title: The effects of reducing the thermal index for bone from 1.0 to 0.5 and 0.1 on common obstetric pulsed wave Doppler measurements in the second half of pregnancy.
abstract: OBJECTIVE
  To test the hypothesis that clinically relevant vessels can be visualized and interrogated with Doppler recording during the second half of pregnancy at an output energy below the currently advocated limits without loss of information.
  
  
  METHODS
  Observational cross-sectional study.
  
  
  METHODS
  Tertiary fetal medicine center.
  
  
  METHODS
  Based on a power calculation for equivalence studies, we recruited 65 pregnant women.
  
  
  METHODS
  Ultrasound examination was performed at 18, 24 or 36 weeks of gestation. The umbilical artery, middle cerebral artery, ductus venosus, and both uterine arteries were identified using color Doppler, and the blood velocities were measured using pulsed wave Doppler at a thermal index for bone (TIB) of 1.0. This procedure was repeated at TIB values of 0.5 and 0.1. The depth of Doppler recording was noted.
  
  
  METHODS
  Visualization of the vessels by color Doppler at all power levels and any systematic changes or increased variance of the recorded parameters with decreasing power level.
  
  
  RESULTS
  All vessels could be visualized by color Doppler and their flow velocities measured using pulsed wave Doppler in all participants and at all power levels. There were no systematic changes or increased parameter variance when reducing the power level, despite the insonation depth being significantly greater than in early pregnancy.
  
  
  CONCLUSIONS
  Reducing the ultrasound power from TIB 1.0 to 0.1 does not alter color Doppler visualization or pulsed wave Doppler measurements in the second half of pregnancy. The lower power level can be recommended as a starting point for clinical examinations throughout pregnancy.
authors: Clinical Fetal Physiology Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway. ragnar.sande@gmail.com
authors: Ragnar K
authors: RK
authors: Sande
authors: Knut
authors: K
authors: Matre
authors: Geir E
authors: GE
authors: Eide
authors: Torvid
authors: T
authors: Kiserud
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000196:embryology / Q000502:physiology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000196:embryology / Q000502:physiology; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000502:physiology