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ObGyn > scanning techniques > Flashcards

scanning techniques Flashcards

1
Q

LMP

A

1st day of last menstrual cycle (day 1 of menses)

2 weeks prior to conception

20-40% of females are uncertain

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2
Q

gravid

A

a pregnant woman

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3
Q

multigravida

A

A woman who has been pregnant 2 or more times

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4
Q

gravida

A

Written according to # of pregnancies including the current one

Example:

gravida 0 (nulligravida) G 0
 gravida 1 = G1
 gravida 2 = G2 gravida 3 = G3
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5
Q

para

A

Number of potentially viable births

Per Taber’s “A woman who has produced a potentially viable infant regardless of whether the infant is alive at birth

Weighing 500 grams or more or over 20 weeks gestation

Multiple births are considered to be a single parous experience.”

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6
Q

multipara

A

More than one potentially viable births

Written according to # of pregnancies

 Example para 0 (nullipara) = P0
 para 1 (primipara) = P1
 para 2 = P2 para 3 = P3

*Multiple births are considered to be a single parous experience.” Taber’s

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7
Q

Parity numberic sequence

A

Describes the outcome of each gravid experience

Written P0000
1st 0 Place = Number of full term pregnancies
2nd 0 Place = Number of premature births
3rd 0 Place = Number of abortions
4th 0 Place = Number of living children

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8
Q

what would a currently pregnant female with history of 1 abortion, and a 2-year-old child is

A

G3, P1, Ab 1 or

G3, P1011

Gives the details why she is G3 P1: 1 full term, 0 premature births, 1 abortion & 1 living child

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9
Q

Currently pregnant female with history of 4 separate pregnancies yet, no live births is

A

G5 P0 or

G5 P0220

Gives the explanation for why she has no children despite being pregnant 5 times: 0 full term pregnancies, 2 premature births, 2 abortions and 0 living children

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10
Q

What do you need to find out about patient history before an exam?

A

Check chart, requisition or ask the following:

Reason for referral
LMP
Parity
H/O surgery?
Abdominal &/or pelvic
Latex allergy?
Pertinent family history
Disease &/or anomaly
H/O ART? (Assisted Reproductive Technology)

Pain?
Where?
Palpable mass?
When?
Type?
Sharp versus dull
Abnormal or irregular bleeding?
Lab’s related to current condition
Fever?

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11
Q

steps prior to performing an exam

A

Set up the room
Select & prepare transducer
Warm gel, K-Y jelly etc
Introduce yourself to patient
Inform patient of what to expect
Ask if patient has any questions
Patient is positioned appropriately for type of exam
Begin imaging

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12
Q

What 4 things must you follow when performing an exam?

A

Be methodical: Each & every exam done must be given importance and thoroughness

Answer the ordering MD’s suspicions

Include all measurements

Follow a standard routine: AIUM (American Institute of Ultrasound in Medicine) or other

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13
Q

what does US documentation need to have?

A

Clearly demonstrate a thorough series of images to document exam

Show anatomical relationships

Have labeled images with scan plane and area of body

 Examples:  Long ML (Longitudinal midline)
 Trans RT (Transverse right side of body)
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14
Q

What is another name for transvaginal?

A

endovaginal

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15
Q

benefits of TA

A

Provides a wider field of view than TV

Better visualization of superficial structures & structures far from the vagina

Use a full bladder

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16
Q

limitation of TA

A

Attenuation of the beam by the anterior wall

Inability to correlate areas of visible pathology with direct clinical palpation

Poor resolution of internal consistency of structures

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17
Q

benefits of TV

A

Allows high frequency transducer to be placed close to “target organs”

Provides anatomic details not obtained with TA

Want patient to empty bladder

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18
Q

Indications for TV (when to use)

A

Better evaluation of relatively small masses (5-10 cm)

Determine the presence or absence of a mass or normal pelvic structures

Determine origin of a mass: Ovarian,Uterine,Tubal

Detail consistency of masses

Better evaluation of endometrium and myometrium and their relationship to pelvic masses

Help determine mobility of masses

Ultrasound guided aspirations

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19
Q

limitatons of TV

A

Limited field of view (depth)

Patient’s history: Age limitations, Virginal patients, Abuse (rape)

Patient’s with inflammatory disease are very tender, may cause too much pain compared to TA

Male sonographer’s especially need a chaperone

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20
Q

When would you do both a TA and a TV

A

TA studies are used in a global fashion because of the restricted view of TV studies

If a relatively large mass is found on TA, TV may not be useful

If TA is technically satisfactory and answers clinical questions, TV may not be necessary

Serial exams of ovaries (esp. hormonal stimulation pt’s) TA may not be necessary

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21
Q

TA patient prep

What didn’t the patient do based on this image?

A

fill her bladder

Do before barium studies
 Full bladder (32 oz of H2 O 1 hour prior to exam). Optimal when it covers fundus and flattens uterus enough to visualize it and adnexa well

Limitations: Pt’s unable to fill bladder, Incontinent patient, Infants, Obese

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22
Q

identify the bladder, fundus, body cervix and vaginal stripe

A
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23
Q

what are the scanning planes for TA

A

long, trans and oblique

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24
Q

TA Exam Protocol (long, trans,measurements)

A

Standard Routine

Longitudinal
Uterus from cervix to fundus, showing vaginal stripe & endometrial stripe
Cul-de-sacs
Right & left ovaries and adnexa

Transverse
Same as above

long measurements: Uterus and endometrial stripe (length, anterior-posterior (AP) dimension), Rt and Lt ovary (length + AP)

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25
Q

Where is this image taken? What do you see?

A

TA long midline

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26
Q

where should the calipers be?

A
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27
Q

TA Tranverse Imaging protocol

A

Vagina

Uterus:
Cervix, Body with measurements, Fundus

Ovaries with measurements
Left ovary, Right ovary

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28
Q

What do you see? What plane is it in?

A

TA trans

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29
Q

TA trans caliper placement

A
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30
Q

What plane is this?

A

TA long right

Pi is piriformis muscles, S is sacrum

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31
Q

What plane is this?

A

TA trans right

pi is piriformis muscle, s is sacrum

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32
Q

What type of Td?

A

TV off-axis or “tilted”

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33
Q

what type of Td?

A

end firing

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34
Q

TV Td Prep

A

Ask patient if have latex allergies

Gel inside cover (NO air bubbles!)
To lubricate probe insertion: Non-contaminated gel outside, KY Jelly, H20 if fertility testing (Lubricant adversely effects sperm motility)

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35
Q

TV Patient Prep

A

Empty bladder
Contraindications: Virginal patient, Vaginal stenosis or atresia

36
Q

how do you place the Td in TV to get the adnexa?

A

somewhat obliquely toward the contralateral side of the pelvis

37
Q

what place is a trans TV scan obtained?

A

coronal

38
Q

What do you need to recognize about anatomy when doing a TV as opposed to TA? Why?

A

there may be rearrangements due ot empty bladder.

39
Q

Tv scan planes

A

saggittal, coronal, oblique

40
Q

Protocol for TV Exam

A

saggital:

Uterus with measurements
Endometrial stripe with measurement
Cul-de-sac
Ovaries with measurements

Adnexa: Sweep left and right (May need to angle the beam slightly anteriorly)

coronal:

Uterus: Cervix, Body with measurements, Stripe, Fundus
Ovaries with measurements

Rt and Lt Adnexa (angle bema towards pt lt to visiaulize lt and vice versa)

41
Q

What is the TV orientation and how is the Td positioned?

A

sagittal

The transducer handle should be more posterior aiming the beam more anterior in order to match the US image & area of interest

42
Q

orientation & probe position

A

sagittal, angled anterior to visualize fundus

43
Q

what is posterior to the uterus?

A

bowel

44
Q

plane and Td position?

A

TV sagittal

Slight withdrawal of the transducer and angling the probe posterior/ inferior demonstrates the cervix and endocervical canal

45
Q

what do you see?

A

TV sagittal

posterior cul-de-sac fluid

46
Q

orientation? what do you see?

A

parasagittal of ft ovary

corpus luteum and ovary measurement in long

47
Q

orientation, probe position

A

TV Coronal, Anterior to get fundus

48
Q

In TV coronal, how should your Td be positioned to get the lower uterine segment and cervix?

A

posterior

49
Q

What do you see?

A

TV coronal lt ovary and uterus (duplicate). white arrows pointing to follicles.

50
Q

What lies to the lateral lt and rt of the uterus in a TV coronal image?

A

piriformis muscles

51
Q

how do you clean a Td

A

Throw away probe cover

Wipe off excess gel

Unplug the transducer from the system & disinfect according to manufacturer

High level disinfection is the accepted method of infection control –> If cover broke extra disinfecting is needed

52
Q

what is the less toxic disinfectant and what steps do you need to take for precautions

A

Cidex / OPA: Less toxic than gluteraldehyde based brands. Must still handle with care!

Wear gloves, gown and mask when pouring into anything else

Check Expiration date: Use test strips & keep track with a log sheet. Once used to disinfect a probe, only potent for 14 days

Soak appropriate time

3 Minute rinse with water: Residual may remain on transducer

53
Q

what disinfectant is most toxic?

A

Glutaraldehyde Based. Toxic so, handle with extreme care

Wear gloves, gown or lab coat & face splash guard when mixing – Gloves should be Nitrile or Butyl Rubber

Avoid fumes

Check manufacturer directions for potency length of time

Soak as directed

Always rinse well with water following disinfections

54
Q

What’s up with this uterus?

A

it’s retroflexed

55
Q

what position is this uterus ?

A

retroflexed

56
Q

What’s going on with this uterus?

A

retroflexed

57
Q

what is happening with this uterus?

A

anteflexed

58
Q

What is the difference b/t these 2 uterus’

A

top is normal or anteverted

bottom is anteflexed

59
Q

what is a uterus displaced to the right of the cervi called?

A

destropositioned

60
Q

What is a uterus displaced to the left of the cervix called?

A

levopositioned

61
Q

what position is this uterus in?

A

retroversion

62
Q

What is the age of the uterus’?

A

puberty, multiparous, post-monopausal

63
Q

what is the age of this uterus?

A

newborn

64
Q

how old is this uterus?

A

2 yrs old

65
Q

how old is this uterus?

A

prepuberty

66
Q

how old is this uterus?

A

13 yrs.

67
Q

how old is this uterus? identify the numbers.

A

nulliparous

68
Q

how old is this uterus?

A

multiparous

69
Q

how old is this uterus?

A

75 yrs old!

70
Q

what is the scan plane? name the orientations (a-g)

A
71
Q

self - quiz

A
72
Q

label a-f

A
73
Q

what are the differences between the internal and external iliac artery and vein flows?

A

Artery: High velocity, High impedance, Some spectral broadening

Vein: Non-pulsatile, Opposite direction, Respiratory variations

74
Q

what does the waveform of a iliac artery taken from a TA exam look like?

A
75
Q

What does at TV waveform of the external iliac artery look like?

A
76
Q

What does a TV of the external iliac vein look like?

A
77
Q

what is Well organized, has Spectral broadening, Changes with the menstrual cycle. has High impedance, low velocity when inactive and Low impedance, higher velocity when active with No flow when torsion occurs

A

ovarian artery flow pattern

78
Q

what days are the ovaries arterial patterns inactive w/ Low velocity, (high) resistance (low or absent diastolic flow)

what days Non-dominant ovary does NOT show cyclic changes, inactive and the Dominant ovary becomes active

A

1 - 5

9-28

79
Q

___ remains relatively constant bilaterally irrespective of side ovulation

A

peak systolic veocity of the ovarian artery.

80
Q

what changes to the flow characteristics of the avariant arteries when a woman has been post-meopausal for 11 yrs or more?

A

absent diastolic flow (RI or 1.0)

81
Q

What does this image represent?

A

inactive ovarian artery.

82
Q

what does this image represent?

A

active ovary w/ corpus luteum.

83
Q

what can you say based upon this image?

A

Days 9-28 Ovary with dominant follicle becomes active with greater perfusion shown by decreased resistance (high diastolic)

Impedance drops dramatically because of Graafian follicle

84
Q

what is Well organized w/ Spectral broadening
and Changes with functional activity of intrauterine contents. has High Impedance when Non-gravid and Low Impedance with Pregnancy or Gestational trophoblastic neoplasia (GTN)

A

uterine arteries

85
Q

what can you see in this image?

A

uterine radial arteries, triple echo sign representing proliferative phase of endometrium.

86
Q

what is this image represent?

A

spiral artery in endometrium

87
Q

what does this image represent?

A

arcuate venous plexus

ObGyn (14 decks)

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