Jury still out on safety of 4-D ultrasounds

WEST PALM BEACH, Fla. — Bring your popcorn and a Coke. Relax and "see your unborn baby in live 4-D motion on a 100-inch screen. Our ultrasound theater can seat 10 family members."

A Tampa imaging center, Storksview Ultasound, runs this ad online. That's the kind of hype that's probably a bit more than most prospective parents need to entice them to see, and buy, amazing photos and videos of their baby, before birth.

"When they come to determine a gender, they bring the grandmother, father, the whole family; it's a very joyful experience for the sonographer and for the mothers. The energy is very happy," says Lorraine Salt, owner of the Look Who's Kickin' Ultrasounds imaging center in Delray Beach, Fla.

What's unique about these centers is that they use sophisticated, 4-D ultrasound equipment that can show the fetus moving around. A 3-D ultrasound takes thousands of images at once that are stored and shaded to make a 3-D image. A 4-D, however, also shows movement.

Ultrasound machines use sound waves, not radiation, that bounce back from the organ or fetus that is being scanned. Those waves are converted into images. Unnecessary procedure?

Not everyone is a fan of this fad. And imaging center operators like Salt are also cautious and have rules. The American College of Obstetricians and Gynecologists, for example, says these keepsake videos may be subjecting the fetus to unnecessary procedures when the ultrasound is performed for other than a medical or diagnostic reason.

"Not much is known about the effects of repeated exposure to ultrasound," ACOG posts on its Web site, www.acog.org. "It seems to be safe, but it is possible that problems could be found in the future."

The Institute of Ultrasound Medicine seemed particularly concerned in 2005 when actor Tom Cruise purchased an ultrasound machine so he and his fiancée, Katie Holmes, could do their own sonograms.

"Purchase of an ultrasound machine for private, at-home use," the association said, "entails inappropriate operation of a prescription medical device designed for diagnostic use by a trained medical professional," the group said in a statement issued at the time. That's one consideration.

Proper training stressed

The second is that even some centers may not have trained ultrasound technicians who can interpret images correctly in case something seems wrong with the baby.

That's also a concern of Delray's Salt, who is a licensed sonographer who has worked for Bethesda Memorial Hospital in Boynton Beach and JFK Medical Center in Atlantis.

"I use the lowest reasonable settings on the machine to achieve the best result," she says. "Not to say anything against anybody else, but anybody who is operating an ultrasound should be a registered technician."

There are operators, she said, who have opened centers without registered technicians "skilled in the machine."

She, and other members of the Look Who's Kickin' franchise, insist that the mothers on whom they perform ultrasounds be under the care of an obstetrician and have already had diagnostic imaging before they come in.

Salt knows that it's possible she will see something a mom would be shocked to know because she's trained to do so.

One mother who came in for a keepsake ultrasound already knew from prior diagnostic testing that her child had a clubfoot, so it was a non-issue for Salt. Beyond diagnostic use, when doctors utilize these expensive 3-D or 4-D machines as part of a medical practice, they can occasionally be used for keepsake videos.

Dr. John Burigo of Ob/Gyn Specialists of the Palm Beaches in West Palm Beach, Fla. in says his practice has equipment that allows 3-D ultrasound in all his office locations. But he stresses that the first priority for their use should be medical.

"Some patients may request an opportunity to see their baby's facial profile. This is not encouraged since there is no medical necessity ... although ultrasound has been performed for many years, and there is no evidence that it is harmful, we recommend that it be used for the medical purposes it was designed for."

Even doctors provide keepsakes

But when push comes to shove, his patients can get the photo album and video variety of pre-birth photos.

"When it is done, patients are provided with still pictures, a DVD and video clip, in most instances. Utilization of this service is not common and is limited to patients of our own practice. We are not in the business of fetal photography," Burigo said.

But he added that "we do strive to be as accommodating to our patients as possible. The cost is $250 plus tax." (Insurance, by the way, doesn't cover this elective procedure.)

Salt feels strongly that the imaging is safe for the fetus.

"There are no proven biological ill effects ... 4-Ds have been on the market five years with no proven detrimental effects. (The imaging) helps the mother bond with her child. The face, heartbeat - it creates a very strong sense of bonding with the baby."

And at $199 for her deluxe package of DVD and photos, this way of bonding might seem cheap at twice the price.

Carolyn Susman writes for The Palm Beach Post.