Ultrasound is not unsound, but safety is an issue

In vitro characterisation of ultrasound-induced heating effects in the mother and fetus: A clinical perspective

INTRODUCTION

The quantification of heating effects during exposure to ultrasound is usually based on laboratory experiments in water and is assessed using extrapolated parameters such as the thermal index. In our study, we have measured the temperature increase directly in a simulator of the maternal-fetal environment, the 'ISUOG Phantom', using clinically relevant ultrasound scanners, transducers and exposure conditions.

METHODS

The study was carried out using an instrumented phantom designed to represent the pregnant maternal abdomen and which enabled temperature recordings at positions in tissue mimics which represented the skin surface, sub-surface, amniotic fluid and fetal bone interface. We tested four different transducers on a commercial diagnostic scanner. The effects of scan duration, presence of a circulating fluid, pre-set and power were recorded.

RESULTS

The highest temperature increase was always at the transducer-skin interface, where temperature increases between 1.4°C and 9.5°C were observed; lower temperature rises, between 0.1°C and 1.0°C, were observed deeper in tissue and at the bone interface. Doppler modes generated the highest temperature increases. Most of the heating occurred in the first 3 minutes of exposure, with the presence of a circulating fluid having a limited effect. The power setting affected the maximum temperature increase proportionally, with peak temperature increasing from 4.3°C to 6.7°C when power was increased from 63% to 100%.

CONCLUSIONS

Although this phantom provides a crude mimic of the in vivo conditions, the overall results showed good repeatability and agreement with previously published experiments. All studies showed that the temperature rises observed fell within the recommendations of international regulatory bodies. However, it is important that the operator should be aware of factors affecting the temperature increase.

Advanced MR imaging of the placenta: Exploring the in utero placenta-brain connection

The placenta is a vital organ necessary for the healthy neurodevelopment of the fetus. Despite the known associations between placental dysfunction and neurologic impairment, there is a paucity of tools available to reliably assess in vivo placental health and function. Existing clinical tools for placental assessment remain insensitive in predicting and evaluating placental well-being. Advanced MRI techniques hold significant promise for the dynamic, non-invasive, real-time assessment of placental health and identification of early placental-based disorders. In this review, we summarize the available clinical tools for placental assessment, including ultrasound, Doppler, and conventional MRI. We then explore the emerging role of advanced placental MR imaging techniques for supporting the developing fetus and appraise the strengths and limitations of quantitative MRI in identifying early markers of placental dysfunction for improved pregnancy monitoring and fetal outcomes.

Imaging and assessment of placental function

The placenta is the vital support organ for the developing fetus. This article reviews current ultrasound (US) methods of assessing placental function. The ability of ultrasound to detect placental pathology is discussed. Doppler technology to investigate the fetal, placental, and maternal circulations in both high-risk and uncomplicated pregnancies is discussed and the current literature on the value of three-dimensional power Doppler studies to assess placental volume and vascularization is also evaluated. The article highlights the need for further research into three-dimensional ultrasound and alternative methods of placental evaluation if progress is to be made in optimizing placental function assessment.

Ultrasound in pregnancy and non-right handedness: meta-analysis of randomized trials

OBJECTIVE

To study the association between exposure to ultrasound in pregnancy and non-right handedness in children with available data from randomized trials.

METHODS

Follow-up data of 8865 children aged 8-14 years from three randomized trials on routine ultrasonography at 15-20 weeks' gestation were available. Handedness was assessed through questionnaires to the parents and classified according to five, 10 or 11 questions. Children not classified as right handed were regarded as non-right handed.

RESULTS

There was a statistically significant increased prevalence of non-right handedness in ultrasonographically screened children compared with controls (odds ratio (OR) 1.15; 95% CI, 1.03-1.29). The results in subgroups according to gender are consistent with the overall results, with no significant differences between boys and girls. Among boys, the association became stronger when an exploratory analysis according to ultrasound exposure before 19-22 weeks' gestation was done (OR 1.30; 95% CI, 1.10-1.53).

CONCLUSION

There is a statistically significant-albeit weak-association between ultrasound screening during pregnancy and being non-right handed later in life.

Handedness in the helsinki ultrasound trial

OBJECTIVES

To determine whether exposure to prenatal ultrasound increases non-right-handedness in boys.

METHODS

The association between exposure to prenatal ultrasound and handedness was tested, using logistic regression analysis, in the Helsinki Ultrasound Trial data. We applied an intention-to-treat approach in this analysis of a subset of 4150 subjects whose parents answered a follow-up questionnaire on handedness when the children were aged 13-15 years.

RESULTS

The odds ratio for non-right-handedness of children who had been exposed to prenatal ultrasound was 1.16 (0.98-1.37) for all subjects, 1.12 (0.89-1.41) for boys and 1.24 (0.97-1.58) for girls.

CONCLUSIONS

We could not confirm the hypothesis that prenatal ultrasound exposure and handedness are associated. Our findings were independent of the particular definition of handedness used, whether it was considered according to the writing hand alone or defined using a laterality quotient.