A teratologic evaluation of continuous-wave, daily ultrasound exposure in unanesthetized pregnant rats

How safe is it to use ultrasound in prenatal medicine? Facts and contradictions - Part 2 - Laboratory experiments regarding non-thermal effects and epidemiological studies

The first part of this CME article (issue 5/20) provided a detailed examination of the biophysical effects of ultrasound waves, the exposure values, and in particular the thermal effect. In vivo and in vitro measurements have shown that the temperature increase in tissue associated with B-mode ultrasound is far too low to pose a potential risk. Even experiments with exposure values in the range of pulsed Doppler have shown that temperature increases of over 1.5 °C can only occur in areas in direct contact with the probe, thus making a limited exposure time particularly in the case of transvaginal application advisable. The second part of this CME article describes various laboratory and animal experiments for evaluating non-thermal effects and also presents the most important epidemiological studies in the last 30 years in the form of an overview and review. In addition to direct insonation of isolated cells to examine possible mutagenic effects, the blood of patients exposed in vivo to ultrasound was also analyzed in multiple experiments. Reproducible chromosome aberrations could not be found in any of the studies. In contrast, many experiments on pregnant rodents showed some significant complications, such as abortion, deformities, and behavioral disorders. As in the case of thermal effects, the results of these experiments indicate the presence of an intensity- or pressure-dependent effect threshold. Numerous epidemiological studies examining possible short-term and long-term consequences after intrauterine ultrasound exposure are available with the most important studies being discussed in the following. In contrast to information presented incorrectly in the secondary literature and in the lay press, health problems could not be seen in the children observed in the postpartum period in any of these studies.

Establishing C. elegans as a Model for Studying the Bioeffects of Therapeutic Ultrasound

Ultrasound is widely used in diagnostic and therapeutic medical procedures and it is becoming an important tool in biomedical research. During exposure, as an ultrasound beam interacts with the tissues in its path, changes known as "bioeffects" can result. Animal studies have suggested that these changes can alter survival, movement, reproduction, development and learning in various species. Additional studies in animals could provide valuable information about the mechanisms of therapeutic ultrasound and may contribute to the development of additional exciting laboratory techniques. Therefore, we developed methods for exposing C. elegans nematode worms to ultrasound and observed that they exhibited exposure-dependent reductions in movement, fecundity and survival. These effects were prevented by polyvinyl alcohol, which suggested that cavitation was the main mechanism of damage. This work provides a foundation for capitalizing on the advantages of C. elegans as a model to thoroughly characterize ultrasound's bioeffects at the cellular and molecular levels.

Mechanical and Biological Effects of Ultrasound: A Review of Present Knowledge

Ultrasound is widely used for medical diagnosis and increasingly for therapeutic purposes. An understanding of the bio-effects of sonography is important for clinicians and scientists working in the field because permanent damage to biological tissues can occur at high levels of exposure. Here the underlying principles of thermal mechanisms and the physical interactions of ultrasound with biological tissues are reviewed. Adverse health effects derived from cellular studies, animal studies and clinical reports are reviewed to provide insight into the in vitro and in vivo bio-effects of ultrasound.

Cincinnati water maze: A review of the development, methods, and evidence as a test of egocentric learning and memory

Advantageous maneuvering through the environment to find food and avoid or escape danger is central to survival of most animal species. The ability to do so depends on learning and remembering different locations, especially home-base. This capacity is encoded in the brain by two systems: one using cues outside the organism (distal cues), allocentric navigation, and one using self-movement, internal cues (proximal cues), for egocentric navigation. Whereas allocentric navigation involves the hippocampus, entorhinal cortex, and surrounding structures, egocentric navigation involves the dorsal striatum and connected structures; in humans this system encodes routes and integrated paths and when over-learned, becomes procedural memory. Allocentric assessment methods have been extensively reviewed elsewhere. The purpose of this paper is to review one specific method for assessing egocentric, route-based navigation in rats: the Cincinnati water maze (CWM). The test is an asymmetric multiple-T maze arranged in such a way that rats must learn to find path openings along walls rather at ends in order to reach the goal. Failing to do this leads to cul-de-sacs and repeated errors. The task may be learned in the light or dark, but in the dark, wherein distal cues are eliminated, provides the best assessment of egocentric navigation. When used in conjunction with tests of other types of learning, such as allocentric navigation, the CWM provides a balanced approach to assessing the two major forms of navigational learning and memory found in mammals.

Effect of diagnostic ultrasound during the fetal period on learning and memory in mice

BACKGROUND

An experiment was conducted to find out whether in utero exposure to diagnostic ultrasound leads to changes in postnatal behavior in adult mice.

METHODS

A total of 15 pregnant Swiss albino mice were exposed to diagnostic levels of ultrasound (3.5 MHz, 65 mW/cm(2), intensity((spatial peak-temporal peak)) (I(SPTP))=1 mW/cm(2), intensity((spatial average-temporal average)) (I(SATA))=240 mW/cm(2)) for 30 min on day 14 or 16 of gestation. All exposed as well as control animals were left to complete gestation and parturition. Their offspring were used in our further studies. They were monitored during early postnatal life for standard developmental markers (such as pinna detachment, eye opening and fur development) and postnatal mortality was recorded up to 6 weeks of age. The litters were subjected to behavioral tests for learning and memory at 4 months of age. Representative animals from each group were sacrificed and the hippocampal region of the brain was assayed for biogenic amines, noradrenaline, dopamine, serotonin (5-HT) and 5-HT's metabolite, 5-hydroxy indoleacetic acid (5-HIAA), in order to determine whether ultrasound exposure produced any biochemical changes in the hippocampal region of the brain. Coronal sections from the dorsal hippocampus from the representative animals from each group were processed for staining and the number of neurons was counted.

RESULTS

Neither the standard developmental markers (such as pinna detachment, eye opening and fur development) nor the postnatal mortality was affected by ultrasound exposure. However, there was a significant impairment in learning (hole board test) and memory functions (shuttle box test) in both the exposure groups. Significant reductions in the biogenic amines and the decrease in the neuronal density were found only in day 14th pc ultrasound-exposed group compared with the control animals. The 16th day exposure group is relatively resistant to ultrasound-induced impairment of brain functions.

CONCLUSIONS

The results suggest that the early fetal brain is highly susceptible to induction of neurobehavioral changes by ultrasound exposure.

Gestational stage sensitivity to ultrasound effect on postnatal growth and development of mice

BACKGROUND

An experiment was conducted to find out whether ultrasound exposure leads to changes in postnatal growth and development in the mouse.

METHODS

A total of 15 pregnant Swiss albino mice were exposed to diagnostic levels of ultrasound (3.5 MHz, 65 mW/cm2, I(SPTP) = 1 mW/cm2 Intensity(Spatial Peak-Temporal Peak), I(SATA) = 240 mW/cm2 Intensity(Spatial Average-Temporal Average)) for 30 min for a single day between days 10 and 18 of gestation (GD 10-18). Virgin female mice were placed with same age group males for mating in the ratio 2 females : 1 male and examined the next morning for the presence of vaginal plug, a sign of successful copulation. The females with vaginal plugs were separated and labeled as 0-day pregnant. Maternal vaginal temperature was also measured. A sham exposed control group of 15 pregnant mice was maintained for comparison. All exposed as well as control animals were left to complete gestation and parturition. Their offspring were used in our further studies. They were monitored during early postnatal life for standard developmental markers, postnatal mortality, body weight, body length, head length, and head width, and growth restriction was recorded up to 6 weeks of age.

RESULTS

An exposure to ultrasound induced nonsignificant deviations in the maternal vaginal temperature or developmental markers. Significant low birth weight was observed in the present study, after exposure at GD 11, 12, 14, and 16. However, 14 and 16 days postcoitus during the fetal period appears to be the most sensitive to the ultrasound effect, in view of the number of different effects as well as severity of most of the observed effects when exposed on these gestation days.

CONCLUSIONS

The results indicate that diagnostic ultrasound can induce harmful effects on mouse growth and development when given at certain critical periods of gestation.

Long-term effects of diagnostic ultrasound during fetal period on postnatal development and adult behavior of mouse

Pregnant Swiss albino mice were exposed to diagnostic levels of ultrasound (3.5 MHz, intensity 65 mW, I(SPTP) = 1 W/cm(2), I(SATA) = 240 W/cm(2)) for 10, 20 and 30 minutes on day 14 of gestation. Sham exposed controls were maintained for comparison. Fifteen pregnant mice were exposed for each group. Exposed as well as control animals were left to complete gestation and parturition. Ultrasound induced changes in maternal vaginal temperature was recorded. The changes in the physiological reflexes and postnatal mortality up to 6 weeks of age were recorded. The litters were subjected to behavioral tests for locomotor activity, learning and memory at 4 month and 1 year of age. Neither the physiological reflexes nor the postnatal mortality was affected by ultrasound exposure. However, there was a noticeable impairment in both locomotor and learning behavior even after a 10 min exposure, which further increased with increases in exposure time. Thus the present study demonstrates the neurotoxicity of diagnostic ultrasound and the high susceptibility of early fetal brain to induction of lasting detrimental changes by ultrasound exposure.

Intrauterine effects of ultrasound: animal studies

During the past several decades, the use of ultrasound technology in the clinical setting has greatly increased. Because nearly every pregnant woman receives at least one sonographic procedure today, there has been developing concern about the safety of such procedures. Since ultrasound exposure can result in hyperthermia and other physiological effects, the determination of a threshold or no-effect exposure has become a high-priority goal. Animal research has been important to the study of the effects of various exposures at all stages of pregnancy, since the clinical use of ultrasonography can occur during the preimplantation, organogenic, and fetal stages. Animal experiments using various mammalian species have been able to determine no-effect exposure levels for embryonic loss, congenital malformations and neurobehavioral effects. The preponderance of evidence from these studies indicates that, in the absence of a thermal effect, ultrasonography represents no measurable risk when used at recommended intensity levels.

Behavioral effects of prenatal exposure to pulsed-wave ultrasound in unanesthetized rats

The present experiment examined the developmental neurotoxicity of pulsed-wave (pw) ultrasound in rats, using an exposure system designed to eliminate restraint or anesthesia from the exposure conditions. Pregnant Sprague-Dawley CD rats trained to remain immobile in a water-filled ultrasound exposure tank were scanned with 3-MHz pw ultrasound at spatial peak temporal average intensities (ISPTA) of 0, 2, 20, or 30 W/cm2 on embryonic days 4-20 for approximately 10 min/day. The data showed that such insonation produced no adverse effects on maternal weight gain or reproductive outcome, nor on the postnatal growth or survival of the offspring. No exposure-related alterations in behavioral development were observed in the offspring of rats scanned with pw ultrasound during gestation. In addition, there was no consistent evidence of an ultrasound-associated change in the adult offspring behaviors tested; i.e., no treatment effects were found on measures of locomotor activity, water maze learning, and acoustic startle reactivity. An effect on tactile startle was observed on some trials in the low exposure group male offspring, but this effect was neither dose dependent nor consistent with any other finding. Overall, these results indicate that the neurobehavioral development of rats was not altered by prenatal exposure to pw ultrasound at ISPTA levels of up to 30 W/cm2.

Diagnostic ultrasound in veterinary practice: How safe is it?

This paper provides information on the safety of ultrasonic diagnostic procedures as currently used in veterinary practice. The known mechanisms of action are described and selected literature on biological effects of ultrasound is reviewed. Current international consensus is presented on the safety of medical ultrasound with respect to thermal effects. To date, there is no independently verified clinical evidence that the level of exposure delivered to the tissues during scanned grey-scale ('B-mode') imaging has any adverse effects. Lung haemorrhage has been observed in animal experiments using diagnostic exposures, but the effects have not been reported in the foetus. Equipment that uses pulsed Doppler transmits higher acoustic outputs in a stationary beam, and can produce temperature increases that may have significant biological consequences. When considering sonographic and pulsed Doppler examinations of the prenatal animal, the safety margins are small and the operator should be aware of the acoustic output of the equipment, the exposure time, and the sensitivity of target tissues.

Behavioral teratologic effects of prenatal exposure to continuous-wave ultrasound in unanesthetized rats

While there are no known risks associated with diagnostic ultrasound, uncertainty about the safety of prenatal ultrasound exposure remains. The purpose of the present experiment was to evaluate the behavioral teratogenic potential of continuous-wave (cw) ultrasound in rats, in the absence of maternal anesthesia or restraint. Pregnant CD rats, trained to remain immobile in a water-filled ultrasound exposure tank, were scanned with 3 MHz cw ultrasound at levels of 0, 2, 10, 20, or 30 W/cm2 ISPTA (spatial peak, temporal average intensity) on gestational days 4-20 for approximately 10 min/day. Offspring were examined postnatally for survival, growth, physical landmarks of development, behavioral development, and the adult functions of locomotor activity, learning and memory, and startle reactivity. No effects of prenatal ultrasound were found on maternal characteristics, offspring survival or growth, physical or behavioral landmarks of development, or adult tests of passive avoidance or startle. Effects at the highest intensity were obtained on corner and side locomotor activity and in a multiple-T water maze on measures of errors of commission and time spent finding the goal. The results showed that prenatal cw ultrasound in rats can induce effects on some postnatal neurobehavioral functions at high exposure intensities (30 W/cm2), but at lower intensities (2-20 W/cm2) no consistent evidence of neurobehavioral effects was observed.

Teratologic evaluation of rats prenatally exposed to pulsed-wave ultrasound

While there are no known risks associated with diagnostic ultrasound, uncertainty about the safety of prenatal ultrasound exposure remains. The purpose of the present experiment was to evaluate the teratogenic potential of pulsed-wave (pw) ultrasound in rats, in the absence of maternal anesthesia or restraint. Pregnant CD rats, trained to remain immobile in a water-filled ultrasound exposure tank, were scanned with 3-MHz pw ultrasound at levels of 0, 2, 20 or 30 W/cm2 ISPTA (spatial peak, temporal average intensity) on gestational days 4-19 for approximately 10 min/day. Examination of fetuses on E20 revealed no increase in skeletal or visceral malformations in groups exposed to pw ultrasound in utero. The number of implantations/dam was significantly increased in all pw ultrasound exposure groups compared to sham-exposed animals and, in a possibly related finding, resorptions were increased in the two highest exposure groups. Although significantly increased compared to controls, resorption frequencies in these groups were low (< 10%). No exposure-related changes in fetal weights were observed in offspring of rats scanned with pw ultrasound during gestation. The results indicate that, under the conditions described, no overt embryotoxicity is associated with gestational exposure to pw ultrasound intensities of up to 30 W/cm2.