scanning techniques Flashcards
LMP
1st day of last menstrual cycle (day 1 of menses)
2 weeks prior to conception
20-40% of females are uncertain
gravid
a pregnant woman
multigravida
A woman who has been pregnant 2 or more times
gravida
Written according to # of pregnancies including the current one
Example:
gravida 0 (nulligravida) G 0 gravida 1 = G1 gravida 2 = G2 gravida 3 = G3
para
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.”
multipara
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
Parity numberic sequence
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
what would a currently pregnant female with history of 1 abortion, and a 2-year-old child is
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
Currently pregnant female with history of 4 separate pregnancies yet, no live births is
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
What do you need to find out about patient history before an exam?
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?
steps prior to performing an exam
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
What 4 things must you follow when performing an exam?
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
what does US documentation need to have?
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)
What is another name for transvaginal?
endovaginal
benefits of TA
Provides a wider field of view than TV
Better visualization of superficial structures & structures far from the vagina
Use a full bladder
limitation of TA
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
benefits of TV
Allows high frequency transducer to be placed close to “target organs”
Provides anatomic details not obtained with TA
Want patient to empty bladder
Indications for TV (when to use)
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
limitatons of TV
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
When would you do both a TA and a TV
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
TA patient prep
What didn’t the patient do based on this image?
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
identify the bladder, fundus, body cervix and vaginal stripe
what are the scanning planes for TA
long, trans and oblique
TA Exam Protocol (long, trans,measurements)
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)
Where is this image taken? What do you see?
TA long midline
where should the calipers be?
TA Tranverse Imaging protocol
Vagina
Uterus:
Cervix, Body with measurements, Fundus
Ovaries with measurements
Left ovary, Right ovary
What do you see? What plane is it in?
TA trans
TA trans caliper placement
What plane is this?
TA long right
Pi is piriformis muscles, S is sacrum
What plane is this?
TA trans right
pi is piriformis muscle, s is sacrum
What type of Td?
TV off-axis or “tilted”
what type of Td?
end firing
TV Td Prep
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)
TV Patient Prep
Empty bladder
Contraindications: Virginal patient, Vaginal stenosis or atresia
how do you place the Td in TV to get the adnexa?
somewhat obliquely toward the contralateral side of the pelvis
what place is a trans TV scan obtained?
coronal
What do you need to recognize about anatomy when doing a TV as opposed to TA? Why?
there may be rearrangements due ot empty bladder.
Tv scan planes
saggittal, coronal, oblique
Protocol for TV Exam
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)
What is the TV orientation and how is the Td positioned?
sagittal
The transducer handle should be more posterior aiming the beam more anterior in order to match the US image & area of interest
orientation & probe position
sagittal, angled anterior to visualize fundus
what is posterior to the uterus?
bowel
plane and Td position?
TV sagittal
Slight withdrawal of the transducer and angling the probe posterior/ inferior demonstrates the cervix and endocervical canal
what do you see?
TV sagittal
posterior cul-de-sac fluid
orientation? what do you see?
parasagittal of ft ovary
corpus luteum and ovary measurement in long
orientation, probe position
TV Coronal, Anterior to get fundus
In TV coronal, how should your Td be positioned to get the lower uterine segment and cervix?
posterior
What do you see?
TV coronal lt ovary and uterus (duplicate). white arrows pointing to follicles.
What lies to the lateral lt and rt of the uterus in a TV coronal image?
piriformis muscles
how do you clean a Td
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
what is the less toxic disinfectant and what steps do you need to take for precautions
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
what disinfectant is most toxic?
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
What’s up with this uterus?
it’s retroflexed
what position is this uterus ?
retroflexed
What’s going on with this uterus?
retroflexed
what is happening with this uterus?
anteflexed
What is the difference b/t these 2 uterus’
top is normal or anteverted
bottom is anteflexed
what is a uterus displaced to the right of the cervi called?
destropositioned
What is a uterus displaced to the left of the cervix called?
levopositioned
what position is this uterus in?
retroversion
What is the age of the uterus’?
puberty, multiparous, post-monopausal
what is the age of this uterus?
newborn
how old is this uterus?
2 yrs old
how old is this uterus?
prepuberty
how old is this uterus?
13 yrs.
how old is this uterus? identify the numbers.
nulliparous
how old is this uterus?
multiparous
how old is this uterus?
75 yrs old!
what is the scan plane? name the orientations (a-g)
self - quiz
label a-f
what are the differences between the internal and external iliac artery and vein flows?
Artery: High velocity, High impedance, Some spectral broadening
Vein: Non-pulsatile, Opposite direction, Respiratory variations
what does the waveform of a iliac artery taken from a TA exam look like?
What does at TV waveform of the external iliac artery look like?
What does a TV of the external iliac vein look like?
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
ovarian artery flow pattern
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
1 - 5
9-28
___ remains relatively constant bilaterally irrespective of side ovulation
peak systolic veocity of the ovarian artery.
what changes to the flow characteristics of the avariant arteries when a woman has been post-meopausal for 11 yrs or more?
absent diastolic flow (RI or 1.0)
What does this image represent?
inactive ovarian artery.
what does this image represent?
active ovary w/ corpus luteum.
what can you say based upon this image?
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
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)
uterine arteries
what can you see in this image?
uterine radial arteries, triple echo sign representing proliferative phase of endometrium.
what is this image represent?
spiral artery in endometrium
what does this image represent?
arcuate venous plexus
