A Future World Ultrasound lets physician 'listen' to growing fetus

May 23, 1993|By Maryalice Yakutchik | Maryalice Yakutchik,Contributing Writer

A bevy of bellies assembles daily in the Village of Cross Keys to await his scrutiny. Some are puffy, others downright mountainous. All are gobbed with goo.

Dr. Roger Sanders looks through the taut tummy skin at males flailing tiny arms, females floating contentedly, twins wrestling. Transducer in hand, he can perceive a being the size of a pinhead, just 2 1/2 weeks after conception. By the time it triples in size to 3 millimeters in length, Dr. Sanders can detect the motion of a heart beating, if not see the muscle itself.

He bears witness to the evolution of the brain and spine and the formation of all major organs within two months of conception. He watches as the fetus hiccups, sucks, flinches and grasps -- determining if it's content or in distress, assessing if it's growing or dying.

Daily, Dr. Sanders peers into the secluded water world of the unborn.

This week, he is directing an international conference on fetal anomalies at the Hyatt Regency at the Inner Harbor, where more than 500 health-care providers will explore and debate the latest research in genetics, prenatal testing, sonography, ethics and neonatology.

Dr. Sanders is the sole physician in the Baltimore area (and one of 40 nationwide) to devote his private practice exclusively to the use and development of ultrasound. (While the bulk of his practice is dedicated to obstetrics, he does perform other diagnostic ultrasound tests.)

At the Ultrasound Institute of Baltimore, as he charts the progress of fetuses, Dr. Sanders nurtures an exclusive medical sub-specialty, the product of the union of maternal-fetal medicine and ultrasound. He is a radiologist admittedly trespassing on obstetric turf.

"I'm doing much more in the way of counseling, of amniocentesis and of managing fetal anomaly cases," he says. "It's an emerging specialty."

His niche, though, is not without controversy.

Obstetric procedures such as amniocentesis and the management of obstetric patients are best left to obstetricians, says Dr. Sharon Dooley, chairman of the Committee of Obstetrics, Maternal and Fetal Medicine for the American College of Obstetricians and Gynecologists.

A turf war may be raging between obstetricians and radiologists, but not at the University of Maryland, where Dr. Sanders is a valued member of the team of specialists who manage high-risk pregnancies.

"There are a handful of people in the country who have the tremendous expertise in a broad base of knowledge that Roger does," says Dr. David A. Nagey, an obstetrician-gynecologist and director of Maternal-Fetal Medicine at the University of Maryland Hospital.

Dr. Sanders says he feels a duty to inform and educate his patients as he shows them real-time images: cinematic scenes of the workings of their bodies. Television monitors in the ceilings of his private office allow patients to follow along as he talks through their exams: "The baby has a full head of hair"; "The two cysts I detected last time on the brain have resolved themselves."

"I feel strongly the patient should be kept in the picture as the diagnostic routine goes on," says Dr. Sanders. "There are some doctors who still cling to the idea that they [and not I] should be the ones to talk to the patient about any sort of news. I've lost referrals because I tell patients what's going on, what I'm thinking. But I think doctors [who don't] are behind the times."

Even worse than being old-fashioned is being inept, and according to Dr. Sanders, "There's a lot of lousy ultrasound going on out there."

Diagnostic medical sonographers (technicians) are tested for proficiency and accredited, but there is no similar qualifying exam or board certification for physicians. Any physician with access to the technology can hang out a shingle and proclaim himself an ultrasonologist, he says.

No one was practicing ultrasound in Maryland 22 years ago when Dr. Sanders arrived at Johns Hopkins from Oxford University in his native England, where he had done "primitive" ultrasound studies of the head. He was the first in this state to use the technology, on both humans and animals.

Learning from dolphins

Having scanned polar bears, monkeys, tigers and apes, he was for a while the official zoo ultrasonologist -- until he realized he was terribly allergic to the animals he was scanning. One case involved an orangutan with a problem pregnancy for which he prescribed bed rest.

The animals from which Dr. Sanders learned the most are dolphins: They depend on ultrasound for communication, emitting high-frequency sounds from their nostrils and receiving them back on bony detectors on their skulls.

In ultrasound testing, the echoes of sound ultimately are translated into black, white and gray images, which, by their shape, position, size and brightness, Dr. Sanders recognizes either as viable organs or anomalies.

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