The New Lexicon for First Trimester Ultrasound

Everyone knows that it is possible to speak accurately and still say the wrong thing. Radiologists have a responsibility to communicate their findings to clinicians and patients clearly while managing expectations, and prenatal ultrasound specialists enter the story at a particularly sensitive time. There are profound emotional, and increasingly legal, stakes to the words used to describe these findings. Lori Strachowski, MD, of ZSFG and UCSF and Shuchi Rodgers, MD, of Thomas Jefferson University Hospitals in New Jersey helped lead The Society of Radiologists in Ultrasound in creating a recommended lexicon for First Trimester Ultrasound, published simultaneously in Radiology and the American Journal of Obstetrics & Gynecology, standardizing the terminology radiologists use to describe prenatal ultrasound findings.

Strachowski and the other committee members met over six months to achieve consensus on each standardized term. They identified both preferred terms to use and terms to avoid.

Patients are Listening

Traditionally, radiologists focused on communicating with other medical professionals through ultrasound reports. However, with increased patient access to medical records, the committee recognized the importance of how terminology impacts patients. The committee focused on using simple, easily understood language while maintaining scientific accuracy. They also prioritized choosing words that minimize anxiety and distress for patients and avoided terms that imply guarantees or outcomes that may not be certain.

The changes include substituting "concerning" for the potentially more alarming term "suspicious." The committee also discourages the use of "viable" in the first trimester, as it can create unrealistic expectations of a successful pregnancy. Similarly, the term pregnancy “failure" should be avoided, as many patients find it insensitive and associated with blame resulting in guilt; instead they  prefer "miscarriage" or “early pregnancy loss”. The Lexicon also advises that radiologists avoid using the term “normal pregnancy” in the first trimester before it is possible to notice most defects.

Legal Implications of Ultrasound Findings

The legal landscape of the United States is changing in ways that must influence the practice of prenatal ultrasound. To avoid misinterpretations related to "heartbeat laws," the committee recommends using "cardiac activity" in place of any reference to the yet incompletely formed “heart” in the first trimester. Additionally, using terms like "live" or "living" in ectopic pregnancy situations can create legal and ethical challenges.

Simple Changes with Profound Impacts

This new lexicon emphasizes the importance of thoughtful communication beyond purely medical accuracy. By considering the emotional and legal implications of their words, radiologists can better support patients during a critical and often emotionally charged time.

Read the Full Paper

Title: A Lexicon for First-Trimester Ultrasound: Society of Radiologists in Ultrasound Consensus Conference Recommendations
Published: August 27, 2024

By Francis Horan