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Ultrasound diagnostic techniques have been shown to be powerful, versatile and well-suited to medical practice. The growth in the use of ultrasound as a diagnostic imaging tool has been rapid. Until 30 years ago ultrasound examinations were rarely performed in hospital settings. Due to recent development, diagnostic imaging ultrasound is now routine and comprises of over 25 per cent of diagnostic imaging examinations undertaken in the investigation of disease (Gibbs et al., 2009). A number of factors have contributed to the success of ultrasound, but primarily it is the relative simplicity of the process involved in obtaining diagnostic images and its non-invasive way of looking inside the human body (Kremkau, 2002).
Ultrasound was first developed during World War Two to detect enemy submarines (Buckly, 2002). Its use in medicine was pioneered by the obstetrician Professor Ian Donald during the 1950's and it was in the early 1950's that the first clinical images were published (Gibbs et al., 2009). Ultrasound examinations do not use ionising radiation as used in x-rays, in fact the technology uses high frequency sound (acoustic) waves to produce images of the body's internal structure (Royal College of Radiologists, 2003). These waves have a frequency above the audible range of human hearing. The audible range of sound is 20hertz to 20 kilohertz, therefore, ultrasound is frequency greater than 20kilohertz. The creation of an image from sound is done in three steps. First is producing a sound wave. Second is receiving echoes and third is interpreting those echoes.
It has been reported that......the ultrasound beam is potentially hazardous to the patient. As it travels through the body, the beam interacts with tissue, and if exposure is sustained and of sufficient intensity, it has the potential to cause a lasting biological effect (REF).
As Ultrasound images are captured in real-time, they can show structure and movement of the body's internal organs as well as blood flowing through the blood vessels. Conventional ultrasound displays the thin, flat sections of the body. Advancements in ultrasound technology include three-dimensional (3D) ultrasound that formats the sound wave data into 3D images. Four-dimension (4D) is 3D Ultrasound in motion. (Wolbarst, 1999)
The National Institute for Health and Clinical Excellence (NICE) recommends that all pregnant women should be offered two scans during their pregnancy (National Institute of Health and Clinical Excellence, 2003). It is possible that further 2D scans may be offered to check for suspected problems. Occasionally 3D scans may be clinically indicated in the presence of certain abnormalities, such as cleft lip and palate.
However the majority of 3D/4D scans is carried out without any clinical indication. These 'bonding' or reassurance scans vary in price and in length. They have become very popular and are advertised requiring no clinical indications for the scans.
One purpose of this study is to find out whether frequent ultrasound scans have an effect on fetal development. By consulting existing documentation I aim to make valuable recommendation/suggestions, allowing decision of new protocol, precaution or policies for use of ultrasound in pregnancy.
Aims and Objectives
The aim of the research is to ascertain whether frequent ultrasounds in pregnancy affect fetal development and to identify and critically evaluate available evidence regarding the potentially hazardous effects of ultrasound scans in pregnancy.
To carry out a literature search of online journals, articles and websites
To review current ultrasound protocols and policies in obstetrics.
To discover and outline the developmental abnormalities in children who were exposed to frequent ultrasounds during the fetal stage.
To determine the stage of fetal development most susceptible to be influenced from frequent ultrasound exposure.
To ascertain the dose of ultrasound that may affect a developing fetus.
This project would be a great informant to radiographers, other healthcare professionals and pregnant women. It will give guidance about ultrasound scans, if and how frequent ultrasound scans affect fetal development, whether good or bad. Another purpose of this research is to find out how attainable information about this research is and what sort of information about this topic is really out there for radiographers.
3.1 Research approaches and Method Reviews:
A non-experimental approach will be used for this research as they have considerable practical advantages because they are relatively easy and inexpensive to conduct. According to Younis (2004) a non-experimental approach raises fewer ethical issues and is valuable in studies that investigate the dimensions of health. It is also greatly useful for qualitative issues and generating hypothesis.
A literature review has been chosen for this research because it will draw together all the latest information and research on the topic. It does not require ethical approval and it is part of academic development, which allows the researcher to become an expert in the field of research. A literature review may be a document survey most researchers are familiar with. Denscombe (2003). According to Blaxter et al (2001) a literature review is a systematic, explicit and reproducible method for identifying, evaluating and interpreting the existing body of recorded work produced by researchers, scholars, and practitioners. It is important for acquiring an understanding of the topic in which a person decides to research with regards to what has already been done, what key issues are and how it has been researched.
A literature review can also answer some of the following questions:
What are the origins and definitions of the topic?
What are the key concept and ideas?
What are the major issues and debates about the topic?
What are the key sources?
3.1.2 Sources of Research/Literature
Books: Use of books from academic libraries.
Journals: Accessible, up-to-date and rigorous source of information.
Government/Medical legislation: The Department of Health website and The British Medical Ultrasound Society (BMUS) Website.
Internet: There is access to a wide range of information including Google Scholar which is a search engine providing a search of scholarly literature across many disciplines.
3.2 Consideration of Alternative Methods:
An experimental method consists of experimental groups, a group involved with the investigation and a group, which does not interact (a control group). An experiment allows cause and effect to be established because it involves the deliberate manipulation and control of an independent variable (IV). Experiments are easily replicated due to detailed written records and produce quantitative data which can be analysed using statistical tests which further determine the effects to be caused by the IV or other factors such as chance.
Although the above explains the advantages of using the experimental approach, this was not used due to the main disadvantages this method would involve in this research, as outlined below:
Fundamental Variables in health cannot be manipulated. Being able to control Variables may have been physically impossible.
It would be unethical to carry an experiment for this research as it could mean disrespecting the rights and dignity of patients and staff, and harm patients and developing fetus.
Experiments are limited in Health research with living subjects such as the developing fetus and pregnant women.
A questionnaire is a method used for collecting data. It consists of written questions which call for responses from the target population. Questionnaires are easy to analyse and are cost effective compared to face-to-face interviews. This method was not chosen due to the main disadvantages that would be involved in this research, as outlined below:
Questionnaires have a generally low response rate of about 34-35%
Gaining permission from appropriate authorities (Hospitals/ Private Scan Clinics) can be time consuming.
Respondents may not understand some questions and the researcher does not have full control over the detail the respondents provide in answers or if they are comprehensible.
3.2.3 Case Studies
A case study investigates a phenomenon within its real life context. It is based on an in-depth, longitudinal study on a particular group and allows a valuable and unique insight. It also allows the use of multiple sources and methods, however this approach was not used sue to the following disadvantages it would occur in this research:
Time constraints would not allow for a valid case study to take place
Ethical clearance would be required which would be time consuming with a possible negative outcome.
Case studies do not address issues of generalisation of results. (Naoum, 2002)
3.3 Research Approach and Technique:
This research provides a qualitative analysis as it is concerned with understanding patterns. E.g. Ultrasound and its effects on Fetal development. It is research that includes natural and uncontrolled observations. Brealey and Glenny (1999, p.139) suggest that qualitative overviews allow "assessment of the overall evidence and discussion of any confounding factors".
3.4 Inclusion/Exclusion Criteria
A systematic review will be adopted for gathering information for this research. Reading of articles, books and journals will be a method of data collection. The inclusion and exclusion criteria for this method of data collection would be as follows:
Only recent literature will be reviews, literature dating a maximum of ten years (2000-2010). This is to ensure that most recent and up-to-date information is reviewed.
Literature should be peer reviewed and written by researchers who have background knowledge on the subject or are health professionals.
Literature must be written in English to avoid misinterpretation during translation.
Well-defined key words will be used in search, such as:
Frequent Ultrasound Scans in pregnancy
Ultrasound during Fetal Development
Is ultrasound safe in pregnancy?
Bonding scans in pregnancy
3.4 Framework of Analysis
4.1 Factors related to ultrasound
4.1.1 Quality of Technique
4.1.2 Birth Weight
4.1.4 Neurological Development
4.1.5 Fetal Stress
4.1.6 Thermal Effects
4.1.7 Mechanical Effects
6.0 Conclusions and Recommendations
Denscombe.M. (2003). The good research guide second edition for small scale research projects. Open University press Berkshire England.
Dr Naoum S.G. Dissertation research and writing for construction students (2002). Butterworth Heinemann. London.
Younis.A (2004) Research methods, qualitative and quantitative research. St George's Medical School (University of London).
The department of Health website: www.dh.gov.uk
Brealey,S and Glenny, A.M. (1999) A framework for radiographers [;anning to undertake a systematic review. Radiography. Volume 5, Issue 3. Pp.229-236