female reproduction imaging techniques Flashcards
advantages of Ultrasound
- no radiation
- non-invasive
- cheap
- localisation of lumps
- well-tolerated
- easily available
- can take measurements
disadvantages of ultrasound
- 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
ultrasound female pelvis
- first choice modality
- followed up by other imaging modalities (depending on findings)
reasons to ultrasound
- unusual pain or bleeding
- infertility
- menstrual problems
- confirmation of a pelvis mass
why is it important to know where the patient is in their cycle
- normal appearances may be reported as abnormal
- Abnormal appearances may be reported as normal
endometrium changes through cycle (day 1-4)
- menstruation
- may see fluid in the cavity when imaging
endometrium changes through cycle (days 5-8)
- early proliferative phase
- very thin echogenic line
endometrium changes through cycle (days 9-15)
- follicular phase
- becomes thicker
- 3 line sign
- ovulation occurs
endometrium changes through cycle (days 16-28)
- luteal phase
- when endometrium is the thickest
Transabdominal approach
- normal eating and drinking
- patient is not required to change
- must have a full bladder
why is a full bladder needed
- moves bowel out of the way
- useful as an anatomical landmark
- manipulates the position of the uterus for it to be visualised
transabdominal scan - technique
- patient ID
- consent
- patient is supine
- paper towels to protect clothes
- questioning the patient about their cycle
- longitudinal and transverse sections
TA aftercare
- patient is given tissue to clean off gel
- they can go to the toilet
- discuss results
TA advantages
- large FOV
- visualise relationship with other organs
- can image large masses
- can image other areas
- can take measurements
TA disadvantages
- limited resolution
- cant pick up small lesions
- uncomfortable full bladder
- some bladders take longer to fill
- retroverted uterus - difficult to scan
Transvaginal approach (TV)
- 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
TV-technique
- positive ID
- Empty bladder
- explanation
- consent
- chaperone
- allergies
- question patient
- sterile gel used
- cover probe and gloves
- probe is inserted and scan is taken
tv advantages
- higher frequencies- better resolution
- no full bladder
- quicker scanning time
- improved visualisation
- chaperone
TV disadvantages
- need to find a good chaperone
- uncomfortable
- smaller FOV
- risk of cross infection
- cant assess other areas
- ## cannot view high positioned masses
pathology (Fibroids)
- benign muscle tumour
- affects age 35+
- asymptomatic
- grow in response to hormones
- can push against other structures when they grow
if endometrium looks thick at wrong part of cycle, it can mimick
a polyp
carcinoma
hormone imbalance
if endometrium looks thick at wrong part of cycle
- could be to do with hormonal imbalance
- could be to with with post menopause
- oral contraception
- absence of periods
polyps
do not undergo malignant transformation
- bleeding and spotting between periods
- problems getting pregnant
treatment of polyps
- removed as a day case
- once treated , it can lead to successful pregnancy
endometrial carcinoma - ultrasound
- appear irregular
- thick walled
- heterogenous different densities
- may be abnormal bleeding
- pain pelvis, back, leg
ovarian carcinoma presentation
- back pain
- abnormal pv bleeding
nusea and indigestion - bloated, swollen adomen
ovarian carcinoma risk factors
- risk increases with age
- family history
- lifestyle
- endometrial tissue migrates and grows in other parts of the body
MRI Female pelvis structures
- reproductive patient
- adjacent gu, gi
- multiplanar capability
MRI female pelvis reasons
- staging for cervical and endometrial cancers
- screening
stages of cervical cancer
- 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
CT staging and response to treatment
- 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
PET- staging and response to treatment
- to do with metabolic activity
HSG (histrosalpinography)
reasons for hsg
- cause of subfertility- is there a blockage in the fallopian tubes
- recurrent miscarriage
- following tubal surgery
hsg patient prep
- 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
HSG procedure
- fluoroscopy/ interventional radiology
- sterile procedure
- patient ID
- patient is supine
catheter is inserted
imaging over pelvis
contrast is introduced
after HSG
the patient is given a pad to wear - not a tampon
patient is also given time and space to clean up and change
uterine artery (fibroid) embolisation
- blocks off the blood supply to the fibroids.
- aims to shrink fibroid
