Biosafety Of Sonography: Survey Of Current Knowledge And Practice Patterns In Obstetrics Providers

Ultrasound is used routinely in the field of obstetrics and has a high clinical utility for a number of reasons. Many people are unaware of the risks of sonography; however, there are 2 main risks associated with the use of ultrasound: diagnostic errors and biological effects. Diagnostic errors encompass overdiagnosis, underdiagnosis, and reporting errors. Biological effects involve heating and cavitation, whichmay cause harmto the fetus during organogenesis. As a result of these possible biologic risks, sonograms have an intensity-output display on themachine when in use. Previous studies researching the understanding of intensity-output displays have found that comprehension was low among users. The goal of this cross-sectional study was to evaluate medical providers' current ultrasound safety knowledge and to create a new learning module on ultrasound safety for use among these providers.The researchers collected ultrasound safety knowledge from providers by emailing a link to a survey asking 9 questions regarding the level of training and experience of the provider and knowledge of the safety/use of sonography (preintervention assessment). Surveys were emailed to obstetrics-gynecology (OB/GYN) residents and faculty, certified nurse midwives (CNMs), OB/GYN subspeciality fellows, OB/GYN subspeciality fellowship-trained faculty, and family medicine (FM) residents and faculty at teaching hospitals. Providers who received the survey were also encouraged to email it to other CNMs and OB/GYN subspecialty fellows and fellowship-trained faculty. Email reminders to complete the survey were sent out 2 and 4 weeks after the initial email. In addition, providers were sent 1 of 3 educational programs on ultrasound safety at random. One program was an article on ultrasound safety, 1 was an educational video, and 1 was a PowerPoint presentation. A posteducational assessment was sent following the program completion. This assessment included questions regarding which educational program was used, the provider's preferred learning style, whether the program was useful in learning ultrasound safety, and if the programmight change the provider's current ultrasound practice. Survey results were collected up to 1month following the initial email with the educational program.Approximately 300 individuals were distinguished as possible respondents. Of the possible 300 respondents, 138 participants submitted answers. In terms of the initial demographic survey, the majority of responses came from OB/GYN residents (n = 25), followed by maternal-fetal medicine fellows (n = 23), FMfaculty (n = 23), and FM residents (n = 21). Overall, 73% of respondents indicated that they routinely perform first-trimester dating sonograms, and 84% perform at least 1 obstetric sonogram per week. For documenting fetal heart rate in the first trimester, 62% of respondents selected that they preferred to use M-mode, whereas 27% preferred using Doppler, and 11% preferred visualization. In all, 53% of subjects did not perform sonograms upon patient request, and 76% of respondents indicated that they received formal teaching on performing sonography, but only 44% indicated that they received formal training on ultrasound safety. Finally, 36% of respondents indicated that they have had an American Institute of Ultrasound inMedicine-certified individual directly involved in their ultrasound education, whereas 17% indicated they did not, and the remaining 47% were unsure. In terms of the preintervention knowledge assessment, the majority of subjects were able to answer questions regarding ultrasound safety correctly. However, 70% were unable to answer the question regarding the functions of the thermal index (TI) and mechanical index (MI). In terms of the postintervention assessment, there was a statistically significant improvement in the number of correct responses for all questions except "Do you use the TI/MI functions when performing ultrasound?"Overall, there was a statistically significant improvement in scores of the 58 participants who completed the learning program and answered both surveys. Lastly, 81% of subjects indicated that they plan to change their practice based on the intervention received. Overall, this study demonstrates that there is a knowledge gap in ultrasound safety among providers. Learning interventions yield an increase in provider knowledge regarding ultrasound safety and improvement in knowledge. Further studies are necessary in order to evaluate the level of knowledge students are receiving regarding ultrasound safety and knowledge to accurately devise an educational plan to review where the gaps in training occur.