Picture this
New 3-D and 4-D ultrasound pictures delight parents-to-be, but some in the medical field don't have such a rosy view.

By Karen Blum
Special To The Sun
Originally published April 1, 2005

On a recent Monday, Tim Brophy and his pregnant wife, Suzanne, went to Little Sprout Imaging in Towson for a sophisticated type of ultrasound, though it wasn't a procedure her doctor had ordered.

The Forest Hill couple, along with his mother and sister, were escorted into Little Sprout's living room-like environment, decorated in rich green tones, where Tim settled into an overstuffed armchair next to the examination table and his mother and sister relaxed on a plush sofa a few feet away.

For the next half-hour on two flat-screen monitors, the family watched little Gavin, due April 14, lick his hands, stick out his tongue and otherwise wriggle around as his escapades were recorded on a DVD and videotape.

While Celine Dion music played quietly, the Brophys studied Gavin in full detail, admiring his fingers and facial features, and concluding that he resembles soon-to-be-older-brother Garrett, age 6.

"I feel like we're right in your stomach with you," Ginny Brophy teased her daughter-in-law.

The Brophys are one of a growing number of couples taking advantage of three- and four-dimensional ultrasound - technology that offers clearer pictures of the fetus than its traditional two-dimensional counterpart. In the process, it has transformed the routine sonogram into an entertainment vehicle, raising some concern in the medical community.

At least 120 fetal-portrait studios are in business across the country, some in shopping malls, according to Little Sprout owner Martha Morgan. Though 3-D and 4-D ultrasound imaging is generally not medically necessary or covered by insurance, expectant parents are paying about $300 on average for the experience.

Little Sprout opened in October, and business has been steadily increasing. The imaging center now has about 50 clients a month, some coming from as far away as Delaware, Northern Virginia and Pennsylvania. Another Maryland studio, Baby Insight of Potomac, opened about two years ago and has 150 to 200 clients each month, according to owner Matt Evans.

Tim Brophy, 29, heard about 4-D ultrasound through a neighbor and a co-worker who each had it done. He searched the Internet and found Little Sprout's Web site.

Besides the DVD and videotape, the Brophys went home with 8x10, 4x6 and wallet-size photos and a CD of the images, all wrapped in peach tissue paper and placed in a bright green gift bag with the Little Sprout logo. They've since showed the videos to family members, and Brophy is posting the photos on a Web site that out-of-town relatives can access.

"It was completely worth it for what you're getting," he said. "It's hard to put a price on seeing your kid before he's out."

FDA has reservations

Not everyone shares his sentiments. The U.S. Food and Drug Administration considers the use of ultrasound to produce fetal keepsake videos to be an unapproved use of a medical device. The images may be made by people not well trained, the FDA cautions, or for longer exposure times than are usually used in medical situations. The agency also is concerned that women might mistake fetal portrait ultrasound for a medical examination.

These arguments are supported by other industry groups, including the American Institute of Ultrasound in Medicine and the American College of Radiology.

Dr. Carol Rumack, chairwoman of the American College of Radiology's Commission on Ultrasound and a professor of radiology at the University of Colorado School of Medicine, said her main complaint is that fetal-portrait studios do not present a written report, as is customary after traditional diagnostic imaging studies.

Morgan and Evans counter that they employ only licensed ultrasound technicians, called sonographers, and have clients sign waivers stating that they understand the 4-D session is not a substitute for obstetrical care. In two cases where a Little Sprout sonographer observed an anomaly during a scan, Morgan said, the clients' doctors were notified.

Evans added, "In more than 300 medical studies, ultrasound has never been shown to be harmful to the mother, baby or operator."

(Although ultrasound is generally considered safe, if it is done for long periods of time or at a high frequency, there may be some risk of heating the mother's body, which could potentially harm the fetus. Medical studies on the overall safety of ultrasound, however, have been inconclusive so far.)

Nearly all women have at least one ultrasound exam, also called sonograms, during the course of their pregnancy to determine fetal growth and position, and to check for birth defects. The technology, similar to sonar, uses high-frequency sound waves to produce images of organs or tissues inside the body.

In two-dimensional ultrasound, a probe placed on the belly sends sound waves into the body. As the waves bounce back, a computer in the ultrasound machine interprets the distance to tissue, as well as the tissue's size, shape and consistency, then turns that information into black-and-white outlines of the baby, seen on the monitor.

Three-dimensional ultrasound uses the same concept, but takes images from multiple angles rather than just one. The image displayed on the screen is a volume rendering of all of the detected soft tissue, including the baby's face, hands and feet.

Four-dimensional ultrasound, developed about four years ago, takes multiple 3-D images in rapid succession, resulting in a motion video of the baby.

Hospitals limit use

Commercial 4-D scans are also offered by some local doctors' offices. Laura Wasserman of Reisterstown took her husband and 8- and 9-year-old daughters to her ultrasound appointment last November at the Owings Mills office of a large obstetrical practice headed by Dr. Albert Gabbay. She made a collage of the photos and hung them in the bedroom of her son, Adam, born Dec. 20.

"It was great," she said. "It made the pregnancy that much more exciting."

Area hospitals, including St. Agnes, Johns Hopkins and the University of Maryland Medical Center, employ the technology only in high-risk pregnancies for further evaluation of abnormalities seen on 2-D sonograms or better visualization of structures not seen well on 2-D.

Dr. Carl Weiner, director of the Center for Advanced Fetal Care at the University of Maryland, advises expectant parents who want a picture to ask for one during their regular 2-D ultrasound "rather than pay the fee or have it done at a mall that has a high overhead. It's really a waste of resources that could perhaps be better spent otherwise."

Still, the technology is popular, and there are several reasons, said Neeli Bendapudi, an associate professor of marketing at Ohio State University's Fisher College of Business. Demographically, women are older when they have children, and therefore many have more disposable income. Psychologically, they like the idea of being able to bond with the baby. And culturally, childbirth has become "a momentous event that has to be documented."

Bendapudi added that 4-D ultrasound also fulfills some parents' need for instant gratification: "If I can see my baby now, why wait?"

Jessica Kralec, one of the sonographers at Little Sprout, said the sessions are more common among women on their second or third pregnancy, who want to do something different this time around.

"They can bond more," she said. "When you can see the chubby cheeks and the face, it looks like a baby and not like a skeleton, like in 2-D."

For the Brophys, the ultrasound provided the reassurance they wanted.

"It's one thing for the doctor to say there are five fingers," said Tim Brophy. "It's another thing to see it for yourself."

Added Suzanne, 27: "This makes you more anxious for the baby to come. I want to touch his little cheeks."

Copyright © 2005, The Baltimore Sun