There has been a lot written on the subject--a quick Google search yielded 188,000 hits. Tops on that list was ingender.com ("The straight truth about gender selection") which provides, among other things, articles on ways how to cope with the issue as well as a discussion forum. One suggestion is for parents-to-be to have a prenatal sonogram so that they can begin to deal with gender disappointment before the birth and, ideally, bond with their baby. This raises the issue of how sonographers deal with their patients--particularly those who are told that their baby isn't the gender they had hoped.

When I was asked if I could tell the baby's gender, I would usually attempt to have the patient tell me what they were hoping it would be. I would always qualify my reply by saying sonography is rarely 100 percent accurate. If the scan suggested they were going to get their wish it's easy, but if I thought the baby was not what they wanted I would sometimes say I wasn't sure (which wasn't always a fib). Fortunately, I never had a patient get too upset during her exam.

No one likes to be the bearer of bad news, so most experienced sonographers have developed their own manner of dealing with the issue. In many instances, the baby's gender is not identifiable and the sonographer can inform the patient of the scan's limitations. Of course, if your employer has an established policy regarding not disclosing fetal gender, you have an easy out and can just tell them that you are not allowed to discuss your findings.

In any case, I would appreciate hearing your experiences with patients whom you thought might have had gender disappointment as well as how you deal with the issue of gender disclosure--when the baby is what the parents hope for as well as when it's not. Perhaps your ideas and experiences can help others.  

Since October is both Medical Ultrasound Awareness Month and Breast Cancer Awareness Month, it seems fitting to extol the virtues of diagnostic medical sonography for breast applications.  In the past, sonographic examinations of the breast were primarily performed to determine if a previously detected mass was a cyst or a solid lesion. Thus, many in the field had low expectations of the modality and didn't consider it very important. However, as a result of significant advances in technology, improved classification systems and recognition of its diagnostic value, sonography is rapidly gaining a reputation as vital imaging modality in the fight against breast cancer. Of course sonography professionals already know this but The Breast Ultrasound Exam and Women's Health Information Hub is devoted to patient education about breast sonography.

Sonography has been proven to be particularly valuable for evaluation of patients with dense breast tissue and / or patients who have breast implants. Virtually all high-volume breast imaging centers include sonography services and some centers employ dedicated breast sonographers. Typically, sonography is used to gain additional diagnostic information about a lesion that is identified by palpation or mammography (i.e., a focused sonogram). However, there are reports that suggest there are benefits to using sonography for screening purposes. As described on The Society of Breast Imaging website, a published study that included 42,838 examinations from six centers found that "...screening breast sonography is capable of detecting some cancers that are undetected by mammography and physical examination."  

There have been vast improvements in image quality and advanced signal processing schemes that have resulted in more accurate assessments of lesions and improved detection of microcalcifications using conventional hand-held transducers. To improve and standardize diagnostic breast sonography interpretations the American College of Radiology developed a lexicon of descriptors and assessment categories called the BI-RADS® - US (The Breast Imaging and Reporting Data System - Ultrasound). The use of computer-aided diagnosis of breast scans is enhancing breast lesion detection and improving the interpretation of breast sonograms. 

An exciting area of technology is the commercial availability of automated breast ultrasound scanners. These systems utilize automated image acquisition techniques which produce volume data that can be viewed off-line on a workstation. Review of data on the workstation allows the interpreting physician or other operator to select specific image planes which may not be obtainable using conventional sonography as well as be more comparable to mammography images. Furthermore, the automated scanner would be ideal for screening sonograms.

The use of sonography has gone beyond examinations of breast lesions. As reported this month by Reuters Health, sonography of lymph nodes can reduce the need for surgery.  A study done in the United Kingdom and presented earlier this month at the 2009 Breast Cancer Symposium in San Francisco found that sonography combined with fine-needle aspiration cytology of lymph nodes (which can be done as an out-patient procedure) can obviate the need to perform surgical sentinel lymph node biopsies in nearly 30% of node-positive, early breast cancer patients. Unfortunately ultrasound-guided FNAC cannot accurately detect micro-metastases.

Described above are just a few of the recent advances in breast sonography. I believe that in the future sonography will be even more valuable in the fight against breast cancer.

Ideally, your employer has already made plans to celebrate MAUM, but if you or they still need ideas a good place to start is with a visit to the Society of Diagnostic Medical Sonography's website where you can download promotional materials, logos and purchase MUAM attire, buttons and other merchandise.

During MAUM the American Registry for Diagnostic Medical Sonography (ARDMS) is encouraging its Registrants to educate their patients about the importance of being certified and the different terms used in the profession (ultrasound, sonography, transducer, etc.). The ARDMS is also suggesting that its members encourage non-registered colleagues to become credentialed.

The American Institute of Ultrasound in Medicine is offering a free information kit, which includes an ultrasound fact and terminology sheet, a list of suggested activities, logos to use in promotional materials, and information on how to get the local media involved.

Cardiovascular Credentialing International also offers MAUM "Catch the Wave" merchandise for sale on their website as well as hyperlinks to other sonography organizations and the American Society of Echocardiography is offering an educational poster to celebrate MAUM.

I hope you will consider doing your part to promote our profession and that you and your co-workers receive the recognition you deserve from your employers. If so I'd love to hear what you have done and how your Department or office is celebrating MAUM.

Although these may seem like technicalities and would likely be overlooked by anyone not familiar with the field, there are a few concerning issues about this school based on the information it provides on its website. First, the term "Diagnostic Medical Ultrasound" is not commonly used to describe a Diagnostic Medical Sonography educational program, and secondly, the "ARDMS" stands for American Registry FOR Diagnostic Medical Sonography (not "of" Medical Sonography). If a school can't even get those facts correct how reliable can it be to provide accurate information regarding the qualifications of its graduates?

I have written about this situation before (see "Students Beware"). In that post I described a few suggestions for students when selecting an educational program and I think they are worth repeating:

1. Get job placement records from the school but don't rely on this information alone. Ask for the names of former students and talk to them about their experiences in landing a job after school. Reputable schools will be happy to provide you with the names of former students. If the school is reluctant to offer this information they may be trying to hide something.
2. Check the prerequisites of the sonography certifying bodies (American Registry for Diagnostic Medical Sonography or Cardiovascular Credentialing International) and make sure that the school's curriculum and accreditation standing meet those prerequisites.

In my previous post I neglected to mention that CAAHEP provides an up-to-date list of accredited schools and it is very easy to check a program's status by simply checking the CAAHEP website (In case you are wondering, when I checked the Modern Technology School in Fountain Valley was not listed as CAAHEP accredited).

The take home message from this and similar stories of students not getting what they expected from a DMS program is that prospective students must do their own research when considering which school to attend and not rely solely on the information provided to them by representatives of the school. The choice of a career and the educational program to enter is extremely important. As in all important choices in life, its your responsibility to practice due diligence or risk the consequences. Although this may not be relevant to you if you are already a sonography professional please consider sharing this information with anyone who may ask you about DMS educational options.  

The physician who inserted the central venous catheter into the patient's jugular vein used a commonly practiced 'landmark' technique (i.e., using anatomical landmarks and palpation to determine where to insert the line) but the United Kingdom's National Institute for Health and Clinical Excellence guidelines recommend using ultrasound imaging guidance (USG) to reduce the risk of complications.

The 20 year old experienced internal bleeding and lost two liters of blood. She died less than two hours after the IV procedure.

This is an example of how the "insight" into the human body provided by the use of ultrasound technology (which, according to the article, was available at the time of the procedure) can easily prevent a catastrophe.

Obstetricians would rarely consider doing an amniocentesis without USG and the number of procedures where USG is becoming the norm as opposed to an option is growing all the time. As early as 2001 the United States' Agency for Healthcare Research and Quality (AHRQ) recognized the use of USG for central line insertions as an important means to reduce the rate of complications. Currently there are portable scanners available that are specifically designed for this purpose and nurses as well as other healthcare practitioners are trained in their use.

With the development of low-cost, highly portable and easy to use ultrasound scanners, the use of USG for everything from thyroid biopsies to bedside line insertions just makes sense - and in some cases it can save lives.  

SDMS Foundation's Sonography Certification Examination Grant Program

As announced in the Society of Diagnostic Medical Sonography's August Newswave, the SDMS Foundation has recently announced that Florida Hospital College of Health Sciences will provide funding for the SDMS Foundation's Sonography Certification Examination Grant Program to help the Foundation provide grants to deserving sonography students and sonographers.

Students and sonographers who are SDMS members can apply for a grant and those who successfully complete a sonography registry examination receive $250 that may be used for any expenses related to the examination (e.g., exam fees, travel expenses, study materials, etc.). The grant award also includes a free copy of the "SDMS National Certification Examination Review Series" book to assist in preparing for the certification examination.

The SDMS Foundation's certification examination grants are available for recent graduates of sonography programs as well as experienced sonographers who wish to gain additional credentials. The application deadline is September 30, 2009 and awardees must complete their certification exams by December 31, 2009.

For more information about this grant program click here  or go to: http://www.sdmsfoundation.org/programs.htm

According to the Bill's wording, it is "... in response to the situation in which persons are acquiring and using ultrasound equipment for nonmedical purposes without a physician's prescription or the proper training."

Although the intent of this bill is to prevent the use of ultrasound technology for nonmedical purposes (i.e., entertainment scans) unfortunately, it doesn't specifically prevent people from performing entertainment scans, it only prevents the sale of equipment for that purpose. Unless I am missing something, the NJ Bill is not really necessary since (as it states) "Ultrasound equipment is designated by the federal Food and Drug Administration as a prescription medical device and should be used to monitor the growth and development of a fetus only by trained personnel." The FDA already has restrictions in place to limit the sale of ultrasound equipment to physicians and we all know how ineffective they are in preventing entertainment services from operating around the country.

A much better approach to put an end to obstetrical entertainment ultrasound services was recently passed in Connecticut (see my previous post about the CT law here) which specifically prevents the use of ultrasound for entertainment purposes.

I suppose the NJ Bill is a step in the right direction but it will be interesting to see if its any more effective than the existing FDA regulations at putting a stop to entertainment ultrasound in the Garden State.

From my experience performing OB scans, parents-to-be who want to know the gender of their baby outnumber those who don't. When my wife was pregnant neither of us gave it a second thought - we were going to know if we were having a boy or girl as soon as we could. That might sound logical coming from a sonographer but then again I'm surprised at the number of sonographers who choose not to know their baby's sex before birth. I've always found it interesting to hear the rationale "We want to be surprised." - as if a birth isn't a big enough surprise already.

My personal belief is that knowing if you are having a girl or boy before they are born allows you to prepare both mentally as well as materially (buying clothes, etc.) and it makes choosing a name a whole lot easier too. Thus, I completely understand why it ranks so high on patients' reasons to have an OB sonogram even if it isn't a "legitimate medical indication".  

If you perform obstetrical sonograms, one thing is sure: you will frequently be asked by your patients to tell them if they are having a boy or a girl. Sometimes it's a loaded question in that if you tell them that you think it's a boy, but they are "carrying high" (or whatever other old wives' tale they believe in) or a fortune teller told them they are having a girl they might think you lack the necessary skills needed for gender determination. Likewise, if you tell a first-time dad that the baby he expects to grow up and become a NFL football player is a girl he'll insist it isn't so.

I had a funny experience once when assisting an amniocentesis on the wife of a very well-known pro baseball player. Of course, they wanted to know their baby's sex and when I told them it looked to me like it was a boy the husband got really excited. He let out a whoop, slapped me on the back and thanked me so much you would have thought that I had something to do with making the baby! When I performed early OB scans in a fertility office I would often get asked if I could tell the sex of a 7-week embryo (usually by the husband). After explaining the limitations of the scan, my reply to the couple - some of which had gone through many months of treatment - was "Does it matter?"  That usually put things in perspective.

Suffice it to say, just like most of medicine, our patients often do some on-line research before they come for their examinations. They arrive for their OB sonograms prepared and know what we are looking for, like major structural defects and the size of the baby, and sometimes demand certain services even when they are not warranted (e.g., 3D / 4D scans).

Case-in-point: I recently found a site with a blog that described how patients can decipher the sonograms of their fetus to help them distinguish "boy parts" (referred to as turtle heads) from "girl parts" (called hamburgers). Oh - if only it was so easy...

Take a look for yourself here or at the link below in case your next OB patient sees a turtle head but you see a burger.

http://www.examiner.com/examiner/x-608-Early-Childhood-Parenting-Examiner~y2009m4d3-Boy-ultrasounds-and-girl-ultrasounds--whats-what-with-a-photo-slide-show

A new urine test was developed that claims to be 80% accurate in identifying the sex of a fetus - read about it here: http://cbs4.com/health/intelligender.unborn.baby.2.1125072.html

A recently released medical ultrasound technology market report provides good news for manufacturers of ultrasound imaging (US) equipment. Sales of US scanners world wide is expected to reach $4.7 billion by the year 2012 with a particularly high demand for hand-carried (i.e., compact) scanners. The growing use of sonography by a variety of new users such as those in anesthesia, sports medicine, emergency medicine and other disciplines was cited as a major contributing factor in sales. Additionally, the demand for US (and other imaging) equipment will continue to rise as a result of the world's aging populations and longer life expectancies. The increased use of sonography in developing countries (where more costly modalities are cost-prohibitive) is also contributing to the growing the demand for US equipment.

The attractiveness of hand-carried scanners, which has been on-going for several years, is related to these scanners’ low cost, ease of use and portability. Additionally, the quality of images produced by compact scanners continues to improve making these small units attractive to both traditional imagers as well as new users who may not be well trained.

Read more about the market report here.

A new Texas law requires coronary artery calcium (CAC) scans and duplex carotid sonography examinations for ALL men ages 45-75 and women ages 55-75, as well as anyone regardless of age who has diabetes or is considered at risk for heart disease. That might sound like good news for both patients as well as healthcare providers but there are several problems with the concept.

First of all, there are no scientific studies that have concluded that this type of screening improves health outcomes. In fact, a U.S. Preventive Services Task Force does not advocate routine CAC screening and the American Heart Association recommends its use only for selective patients.

Another problem of wide-spread screening is that it subjects patients to potentially unnecessary risks in the form of radiation exposure and the possibility of detecting disease that may not pose a health problem (i.e., false positive exam results) and could lead to additional, costly examinations or procedures that carry their own risks.

An online article on Star-Telegram.com described the new Texas law as “a classic case of marketing and advocacy preceding science.” The article describes how the Texas law came about as a result of Texas State Rep. Rene Oliveira’s health problems and numerous conflict of interest issues that combined beg for greater scrutiny and at least additional consideration and perhaps even a reversal of the new legislation.

But as of September 1, 2009 when the new law takes effect or soon after, Texans will be paying higher insurance premiums because their carriers will be required to pay for screening of healthy patients. Additionally, the Texas healthcare system (which, if its like a lot of areas of the country, is already limited in its ability to accommodate patient needs) will be forced to provide screening exams for thousands more patients. My guess is that the non-invasive vascular labs in Texas won't be able to keep up with the demand.

Lastly there are costs to consider: According to the Star-Telegram piece, the U.S. Preventive Services Task Force estimates that about 4,348 people would have to be screened to prevent one stroke after five years. Twice that many, or 8,696 people, would need to be screened to prevent one disabling stroke. Applying the new Texas mandate of $200, finding one stroke would cost more than $869,000, and more than $1.7 million would be spent to prevent the disabling stroke.

This sure doesn’t sound like a good step towards health care reform to me.

Read more about the Texas law here:

http://www.star-telegram.com/news/columnists/steve_jacob/story/1506573.html

The bill will require sonographers working in Oregon to become licensed by the newly reorganized Oregon Board of Medical Imaging (OBMI) effective July 1, 2010. Beginning January 1, 2014, all sonography licensees would be required to hold a national sonography credential or be enrolled as a student in a sonography program.

Registered sonographers should welcome these new laws and encourage similar legislation in their states. Licensure laws combined with tighter restrictions on the use of keepsake obstetrical scanning could prove beneficial for both the profession as well as our patients.

Dr. Steve Smith, one of the Duke investigators, was quoted as saying "Eventually you could have a $10 biopsy done inside in a supermarket."  What's next, an automated kiosk at the mall where you can get a 50-cent gallbladder sonogram?

Read more about the Duke robotic research here:

In my last post I described a bill that was pending in Connecticut that would ban businesses that provided entertainment obstetrical sonograms. As an update: Connecticut's Governor M. Jodi Rell last week signed the bill into law. According to a story in the New Haven Register, the law was passed "...out of concern that businesses that offer ultrasounds to parents-to-be as keepsakes are potentially endangering the fetus."

Typically, in the past, these "keep-sake" sonography services would require a customer (they cannot be considered "patients") to provide a note from their OB doctor indicating that they had received a legitimate diagnostic scan. Although in most cases the parents-to-be would be informed that the pretty-pictures scan was not for diagnostic purposes many lay people didn't know that the individual performing the scan may not have had any medical training. Thus, not only wouldn't these untrained probe-holders be able to recognize an abnormality (if one was present), they also had no obligation to inform the customers of potentially life-threatening issues. Entertainment scans could, therefore, provide customers with a false sense of security regarding their pregnancies.

The new law, to my knowledge the first of its kind in the USA, requires an obstetrical sonogram to be "ordered by a licensed health care provider ... for a medical or diagnostic purpose".

It will be interesting to see how effective it is in shutting down the entertainment sonography businesses. Connecticut is a small state. How long will it be before the entertainers set up shop just over the state's borders with New York and Massachusetts?

According to a Food and Drug Admin­istration's Consumer Health Information report entitled Taking a Closer Look at Ultrasound, "Ultrasound equipment is regu­lated by the Food and Drug Admin­istration's (FDA) Center for Devices and Radiological Health (CDRH). Ultrasound imaging devices are approved for use only with a pre­scription. Information accompany­ing the devices explains the risks and benefits of the approved uses. However, FDA does not regulate how health professionals actually use the equipment."   

Another FDA document warns the public to Avoid Fetal "Keepsake" Images, Heartbeat Monitors: "The use of ultrasound imaging devices for producing fetal keepsake videos is viewed as an unapproved use by the FDA. Doppler ultrasound heartbeat monitors are not intended for over-the-counter use. Both products are approved for use only with a prescription."

But the FDA's warnings and regulations have done little to stop the proliferation of entertainment OB services (an unfortunate example of supply meeting demand), and while the legitimate health care industry is suffering from the impact of state and federal funding cut-backs and the overall economic down-turn, the demand for non-medical obstetrical sonograms continues to grow.

But recently, the use of sonography for entertainment purposes has gained the attention of lawmakers in Connecticut. A new bill, HB-5635 titled "AN ACT CONCERNING ULTRASOUND PROCEDURES FOR MEDICAL AND DIAGNOSTIC PURPOSES," threatens to ban all non-medical sonograms.

It will be interesting to see how this precedence-setting measure impacts the OB entertainment industry in this country as well as around the world.

Well, here is even more reason to smile, and maybe even raise your glass in cheer at your favorite watering hole (after work, of course): Yet another report has indicated that the field of sonography is one of the best "well-paying, satisfying professional jobs...begging for qualified applicants."

According to a story on Yahoo Hot Jobs, "health care is a huge and multifaceted field with a wide range of opportunities." Although the story specifically mentions diagnostic cardiac sonographers as being in high demand, numerous other recent reports have indicated that all sonography sub-specialties will experience good growth and employment security.

According to the U.S. Government's Bureau of Labor and Statistics, sonographers earned a median annual salary of $57,160 in May 2006, while the highest 10 percent earned more than $77,520.

Read more about what the BLS has to say about the medical sonography professions, including the job outlook and earning potentials, in the BLS Occupational Outlook Handbook.