The following appeared in the March 1998 Issue of American Baby

Can You Read Me?

Ever notice how certain ultrasound technicians are consistently able to get a clearer picture or to offer you a better understanding of what you’re both looking at?

An ultrasound, or sonogram (the terms are interchangeable), uses high frequency sound waves -- similar to sonar, which ships use to see what lies under water -- to get a peek at your developing baby in the womb. Though ultrasound procedures are ordered and interpreted by your doctor, there are no laws mandating a minimum level of education, training, or experience for the individual technicians who actually obtain the images. This can be a real problem, whether you’re simply hoping to learn the sex of your baby or, more important, screening for abnormalities.

Responding to a rise in malpractice claims involving ultrasound, the Physician Insurers Association of America and the American College of Radiology issued a study, which revealed a diagnostic error in over 80 percent of the 472 claims they looked at:

In 40 percent of these cases, the sonogram failed to pick up an abnormality that was later confirmed.

In more than 70 percent, the ultrasound report failed to accurately document suspicious anomalies.

In 30 percent of cases, image quality was an issue.

Since the quality of the ultrasound can have such an impact on your doctor’s ability to detect abnormalities and anomalies, and since there are no laws to guarantee the expertise of the technician obtaining the image, it’s up to you to make sure your sonographer is qualified (see below "Testing Your Technician"). One way to do that is to look for credentials following his or her name. The initials RDMS indicate that your technician has passed two comprehensive exams given by the American Registry of Diagnostic Medical Sonographers (ARDMS), the only U.S. certifying organization for non-physician sonogram technicians. After you've ascertained his credentials, ask about his specialty. Given that he is conducting your prenatal ultrasound test, his specialty should be ob/gyn.

For doctors the ultrasound exam is a valuable and effective diagnostic tool. For parents it may have a more personal significance. "Some believe that women bond with their babies earlier when they have ultrasound," says Ella A. Kazerooni, MD, assistant professor of radiology at the University of Michigan Medical Center, Ann Arbor. Her paper, presented at the 83rd Scientific Assembly and Annual Meeting of the Radiological Society of North America, reported that of 318 women surveyed, 83 percent said they would worry less if an ultrasound came up normal. "When there’s reassurance things are okay, mothers tend to worry less, and the whole physical and emotional picture can affect their well-being."

An overwhelming 97 percent of the women said they expected to have an ultrasound, and 44 percent were willing to pay for it themselves if their insurance wouldn’t cover it. "There’s something about seeing the baby and taking home that first picture and showing everybody," Dr. Kazerooni adds.

If you will be undergoing an ultrasound exam, the brochure "Ultrasound: Who Is Qualified to Perform Your Exam?" is free; call 800-541-9754.

To read Dr. Applebaum's response to American Baby, click here.


Testing Your Technician

To ensure that your ultrasound exam is performed by a qualified technician, the ARDMS offers these tips:

Call ahead. Call the office where your exam has been scheduled and ask for the credentials of the technician who will be performing your study.

Ask again in person. When you are introduced to your ultrasound technician, ask again about her credentials. Many technicians are trained in X ray, nursing, or related fields, but this does not qualify them to perform ultrasound. Ask if she has credentials from the ARDMS.

Look for signs of certification. Check out the walls for certificates to see if there is one from the ARDMS. Some certified sonographers and vascular technologists wear ARDMS patches or pins on their lab coats or carry identification cards that indicate their specialties. Membership and education-program certificates show that your technician is keeping up with the changes in the field.

Evaluate your technician’s performance. Does she ask questions? A good technician will want to know about your medical history.

To read Dr. Applebaum's response to American Baby, click here.