Rules for Ultrasound of Intimate Areas
By nature of the way ultrasound images are acquired, an ultrasound examination is frequently one of the most intimate and time-intensive examinations in medical imaging. Many radiographic examinations such as x-ray, CT, and MRI are done remotely with a technologist outside the room or behind a leaded shield for protective reasons, but ultrasound requires a technologist to physically examine a patient with an ultrasound probe while simultaneously documenting and annotating images on a computer for subsequent interpretation. Rooms are typically kept dimly lit to better see real-time images/video on the ultrasound unit, and patients are physically exposed during their examination. Unlike x-ray exams, CT, and MRI where exams are frequently performed with the patient fully clothed, ultrasound requires exposed skin for direct transducer contact and/or access for internal examination via the mouth, vagina, and/or rectum. Ultrasound exams cannot physically be completed without direct patient contact. Exams generally last for 15-30 minutes, but it is not uncommon to surpass 30 minutes for complex patients.
Ultrasound technologists work in immediate proximity to their patients. The application of gel, the transducer probe, physical touching, and medically necessary maneuvers that are part of an appropriate and routine evaluation can be misinterpreted and become the focus of a sexual assault allegation. Technologists generally receive some training regarding sensitive examinations. This includes appropriate use of chaperones, patient’s right to refuse examination, and refrainment from light-hearted or personal comments. Due to ultrasound’s use of non-ionizing radiation, it is many times the preferred modality to examine the sex organs, young patients, and pregnancies.
True sexual assault during patient-practitioner encounters is rare. Allegations of sexual assault against ultrasound practitioners has been reported to be on the rise due to due to high profile cases, increased public awareness, and the increased number and complexity of ultrasound examinations being performed. Data is limited, but studies suggest that allegations have significantly increased while practitioners who were convicted of a criminal offense remained exceedingly low.