Obstetric ultrasonography: a biophysical consideration of patient safety--the "rules" have changed

We address the issue of health and safety in relation to exposure to diagnostic ultrasound, with particular emphasis given to obstetrics. In terms of fetal and maternal outcomes, the epidemiologic record of diagnostic ultrasound is exemplary but is primarily made on the basis of data derived from clinical devices whose outputs were relatively low compared with what is now allowable and available. The power outputs of clinical devices have been increasing over the past decade such that the potential for thermal and nonthermal insults is increased. For obstetric devices that use these higher outputs, the Food and Drug Administration now requires the presentation of 2 on-screen indexes, the thermal index and the mechanical index, in recognition of the 2 major mechanisms by which ultrasonography is known to affect cells and tissues. Greater responsibility for patient safety is now placed on the diagnostician; for the new indexes to be meaningful the diagnostician must be cognizant of the health and safety implications. The purpose of this article is to provide some guidance to the obstetrician in interpreting the indexes and to review the current status of ultrasonography biophysics in relation to the use of diagnostic ultrasound in obstetrics.