Female Pelvis & TA's/TV's Flashcards
What is PATIENT PREP for a TRANS-VAGINAL scan?
NO PREP
Have patient urinate, getting out as much fluid as possible; bladder should be as empty as possible
What is PATIENT PREP for a TRANS-ABDOMINAL scan?
Full bladder - 4 to 6 glasses of water; finish 1 hour prior to exam
Do not void (urinate) prior to exam
What are the 6 reasons for having a full bladder during a TRANS-ABDOMINAL scan?
Displaces bowel/colon out of true pelvis
Better acoustic window - “overview” of organs
Anatomic & “cystic” reference point
Decreases mobility of organs/masses - full vs. empty
Contour reflects size/shape of surrounding organs
Causes physiologic retroversion of uterus
What are 3 different ways a bladder can be described based on fullness?
Not full, adequate, overdistended
What PATIENT HISTORY needs to be asked before a pelvic exam?
12 items
First day of last period. How was flow?
Gravid/Parity/Abortions. Menstrual status
Symptoms. Personal/family history of cancer
Previous surgeries. Previous pap/biopsy results
Lab tests. Findings on pelvic exam
Latex allergies? Previous US or other imaging
What is gravid?
Number of pregnancies
What is parity?
Number of live births
When talking about Menstural status, what is premenarch?
Prepuberty; prior to onset of menses
When talking about Menstural status, what is menarche?
Reaching puberty; menses every 21-28 days
When talking about Menstural status, what is peri/premenopausal?
2-10 years prior to cessation of menses
When talking about Menstural status, what is menopause?
Menses ceases permanently; AT LEAST one year without menses
BE ABLE TO EXPLAIN PROCEDURES:
- Transabdominal (TA)
- Transvaginal (TV)/Endovaginal (EV)
TA - done on belly, use of gel, take images, need a full bladder, can empty when done on top
TV/EV - use of condom & gel, empty bladder, insert into vagina, take images
What 4 organizations control performance standards in Pelvic US?
SDMS, AIUM, ACOG, ACR
What is SDMS?
Society of Diagnostic Medical Sonography
What is AIUM?
American Institute of Ultrasound in Medicine
What is ACOG?
American College of Obstetrics & Gynecology
What is ACR?
American College of Radiology
Mainly used for Pelvic US guidelines
What are some ACR guidelines for Pelvic US?
Valid reason for medical exam
Lowest possible dose - 100 mW/cm squared (AIUM bioeffects range)
Must identify & document ALL anatomy & pathology
Transperineal scan for PROM or prolapsed uterus
Must be accredited through ARDMS, follow protocols, up to date equipment, QA, quality improvement
What is PROM?
Premature rupture of membranes
What transducer would be used for a TA?
Curvilinear or sector/vector up to 5 MHz - “overview”
What transducer would be used for a TV?
TV transducer 7.5 MHz or higher - detail & characterization
When identifying pathology in a structure, what guidelines should be followed?
Identify anatomy and pathology in 2 planes - long & transverse
What should be remembered when setting up equipment for a scan?
Built in presets
Should tweak to improve
Harmonics
Highest frequency to penetrate; decrease if need more penetration
When describing anatomy and pathology, what 5 details need to be included?
Identity sonographic characteristics Location Size External contours Internal consistency
What is the normal size of a follicle?
Under 2.0-2.5 cm
What measurement size is labeled as possible cyst?
Above 2.5 cm
What is a limitation of the TA scan?
Obese patients or unable to fill bladder
2 important things to remember about TA & TV scans…
Take images in long and transverse
Be methodical and routine; follow SAME imaging protocol
List LONGITUDINAL TA & TV protocol…
Long ML UT w/ & w/o measure (fundus to cervix & AP)
Long Endometrium w/ & w/o measure (wall to wall; exclude fluid)
Long RT UT
Long RT edge of UT
Long RT ADX (between unsterile edge & iliac vessels)
Long ML UT
Long LT UT
Long LT edge of UT
Long ADX
List TRANSVERSE TA & TV protocol…
Trans Vagina Trans Cervix Trans LUS Trans UT w/ & w/o measure Trans Fundus Trans RT ADX Trans LT ADX
How do you scan an OVARY Transabdominally & Transvaginally?
Find ovaries transversely - follow ligament Take multiple images of ovary Measure ovary side to side Turn 90° for longitudinal scan Sweep through ovary Measure ovary - long & AP
What should you always be evaluating the pelvis for?
Masses or cysts
What are the steps for a TV scan?
Explain procedure Prep probe Have patient empty bladder & remove clothes from waist down Position patient on bed Have patient "guide" probe into vagina Follow protocol for TA & TV
For TV scanning, the LEFT side of the screen is showing what?
Cranial/right side of patient
For TV scanning, the RIGHT side of the screen is showing what?
Caudal/left side of patient
For TV scanning, the TOP is describing what scanning plane?
Caudal
For TV scanning, the BOTTOM is describing what scanning plane?
Cranial
For TV scanning, the RIGHT is describing what scanning plane?
Anterior
For TV scanning, the LEFT is describing what scanning plane?
Posterior
Direction of the TV transducer is based on the movement of the ______ of the transducer and not the ______ of the transducer.
Face; handle
When doing a TV scan longitudinally, the notch of the transducer is pointed which direction?
Notch of transducer is up
When doing a TV scan transversely, the notch of the transducer is pointed which direction?
Notch is pointed toward the sonographer
When doing a TV scan, tilting the transducer anteriorly will bring what into view?
The fundus
When doing a TV scan, tilting the transducer posteriorly will bring what into view?
Cul-de-sac
Be sure to ALWAYS do what when finished with a TV scan?
Clean the probe
When is a TRANSLABIAL scan done?
When a patient has PROM, cervical incompetence, or prolapsed uterus/cervix
How is a TRANSLABIAL scan done and what transducer is used?
Considered a transperineal
Use a 3.5-5.0 MHz or TV probe
Cover probe & place in perineal area towards vagina
When scanning, how do you know you’re imaging a muscle?
It will be hypoechoic structures with echogenic striations
How are muscles seen when imaging? What type of transducer is used?
With a full bladder
Sector/vector or Linear transducer
What is the Obturator Internus muscle?
Posterior lateral corners of bladder at vagina/cervix level
What is the Pelvic Floor muscles?
Transverse inferior aspect of bladder
What is the Piriformis muscles?
Posterior lateral to upper half of uterine body/fundus
What muscles are scanned with a sector or vector transducer?
Obturator Internus muscles
Pelvic floor muscles
Piriformis muscles
What is the Rectus Abdominus muscles?
Anterior abdominal wall
What muscles are scanned with a linear transducer?
Rectus Abdominus muscles
Iliopsoas muscles
