recently and you didn’t get to see this:

SONY DSC

Don’t panic!

Maybe Sweet Pea will let you see his great profile next time:)

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Posted on August 17th, 2012 by wombwithaviewblog.com

Sometimes, the answer to that question is a big fat no.  It’s actually a little condescending to us sonographers who always try to give a patient great ultrasound pictures and will usually give MANY images if baby is cooperating so it implies that we are not TRYING to give you great pics.  I know that some sonographers are just downright unfriendly and unhappy in their hospital jobs (prey tell, why?) so I cannot say this is not sometimes the case, unfortunately.  In ultrasound, fetal cooperation IS the name of the game.  If baby doesn’t cooperate, cute pictures simply are not gonna happen.  Especially when baby is facing mom’s back, it then becomes very difficult for me to see the specific organs and structures that I need to document much less to be able to get cute pics of the face.  Because of the way ultrasound works, baby needs to be facing upward toward mom’s belly in order to see the face well.  Usually, if baby is in this position without limbs or the cord in the way, we can typically get some really great shots of the fetal facial profile.  The feet and hands are cute but it is seeing that face that identifies us with another person.  Without this shot, the patient usually leaves feeling a little empty-handed.  Poo.  I hate when this happens.  I usually apologize profusely and just say that their baby simply did not want to cooperate that day.

Also, the one major thing that can hamper images..weight.  I will never say this to a patient when she asks the above question but it is truth.  The more tissue the sound waves have to penetrate, the worse the image will be on the monitor…Ultrasound Physics 101.  So, unfortunately, the more a patient weighs, the less likely it will be that I can get good pictures no matter what position baby is in.  Same for 3D.  We cannot tell a patient who weighs 300lbs that she cannot have a 3D scan, but we know it will simply not be a good one and we just try to get her the best images we can.

So, at the end of the day, we can jiggle all we want, we can poke at the belly and we can stand mom on her head but sometimes those babies just won’t budge.  “Can’t you get me better pictures?”  For the 20th time this week, I’ll just smile , apologize and hand her an image of a penis and a foot.

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Posted on March 12th, 2012 by wombwithaviewblog.com

Consulting Dr. Google…

Don’t do it, Moms-to-be! As much as you may be tempted, I have to caution you to not web-surf fetal abnormalities on ultrasound.

In this day and age of anything we want to know at our fingertips, it is nearly impossible to NOT research something that piques our curiosity. So, naturally, when you get your ultrasound results from your doctor, and he mentions you have a lot of amniotic fluid (polyhydramnios) or your baby has cysts on its brain (choroid plexus cysts), you freak out a little (or a lot). It’s completely understandable!

The truth is, however, that when you surf the net for these details you end up finding an entire spectrum of possibilities ranging from normal to severely abnormal fetal findings. And most of them may not apply to your circumstances at all. The result is usually the same. Your imagination runs away with you, and you start to worry that everything you’re reading applies to you and your baby. I always know a mom has been consulting Dr. Google when I get questions like “Is my baby’s bladder inside its body??” My response is usually the same…I reassure her with an “It sure is!” Then with a little smile, I advise “Quit looking up stuff on the internet!!!” Moms’ responses are usually the same, too. “I know, I know…I just can’t help myself!”

If Your Doc Wants to Refer You…

Sometimes, we sonographers (even the experienced ones) detect things we just can’t explain. This doesn’t mean something detrimental to your baby; it just means we can’t fully explain it. We know this is disconcerting to an expectant parent(s). Usually, if something requires the attention of a high-risk specialist (aka a perinatologist or MFM or Maternal Fetal Medicine), your doctor will tell you when he discusses your ultrasound results. In such a particular case, he/she will usually express that something noted on the examination stands out as abnormal (or possibly a normal variant – something that’s a little different but considered normal), and he would like a second opinion.

In my experience, if your provider feels it is not grossly worrisome, he/she will say so. Your doctor will then refer you to MFM so they can do a more extensive Level 2 ultrasound. The perinatologist should discuss this ultrasound with you, provide an opinion on the issue, and the severity of the problem. MFM will also let you know if they feel there really is no problem.

If Your Report is Normal

If you are not referred to a perinatologist, then it’s very likely that nothing worrisome enough was seen on your ultrasound. Your doctor will also let you know that your ultrasound was negative or unremarkable. At times, we can’t see something well because of Baby’s position or other factors. Usually, it’s something like Baby’s heart or spine. In these cases, your doc may want to look again to ensure a normal appearance. There are many minor findings that we may note on a regular sonogram which may not be alarming to your doctor. Mostly, they just require a follow-up later to see if the issue is resolved. They mostly turn out to be insignificant, especially if no other abnormalities are seen with your baby. In other words…they are likely not a big deal!!!

So don’t make yourself worry! Don’t ask Dr. Google, ask your doctor instead. Make a list of all your questions, and he/she will let you know if other tests are needed. I know it’s tempting, but this is only the beginning of all the things that drive us crazy as moms! Save your sanity for when your kid is a driving teenager!

Best wishes for a happy and healthy pregnancy!

wwavblogger, RDMS

wwavblogger, RDMS

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