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Obstetrical Ultrasound: Application in a Clinic Setting
letters Obstetrical Ultrasound Application in a Clinic Setting
We are writing to comment on several statements in the article by Lewis and Mocarski, “Obstetrical Ultrasound: Application in a Clinic Setting” (JOGNN January/ February 1987) that lend themselves to misinterpretation. The areas that concern us follow. On page 56, the authors state that ultrasound has overcome many of the diagnostic limitations associated with ionizing radiation. But on page 59, under “Nursing Implications,” the authors state that nursing personnel “should be aware that ultrasound performed during 16 and 26 weeks allows for accurate gestational dating. This avoids exposing the fetus to low dose radiation during the first critical weeks of development.” This statement may be misinterpreted to mean that radiation is involved in a sonogram. In fact, there is no radiation exposure during a fetal ultrasound. On page 56, the authors state that “some fetuses may suffer deleterious effects at dosages proved innocuous to most populations.” We are not aware of any published experimental o r clinical data to support this statement. Unreferenced, this statement may be misinterpreted. The authors also recommend that the examiner meet requirements for uniform credentialling.
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A reference as to the criteria for such certification would be very important for this statement. We are not aware that either guidelines or standards are published for this recommendation.
JOSEPH A~uzzio,MD Associate Professor, Department o f Obstetrics & Gynecology University of Medicine and Dentishy, Newark, New Jersey
KATHLEENK. FURNISS, RNC, MSN Perinatal Outreach Education Coordinator University of Medicine and Dentistry, Newark, New Jersey Authors’ Reply We regret that some of our statements a r e viewed a s lending themselves to misinterpretation. Radiation is involved in a sonogram. However, an important difference exists between ionizing radiation and ultrasonic radiation. Webster defines radiation as “energy radiated in the form of waves o r particles.” Ultrasound involves the use of pressure waves propagated in a medium at frequencies which a r e above t h e normal ranges of human audibility. Richard T. Thomson writes “ultrasound is a form of radiation, and no one can say for certain that it is harmless.”’ Although ultrasound is considered a form of radiation, ultrasonic radiation is not t h e same as ionizing radiation.
We regret our error in not referencing the statement, “Some fetuses may suffer deleterious effects at dosages proved innocuous to most populations.” As Michael Haupt, et al. write, “A few individuals (fetuses) may lack the capacity to respond normally to ultrasound, thus showing deleterious effects at dosages that prove innocuous to most in the population.”’ Ultrasonographers are currently credentialled through a national examination given by the American Registered Diagnostic Medical Sonographers. To qualify for this examination, candidates need one year’s clinical experience in ultrasonography and are , required to participate in a oneyear ultrasound educational program. CLAUDIALEWIS,RN, MS, CNS Certified Clinical Nurse Specialist, Mount Sinai Hospital, Hartford, Connecticut VIRGINAMOCARSKI, RN, MS, CNA Nurse Coordinater, Mount Sinai Hospital, Hartford, Connecticut REFERENCES 1 . Thomson, R.T. 1983. The unknowns of ultrasound. FDA Consumer, March. 2. Haupt, M. et al. 1981. Ultrasonic induction of sister chrornated exchanges in human lymphocytes. Human Genetics 59:221-26.
September/October 1987 JOGNN
We are writing to comment on several statements in the article by Lewis and Mocarski, “Obstetrical Ultrasound: Application in a Clinic Setting” (JOGNN January/ February 1987) that lend themselves to misinterpretation. The areas that concern us follow. On page 56, the authors state that ultrasound has overcome many of the diagnostic limitations associated with ionizing radiation. But on page 59, under “Nursing Implications,” the authors state that nursing personnel “should be aware that ultrasound performed during 16 and 26 weeks allows for accurate gestational dating. This avoids exposing the fetus to low dose radiation during the first critical weeks of development.” This statement may be misinterpreted to mean that radiation is involved in a sonogram. In fact, there is no radiation exposure during a fetal ultrasound. On page 56, the authors state that “some fetuses may suffer deleterious effects at dosages proved innocuous to most populations.” We are not aware of any published experimental o r clinical data to support this statement. Unreferenced, this statement may be misinterpreted. The authors also recommend that the examiner meet requirements for uniform credentialling.
298
A reference as to the criteria for such certification would be very important for this statement. We are not aware that either guidelines or standards are published for this recommendation.
JOSEPH A~uzzio,MD Associate Professor, Department o f Obstetrics & Gynecology University of Medicine and Dentishy, Newark, New Jersey
KATHLEENK. FURNISS, RNC, MSN Perinatal Outreach Education Coordinator University of Medicine and Dentistry, Newark, New Jersey Authors’ Reply We regret that some of our statements a r e viewed a s lending themselves to misinterpretation. Radiation is involved in a sonogram. However, an important difference exists between ionizing radiation and ultrasonic radiation. Webster defines radiation as “energy radiated in the form of waves o r particles.” Ultrasound involves the use of pressure waves propagated in a medium at frequencies which a r e above t h e normal ranges of human audibility. Richard T. Thomson writes “ultrasound is a form of radiation, and no one can say for certain that it is harmless.”’ Although ultrasound is considered a form of radiation, ultrasonic radiation is not t h e same as ionizing radiation.
We regret our error in not referencing the statement, “Some fetuses may suffer deleterious effects at dosages proved innocuous to most populations.” As Michael Haupt, et al. write, “A few individuals (fetuses) may lack the capacity to respond normally to ultrasound, thus showing deleterious effects at dosages that prove innocuous to most in the population.”’ Ultrasonographers are currently credentialled through a national examination given by the American Registered Diagnostic Medical Sonographers. To qualify for this examination, candidates need one year’s clinical experience in ultrasonography and are , required to participate in a oneyear ultrasound educational program. CLAUDIALEWIS,RN, MS, CNS Certified Clinical Nurse Specialist, Mount Sinai Hospital, Hartford, Connecticut VIRGINAMOCARSKI, RN, MS, CNA Nurse Coordinater, Mount Sinai Hospital, Hartford, Connecticut REFERENCES 1 . Thomson, R.T. 1983. The unknowns of ultrasound. FDA Consumer, March. 2. Haupt, M. et al. 1981. Ultrasonic induction of sister chrornated exchanges in human lymphocytes. Human Genetics 59:221-26.
September/October 1987 JOGNN