Sonographic Evaluation of the Female Pelvis
What is the resistive index (RI) equation??
(S-D)/D
What is the pulsatility index equation?
(S-D)/mean
The ratio of a prepubertal girl is ______.
1:1
Most endovaginal transducers supply a broadband frequency range between _______.
5 and 9 MHz
Veins can be prominent but should not dissent to measure over _____ in a non gravid uterus
5 mm
sonohysterography is usually performed on premenopausal women between which days of the menstrual cycle?
6 and 10
List some history questions you ask the patient.
LMP, Gravidity and Parity, hormones, symptoms, family hx of cancer, any surgeries to the pelvis
What is another term for sonohysterography?
SIS-saline infused sonography or hysterosonography
(TA/TV) is the best way to measure the uterus.
TA
When is the bladder to full?
When the uterus is flattened and it extends past the fundus
What is the first question you ask your patient.
Why did you doctor order this exam?
Which vessels are often seen in the periphery of the uterus and should not be mistaken for pathology
arcuate arteries
Name the vessel of the uterus.
arcuate, radial, straight, and spiral
To get the cervix of the uterus endovaginally, the probe is moved ______.
away from the bed
Where are nabothian cysts found?
cervix
Which probes are typically used with pelvic ultrasounds?
curvilinear and endovaginal
If you see a mass, what is the protocol?
document size, location, shape, echogenicity
What is the preparation for a TA ultrasound?
drink 32 oz of water 1 hour before the exam
Evaluate the cul-de-sac for presence of _______ or ______.
free fluid or mass
List the PROS of trans abdominal scanning
global view, perform on everyone, applicable to all patient populations
Arterial doppler flow is categorized into two different types:
high resistive and low resistive
What is high resistive?
high systolic peak and low diastolic flow
What is another name for the internal iliac vessels?
hypogastric
If an ovary is very superior and anterior, what transducer should you switch to?
linear
How could you differentiate loops of bowel from a mass?
look for peristalsis
List the CONS of trans abdominal scanning.
lower frequency required, anatomic resolution, discomfort for pt due to bladder filling
What two muscles can be mistake for an ovary?
obturator internus or iliopsoas
List the absolute contraindications for transvaginal imaging
pediatric age group, bleeding associated with known placenta previa, PROM
If velocities are greater than 10 cm/sec then what should we think?
pelvic congestion syndrome
Name the three layers of the uterus.
perimetrium, myometrium, endometrium
List three locations that the ovary might be.
posterior cul-de-sac, adnexal space lateral to uterus, behind the fundus
List of the relative contraindications for transvaginal imaging
pt is a virgin, pt refuses exam
The endometrium should be measured in which plane?
sagittal
Ultrasounds should only be performed if there is a _______.
script
What do we document on the uterus
size, shape, orientation, endo, myometrium, cervix
List the CONS of scanning transvaginally
smaller field of view, discomfort for the pt, limited patient population
What is low resistive?
sometimes a biphasic systolic peak and high diastolic flow
Which technique uses a catheter inserted into the endometrial cavity with saline to fill it. This helps demonstrate if there are any abnormalities within the uterine tube.
sonohysterography
We can usually only see Fallopian tubes on ultrasound if they are ______ or _______.
surrounded by fluid or filled with fluid
Always survey though each organ before taking images. Why do we do this?
to make sure we don't miss a mass that is outside of the organ
To get the fundus of the uterus endovaginally, the probe is moved ________.
toward the bed
What is the location of the bladder on TV imaging?
upper left screen
List the PROS of scanning transvaginally
use higher frequency, better detail resolution, proximity to area of interest, empty bladder