Multiple issues affecting the prudent use of diagnostic sonography in the clinical environment are discussed. Topics include an analysis of the concept of benefits versus risks, clinical efficacy in obstetrics, minimum threshold for thermal effects, Output Display Standard, mechanical index, thermal index, user responsibility, and ALARA (as low as reasonably achievable). Thermal and mechanical acoustic output indices offer a uniform approach to control ultrasonic exposure of patients and to provide assurance of safety.
Hedrick WR, Hykes DL, Starchman DE: Ultrasound Physics and Instrumentation. 4th ed.Saint Louis, MO: Elsevier-Mosby, 2005.
2.
Barnett SB, Ter Haar GR, Ziskin MC, Rott HD, Duck FA, Maeda K: International recommendations and guidelines for the safe use of diagnostic ultrasound in medicine. Ultrasound Med Biol2000;26:355-366.
3.
Nyborg WL: Safety of medical diagnostic ultrasound. Semin Ultrasound, CT, MRI2002;23:377-386.
4.
National Institutes of Health: Diagnostic Ultrasound in Pregnancy: Report of a Consensus Development Conference. NIH Pub. 84-667. Bethesda, MD: National Institutes of Health, 1984.
5.
National Council on Radiation Protection and Measurements: Exposure Criteria for Medical Diagnostic Ultrasound: I. Criteria Based on Thermal Mechanisms. NCRP Report 113. Bethesda, MD: NCRP, 1992.
6.
American Institute of Ultrasound in Medicine and National Electrical Manufacturers Association: Standard for Real-Time Display of Thermal and Mechanical Indices on Diagnostic Ultrasound Equipment. Rockville, MD: AIUM-NEMA, 1992.
7.
Hedrick WR, Hykes DL: An overview of thermal and mechanical acoustic output indices. J Diagn Med Sonogr1993;9:228-235.
8.
National Council on Radiation Protection and Measurements: Exposure Criteria for Medical Diagnostic Ultrasound: II. Criteria Based on All Known Mechanisms. NCRP Report 140. Bethesda, MD: NCRP, 2002.
