Safety Aspects of Perinatal Ultrasound

Abstract

Ultrasound safety is of particular importance in fetal and neonatal scanning. Fetal tissues are vulnerable and often still developing, the scanning depth may be low, and potential biological effects have been insufficiently investigated. On the other hand, the clinical benefit may be considerable. The perinatal period is probably less vulnerable than the first and second trimesters of pregnancy, and ultrasound is often a safer alternative to other diagnostic imaging modalities. Here we present step-by-step procedures for obtaining clinically relevant images while maintaining ultrasound safety. We briefly discuss the current status of the field of ultrasound safety, with special attention to the safety of novel modalities, safety considerations when ultrasound is employed for research and education, and ultrasound of particularly vulnerable tissues, such as the neonatal lung. This CME is prepared by ECMUS, the safety committee of EFSUMB, with contributions from OB/GYN clinicians with a special interest in ultrasound safety.

Frame Rate Exposimetry for Pulmonary Capillary Hemorrhage During Lung Ultrasound

“…However, LUS in neonatal patients may have similar exposimetric conditions as rats, with a 2–8 mm range of CWT 20 . A prudent safety recommendation for neonatal LUS is to limit the B mode MI OS ≤0.3, 7 which could be facilitated by the creation and use of safe neonatal imaging presets.…”

“…This exposure quantity is important because the regulatory Mechanical Index is presented on screen (MI OS ) for many ultrasound machines, thus providing an indicator of ultrasound exposure for sonographers. Prudent of use of lung ultrasound in patients should include consideration of possible PCH occurrence and use of the recommendation that LUS should be conducted with MI OS ≤0.4 or 0.3 in vulnerable patients 6,7 . Lower Mis are also suggested to avoid compromising the quality of the lung surface image due to saturation phenomena 8 .…”

“…Prudent of use of lung ultrasound in patients should include consideration of possible PCH occurrence and use of the recommendation that LUS should be conducted with MI OS ≤0.4 or 0.3 in vulnerable patients. 6,7 Lower Mis are also suggested to avoid compromising the quality of the lung surface image due to saturation phenomena. 8 If output >MI OS is needed for optimal imaging, then the practice of the As Low As Reasonably Achievable (ALARA) principal is recommended.…”

Ultrasound, the handyman serving our whole populations in the post COVID-19 pandemic

“…For instance, if we consider the ages of the population, these articles show how ultrasound is regularly utilized with great benefit at any time of the human life. Its use spans from the very early times, like the prenatal intrauterine conditions [1], moving to the perinatal period [2], the adult life [3,4], times at which CT or MRI are scantly of any use and finally to the disease of the elderly, such as Alzheimer's dementia [5]. Not only applications of ultrasonography cover the entire spectrum of human life in terms of time, but the size and price of the scanners range from relatively large top level scanners movable only on wheels, where the newest advanced technologies can be implemented [3] and valued over 100 000 Euros, to pocket size scanners, which are conveniently utilized at the bedside [6] and easily held in one hand.…”

“…Betrachtet man beispielsweise das Alter der Bevölkerung, so zeigen diese Arbeiten, wie Ultraschall regelmäßig und mit großem Nutzen in jeder Lebensphase angewandt wird. Sein Einsatz erstreckt sich von den sehr frühen Phasen, wie den pränatalen intra-uterinen Erkrankungen [1], bis zur Perinatalperiode [2], dem Erwachsenenalter [3,4], Zeiten, in denen CT oder MRT kaum von Nutzen sind, bis hin zu den Erkrankungen im Alter, wie der Alzheimer-Demenz [5]. Die sonografischen Anwendungen decken nicht nur die gesamte Zeitspanne eines menschlichen Lebens ab.…”