Sonographers in hospital, private settings debate elective ultrasound

By Matt Mattei - [email protected] | July 25th, 2017 6:00 am

Editor’s note: Dr. Alfred Casale’s regular column, ‘To Your Health,’ does not appear in this print edition of the Times Leader. The column can be read online at timesleader.com, and ‘To Your Health’ will return to print next Tuesday.

The use of ultrasound technology to render three-dimensional keepsake imagery of babies in fetal stages of development is a fervently debated topic among traditional ultrasound technicians and 3D imagery business owners.

But the two sides of the argument may not be as black and white as they seem at first glance.

A group of local sonographers is adamantly opposed to elective ultrasound, and they have decades of experience and the Food and Drug Administration in their corner, but at least one business owner in the Wyoming Valley has made a case that the practice shouldn’t be condemned.

Janine Oliveri, of Forty Fort, has practiced sonography for over 36 years. From 2000 to 2001, she assisted in writing the diagnostic medical ultrasound program curriculum at Misericordia University in Dallas Township, and from 2004 to 2006, while employed as the program director and instructor for the vascular program at Lackawanna College in Scranton, Oliveri helped the vascular program become accredited and started the diagnostic medical ultrasound program.

Conventional medicine

Oliveri aligns with the FDA’s statement, available at bit.ly/2tmrdmy, that “the use of ultrasound for non-medical purposes such as obtaining fetal ‘keepsake’ videos has been discouraged.”

The FDA’s stance is concurrent with that of the American Institute of Ultrasound in Medicine, the Society of Diagnostic Medical Sonographers and the American College of Radiology, organizations of which Oliveri is a member.

Oliveri said she and other sonographers in the medical field are concerned that a lack of professionalism and regulation in the private sector of elective ultrasound can be dangerous for clients.

She and three of her tenured colleagues — Marianne West, of Wilkes-Barre, Henrietta Whipple, of West Wyoming, and Stephanie McDaniels, of Drums — have prepared letters to Pennsylvania state representatives and were among 135 technologists who signed a petition between 2009 and 2010 requesting legislation be passed outlawing keepsake imagery in the state — a movement that was already successful in Connecticut.

“These types of businesses have no regulations,” Oliveri said of 3D imagery operations. “They’re not overseen by physicians. There are no regulations put on the time of exposure or the power being used.”

Ultrasound imaging utilizes high frequency sound waves, and although these waves do not present the same risks as X-rays, which expose patients to ionizing radiation, ultrasound waves can heat body tissue and cause cavitation, gas pockets in body tissues or fluids.

“If you’re doing an ultrasound on a pregnancy in a hospital setting or outpatient clinic, there’s a certain amount of time you set aside to get appropriate images to make a diagnosis,” Oliveri said.

Oliveri argues that the pop-up industry of 3D keepsake imaging has bred an environment in which people with no training or education can pose as professionals after buying the proper equipment.

Smarterfinanceusa.com will show you how to start a 3D ultrasound business,” Oliveri said in reference to a website that shows people how to procure ultrasound units and take four-day crash courses in the operation of those units. “They’ll train you, and within a week, you’ll be up and running.”

Oliveri is also opposed to the use of dopplar fetal heart monitors to listen to a baby’s heartbeat, a practice common at keepsake imagery businesses.

“We’re taught, when we’re doing a diagnostic ultrasound, to not use dopplar on the fetus if it’s not necessary,” Oliveri said. “You don’t have to (expose them to) the extra energy to hear the heartbeat.”

In addition, Oliveri said, keepsake operations give clients a false sense of security because customers assume they are getting a diagnostic exam when their ultrasound is purely for the sake of rendering an image.

“There have been reports that abnormalities have been present that haven’t been reported,” Oliveri said.

Elective ultrasound technicians, however, are not under obligation to perform diagnostic procedures, and Oliveri’s issue lies with a lack of communication between business owners and uniformed clients.

In line with the various American health agencies she agrees with, Oliveri takes a firm stance that medical equipment should be used only for medical reasons.

“Right now, there’s no evidence of harm to the fetus (from elective ultrasound),” she admitted, “but who knows in the future. I feel the public should be aware. It’s all about patient safety and upholding the highest standards. I take my profession very seriously.”

3D keepsake imaging

Shannon Shovlin owns Baby To Be 3D in Plymouth Township. She is also the licensed sonographer that operates the business, and she shares the philosophy that ultrasound can be harmful in the hands of an untrained person.

“I 100 percent agree with their stance on that,” Shovlin said. “That’s a huge issue for me as well. Ultrasound is a profession. It’s an art and a skill, and it takes a lot of practice and dedication.”

Shovlin earned a degree in diagnostic medical sonography from Misericordia University in Dallas Township and is certified in her field. She points out that even after the proper education she still “had so much more to learn in the professional setting.”

She was employed at a local hospital in March of 2010 and spent seven years in the hospital setting before leaving in May.

While Shovlin concedes that pregnant mothers should not be overexposed to ultrasound, she believes that minimal elective ultrasound in addition to minimal prescribed procedures can constitute low-risk practice.

“I use the same machine setting that the hospital would use,” Shovlin said. “It has the lowest amount of frequency possible going to that baby.”

Shovlin also points out the irony that the highest risk pregnancies often warrant the most frequent ultrasounds.

“I myself had a high-risk pregnancy,” she said. “I had maternal anemia and that caused my baby to be small. Smaller babies have a higher risk of in-utero deaths. I had ultrasounds regularly to make sure he was moving.”

But Shovlin’s target clientele consists of low-risk women who have healthy babies.

“They’re going to have one scan (in a medical setting) to make sure development is OK,” she said. “I’m more going for women who are only going to see their baby once.”

Shovlin said most of her clients visit twice, once to learn gender, which is a 10-minute procedure, and again in the third trimester for a 3D image of the child’s face. More than half, she said, only visit once.

“My longest package is set at 30 minutes,” Shovlin said. “If your baby doesn’t cooperate, you can come back for an additional session if you chose to.

“It’s quicker than some scans at the hospital. When you have an anatomy scan, they give you one hour to do it.”

Shovlin also said the fetal dopplar procedure she uses to let clients hear their babies’ heartbeats only lasts three to five seconds.

“It’s the same amount of energy as the little dopplar probe your doctor uses to check the heartbeat during prenatal checkups,” she said.

Her equipment, she said, is updated and serviced by a local company to maintain safety standards.

The business owner makes clear that the nature of elective ultrasound is strictly to render imagery.

“We are not looking at anatomy. I’m not checking for heart and brain defects,” Shovlin said. “That’s what your doctor provides you. My clients know that going in. They sign paperwork.”

Shovlin said she is adamantly opposed to the irresponsible and untrained use of ultrasound.

“I signed a petition in 2009 to shut down a business by two sisters who took a one-week crash course and opened up,” she said. “I’m against that.”

She’s also transparent about the unknown variables of her practice.

“I get that I’m the practitioner that’s not doing what the FDA recommends,” Shovlin said. “I don’t want to fool people into thinking it’s (completely) safe. I just want to use the skills and talents I have to provide an experience for families they wouldn’t get elsewhere.”

After seven years in a hospital setting, Shovlin said, she performed many “in-and-out” procedures which left little time for expectant mothers to see their babies.

“If ultrasound is in the right hands, it’s a breathtaking experience,” Shovlin said.

To this day, she said, she shares some of the opinions of people who oppose her.

But, “It’s a free country,” Shovlin said.

Oliveri, however, is steadfast in her judgment of using ultrasound to produce keepsake imagery.

“I would change my opinion if the professional organizations I belong to would change their position statements on it.”

Brandon Frame feels for his daughter Pheonyx Marie during a 3D ultrasound in Baby To Be 3D in Plymouth. Baby To Be owner Shannon Shovlin said her intention is to provide an experience for families they can’t get in a medical setting.
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound2.jpgBrandon Frame feels for his daughter Pheonyx Marie during a 3D ultrasound in Baby To Be 3D in Plymouth. Baby To Be owner Shannon Shovlin said her intention is to provide an experience for families they can’t get in a medical setting. Sean McKeag | Times Leader
Owner Shannon Shovlin performs a 3D ultrasound on Kim Barret while the baby’s father Brandon Frame, Frame’s mother, Emily Zim, and his grandmother Anna Evarts sit on the couch to watch the baby move around on the screen. A group of local sonographers, including 36 year veteran Janine Oliveri oppose the elective practice of ultrasound citing a general lack of training and regulation by practitioners.
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound3.jpgOwner Shannon Shovlin performs a 3D ultrasound on Kim Barret while the baby’s father Brandon Frame, Frame’s mother, Emily Zim, and his grandmother Anna Evarts sit on the couch to watch the baby move around on the screen. A group of local sonographers, including 36 year veteran Janine Oliveri oppose the elective practice of ultrasound citing a general lack of training and regulation by practitioners. Sean McKeag | Times Leader
With seven years of experience in a hospital setting behind her, sonographer Shannon Shovlin believes minimal elective ultrasound in addition to minimal diagnostic ultrasound can constitute low-risk practice.
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound4.jpgWith seven years of experience in a hospital setting behind her, sonographer Shannon Shovlin believes minimal elective ultrasound in addition to minimal diagnostic ultrasound can constitute low-risk practice. Sean McKeag | Times Leader
Shovlin, left, brings experience and professionalism to her keepsake imagery business. Other elective ultrasound practitioners, however, have started businesses after purchasing ultrasound equipment and taking training courses that last less than a week.
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound5.jpgShovlin, left, brings experience and professionalism to her keepsake imagery business. Other elective ultrasound practitioners, however, have started businesses after purchasing ultrasound equipment and taking training courses that last less than a week. Sean McKeag | Times Leader
Shovlin said in the proper hands, elective ultrasound can expose mothers-to-be and babies to the lowest amount of frequency possible and can be a ‘breathtaking experience.’
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound6.jpgShovlin said in the proper hands, elective ultrasound can expose mothers-to-be and babies to the lowest amount of frequency possible and can be a ‘breathtaking experience.’ Sean McKeag | Times Leader
Oliveri said untrained owners of keepsake imagery businesses can overexpose expectant mothers to too much high frequency energy, risking the health of an unborn child and going against the ethics of professional sonographers.
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound7.jpgOliveri said untrained owners of keepsake imagery businesses can overexpose expectant mothers to too much high frequency energy, risking the health of an unborn child and going against the ethics of professional sonographers. Sean McKeag | Times Leader
Shovlin said she understands elective ultrasound is not condoned by the FDA, but that she maintains standards of practice to provide the safest possible environment for her clients.
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound8.jpgShovlin said she understands elective ultrasound is not condoned by the FDA, but that she maintains standards of practice to provide the safest possible environment for her clients. Sean McKeag | Times Leader
During the 3D ultrasound, baby Pheonyx Marie shows her face on the screen for her family to see at Baby To Be 3D in Plymouth Township. Although the long term effects of elective ultrasound are unknown, the FDA recommends ultrasound for strictly medical use.
http://www.timesleader.com/wp-content/uploads/2017/07/web1_TTL062017Ultrasound1.jpgDuring the 3D ultrasound, baby Pheonyx Marie shows her face on the screen for her family to see at Baby To Be 3D in Plymouth Township. Although the long term effects of elective ultrasound are unknown, the FDA recommends ultrasound for strictly medical use. Sean McKeag | Times Leader
Local pros debate elective ultrasound

By Matt Mattei

[email protected]

Editor’s note: Dr. Alfred Casale’s regular column, ‘To Your Health,’ does not appear in this print edition of the Times Leader. The column can be read online at timesleader.com, and ‘To Your Health’ will return to print next Tuesday.

Reach Matt Mattei at 570-991-6651 or on Twitter @TimesLeaderMatt.


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