female reproduction imaging techniques

Question 1

advantages of Ultrasound

Answer 1

• no radiation
• non-invasive
• cheap
• localisation of lumps
• well-tolerated
• easily available
• can take measurements

Question 2

disadvantages of ultrasound

Answer 2

• this modality is operator dependent- because it is so specialised
• does not give functional information
• cannot image gas or air-filled structures
• bones also get in the way
• patient habitus - bigger patients may affect resolution/quality of image
• requires prep

Question 3

ultrasound female pelvis

Answer 3

• first choice modality

- followed up by other imaging modalities (depending on findings)

Question 4

reasons to ultrasound

Answer 4

• unusual pain or bleeding
• infertility
• menstrual problems
• confirmation of a pelvis mass

Question 5

why is it important to know where the patient is in their cycle

Answer 5

• normal appearances may be reported as abnormal

- Abnormal appearances may be reported as normal

Question 6

endometrium changes through cycle (day 1-4)

Answer 6

• menstruation

- may see fluid in the cavity when imaging

Question 7

endometrium changes through cycle (days 5-8)

Answer 7

• early proliferative phase

- very thin echogenic line

Question 8

endometrium changes through cycle (days 9-15)

Answer 8

• follicular phase
• becomes thicker
• 3 line sign
• ovulation occurs

Question 9

endometrium changes through cycle (days 16-28)

Answer 9

• luteal phase

- when endometrium is the thickest

Question 10

Transabdominal approach

Answer 10

• normal eating and drinking
• patient is not required to change
• must have a full bladder

Question 11

why is a full bladder needed

Answer 11

• moves bowel out of the way
• useful as an anatomical landmark
• manipulates the position of the uterus for it to be visualised

Question 12

transabdominal scan - technique

Answer 12

• patient ID
• consent
• patient is supine
• paper towels to protect clothes
• questioning the patient about their cycle
• longitudinal and transverse sections

Question 13

TA aftercare

Answer 13

• patient is given tissue to clean off gel
• they can go to the toilet
• discuss results

Question 14

TA advantages

Answer 14

• large FOV
• visualise relationship with other organs
• can image large masses
• can image other areas
• can take measurements

Question 15

TA disadvantages

Answer 15

• limited resolution
• cant pick up small lesions
• uncomfortable full bladder
• some bladders take longer to fill
• retroverted uterus - difficult to scan

Question 16

Transvaginal approach (TV)

Answer 16

• empty bladder
• normal eating and drinking
• undressed from the waist down
• consent needed, as it is more invasive than TA
• uphold patient privacy and dignity
• chaperone needed

Question 17

TV-technique

Answer 17

• positive ID
• Empty bladder
• explanation
• consent
• chaperone
• allergies
• question patient
• sterile gel used
• cover probe and gloves
• probe is inserted and scan is taken

Question 18

tv advantages

Answer 18

• higher frequencies- better resolution
• no full bladder
• quicker scanning time
• improved visualisation
• chaperone

Question 19

TV disadvantages

Answer 19

• need to find a good chaperone
• uncomfortable
• smaller FOV
• risk of cross infection
• cant assess other areas
• ## cannot view high positioned masses

Question 20

pathology (Fibroids)

Answer 20

• benign muscle tumour
• affects age 35+
• asymptomatic
• grow in response to hormones
• can push against other structures when they grow

Question 21

if endometrium looks thick at wrong part of cycle, it can mimick

Answer 21

a polyp
carcinoma
hormone imbalance

Question 22

if endometrium looks thick at wrong part of cycle

Answer 22

• could be to do with hormonal imbalance
• could be to with with post menopause
• oral contraception
• absence of periods

Question 23

polyps

Answer 23

do not undergo malignant transformation

• bleeding and spotting between periods
• problems getting pregnant

Question 24

treatment of polyps

Answer 24

• removed as a day case

- once treated , it can lead to successful pregnancy

Question 25

endometrial carcinoma - ultrasound

Answer 25

• appear irregular
• thick walled
• heterogenous different densities
• may be abnormal bleeding
• pain pelvis, back, leg

Question 26

ovarian carcinoma presentation

Answer 26

• back pain
• abnormal pv bleeding
  nusea and indigestion
• bloated, swollen adomen

Question 27

ovarian carcinoma risk factors

Answer 27

• risk increases with age
• family history
• lifestyle
• endometrial tissue migrates and grows in other parts of the body

Question 28

MRI Female pelvis structures

Answer 28

• reproductive patient
• adjacent gu, gi
• multiplanar capability

Question 29

MRI female pelvis reasons

Answer 29

• staging for cervical and endometrial cancers

- screening

Question 30

stages of cervical cancer

Answer 30

• 0 - Abnormal cells
• 1 - cancer is only in cervix
• 2 - cancer is invading surrounding tissue
• 3 - cancer spread to lower vagina or pelvic wall
• 4 - cancer has spread to other organs

Question 31

CT staging and response to treatment

Answer 31

• looking at diseases that have moved into other structures
• how far has the cancer spread
• determine the treatment options available e.g. radiotherapy, immunotherapy, chemotherapy, surgery

Question 32

PET- staging and response to treatment

Answer 32

• to do with metabolic activity

Question 33

HSG (histrosalpinography)

Question 34

reasons for hsg

Answer 34

• cause of subfertility- is there a blockage in the fallopian tubes
• recurrent miscarriage
• following tubal surgery

Question 35

hsg patient prep

Answer 35

• patient receives leaflet
• chlamydia test is taken
• patient is told to make an appointment on day 1 of their menstrual cycle
• appointment is made around day 10 (patient cannot have unprotected intercourse from day 1)
• on the appointment day, a urine sample and pregnancy test is taken
• consent also needed
• patient wears gown

Question 36

HSG procedure

Answer 36

• fluoroscopy/ interventional radiology
• sterile procedure
• patient ID
• patient is supine
  catheter is inserted
  imaging over pelvis
  contrast is introduced

Question 37

after HSG

Answer 37

the patient is given a pad to wear - not a tampon

patient is also given time and space to clean up and change

Question 38

uterine artery (fibroid) embolisation

Answer 38

• blocks off the blood supply to the fibroids.

- aims to shrink fibroid