To develop a revised statement, a Keepsake Ultrasound Task Force was created to consider the various aspects of the use of ultrasound for entertainment. The AIUM wanted to ensure that all positions were addressed, so the task force encouraged input from all ultrasound professions. An e-mail was sent to AIUM members asking them to provide comments on specific keepsake issues they had, and members were able to provide their comments via the AIUM's website.
"The Task Force on Keepsake Ultrasound met by conference call several times and had a vigorous e-mail correspondence," said Joshua A. Copel, MD, chair of the committee. "The new statement is comprehensive and robust and is the result of outstanding contributions by all members of the committee and AIUM members who submitted comments."
The new position statement is as follows:
The AIUM advocates the responsible use of diagnostic ultrasound for all fetal imaging. The AIUM understands the growing pressures from patients for the performance of ultrasound examinations for bonding and reassurance purposes largely driven by the improving image quality of 3D sonography and by more widely available information about these advances. Although there is only preliminary scientific evidence that 3D sonography has a positive impact on parental--fetal bonding, the AIUM recognizes that many parents may pursue scanning for this purpose.
Such "keepsake imaging" currently occurs in a variety of settings, including the following:
- 1. Images or video clips given to parents during the course of a medically indicated ultrasound examination;
- 2. Freestanding commercial fetal imaging sites, usually without any physician review of acquired images and with no regulation of the training of the individuals obtaining the images; these images are sometimes called "entertainment videos"; and,
- 3. As added cost visits to a medical facility (office or hospital) outside the coverage of contractual arrangements between the provider and the patient's insurance carrier.
The AIUM recommends that licensed medical professionals (either physicians or registered or registry-eligible sonographers) who have received specialized training in fetal imaging perform all fetal ultrasound scans. These individuals have been trained to recognize medically important conditions, such as congenital anomalies, artifacts associated with ultrasound scanning that may mimic pathology, and techniques to avoid ultrasound exposure beyond what is considered safe for the fetus. Any other use of "limited medical ultrasound" may constitute practice of medicine without a license. The AIUM reemphasizes that all imaging requires proper documentation and a final report for the patient medical record signed by a physician.
Although the general use of ultrasound for medical diagnosis is considered safe, ultrasound energy has the potential to produce biological effects. Ultrasound bioeffects may result from scanning for a prolonged period, inappropriate use of color or pulsed Doppler ultrasound without a medical indication, or excessive thermal or mechanical index settings. The AIUM encourages patients to make sure that practitioners using ultrasound have received specific training in fetal imaging to ensure the best possible results.
The AIUM also believes that added cost arrangements other than those of providing patients images or copies of their medical records at cost may violate the principles of medical ethics of the American Medical Association (E-8.0621 and E-8.0632) and the American College of Obstetricians and Gynecologists.3 The AIUM therefore reaffirms the Prudent Use Statement4 and recommends that only scenario 1 above is consistent with the ethical principles of our professional organizations.
The market for keepsake images is driven in part by past medical approaches that have used medicolegal concerns as a reason not to provide images to patients. Sharing images with patients is unlikely to have a detrimental medicolegal impact. Although these concerns need further analysis and evaluation, we encourage sharing images with patients as appropriate when indicated obstetric ultrasound examinations are performed.5
1. American Medical Association. E-8.062: Sale of Non-Health-Related Goods From Physician's Offices. Chicago, IL: American Medical Association; 1998.
2. American Medical Association. E-8.063: Sale of Health-Related Products From Physician's Offices. Chicago, IL: American Medical Association; 1999.
3. American College of Obstetricians and Gynecologists. Commercial Enterprises in Medical Practice. In: Ethics in Obstetrics and Gynecology. Washington, DC: American College of Obstetricians and Gynecologists; 2004 4. American Institute of Ultrasound in Medicine. Prudent Use. Laurel, MD: American Institute of Ultrasound in Medicine; 1999.
5. American Institute of Ultrasound in Medicine. Providing Images to Patients. Laurel, MD: American Institute of Ultrasound in Medicine; 1998.
For more information about the inappropriate use of ultrasound for entertainment purposes, visit the AIUM website at www.aium.org under "Patient Info," and then click on "Entertainment Ultrasound."
The American Institute of Ultrasound in Medicine is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation.