Female Pelvis & TA's/TV's

Question 0

What is PATIENT PREP for a TRANS-VAGINAL scan?

Answer 0

NO PREP

Have patient urinate, getting out as much fluid as possible; bladder should be as empty as possible

Question 1

What is PATIENT PREP for a TRANS-ABDOMINAL scan?

Answer 1

Full bladder - 4 to 6 glasses of water; finish 1 hour prior to exam
Do not void (urinate) prior to exam

Question 2

What are the 6 reasons for having a full bladder during a TRANS-ABDOMINAL scan?

Answer 2

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

Question 3

What are 3 different ways a bladder can be described based on fullness?

Answer 3

Not full, adequate, overdistended

Question 4

What PATIENT HISTORY needs to be asked before a pelvic exam?

12 items

Answer 4

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

Question 5

What is gravid?

Answer 5

Number of pregnancies

Question 6

What is parity?

Answer 6

Number of live births

Question 7

When talking about Menstural status, what is premenarch?

Answer 7

Prepuberty; prior to onset of menses

Question 8

When talking about Menstural status, what is menarche?

Answer 8

Reaching puberty; menses every 21-28 days

Question 9

When talking about Menstural status, what is peri/premenopausal?

Answer 9

2-10 years prior to cessation of menses

Question 10

When talking about Menstural status, what is menopause?

Answer 10

Menses ceases permanently; AT LEAST one year without menses

Question 11

BE ABLE TO EXPLAIN PROCEDURES:

• Transabdominal (TA)
• Transvaginal (TV)/Endovaginal (EV)

Answer 11

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

Question 12

What 4 organizations control performance standards in Pelvic US?

Answer 12

SDMS, AIUM, ACOG, ACR

Question 13

What is SDMS?

Answer 13

Society of Diagnostic Medical Sonography

Question 14

What is AIUM?

Answer 14

American Institute of Ultrasound in Medicine

Question 15

What is ACOG?

Answer 15

American College of Obstetrics & Gynecology

Question 16

What is ACR?

Answer 16

American College of Radiology

Mainly used for Pelvic US guidelines

Question 17

What are some ACR guidelines for Pelvic US?

Answer 17

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

Question 18

What is PROM?

Answer 18

Premature rupture of membranes

Question 19

What transducer would be used for a TA?

Answer 19

Curvilinear or sector/vector up to 5 MHz - “overview”

Question 20

What transducer would be used for a TV?

Answer 20

TV transducer 7.5 MHz or higher - detail & characterization

Question 21

When identifying pathology in a structure, what guidelines should be followed?

Answer 21

Identify anatomy and pathology in 2 planes - long & transverse

Question 22

What should be remembered when setting up equipment for a scan?

Answer 22

Built in presets
Should tweak to improve
Harmonics
Highest frequency to penetrate; decrease if need more penetration

Question 23

When describing anatomy and pathology, what 5 details need to be included?

Answer 23

Identity sonographic characteristics 
Location
Size
External contours
Internal consistency

Question 24

What is the normal size of a follicle?

Answer 24

Under 2.0-2.5 cm

Question 25

What measurement size is labeled as possible cyst?

Answer 25

Above 2.5 cm

Question 26

What is a limitation of the TA scan?

Answer 26

Obese patients or unable to fill bladder

Question 27

2 important things to remember about TA & TV scans...

Answer 27

Take images in long and transverse Be methodical and routine; follow SAME imaging protocol

Question 28

List LONGITUDINAL TA & TV protocol...

Answer 28

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

Question 29

List TRANSVERSE TA & TV protocol...

Answer 29

``` Trans Vagina Trans Cervix Trans LUS Trans UT w/ & w/o measure Trans Fundus Trans RT ADX Trans LT ADX ```

Question 30

How do you scan an OVARY Transabdominally & Transvaginally?

Answer 30

``` 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 ```

Question 31

What should you always be evaluating the pelvis for?

Answer 31

Masses or cysts

Question 32

What are the steps for a TV scan?

Answer 32

``` 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 ```

Question 33

For TV scanning, the LEFT side of the screen is showing what?

Answer 33

Cranial/right side of patient

Question 34

For TV scanning, the RIGHT side of the screen is showing what?

Answer 34

Caudal/left side of patient

Question 35

For TV scanning, the TOP is describing what scanning plane?

Answer 35

Caudal

Question 36

For TV scanning, the BOTTOM is describing what scanning plane?

Answer 36

Cranial

Question 37

For TV scanning, the RIGHT is describing what scanning plane?

Answer 37

Anterior

Question 38

For TV scanning, the LEFT is describing what scanning plane?

Answer 38

Posterior

Question 39

Direction of the TV transducer is based on the movement of the ______ of the transducer and not the ______ of the transducer.

Answer 39

Face; handle

Question 40

When doing a TV scan longitudinally, the notch of the transducer is pointed which direction?

Answer 40

Notch of transducer is up

Question 41

When doing a TV scan transversely, the notch of the transducer is pointed which direction?

Answer 41

Notch is pointed toward the sonographer

Question 42

When doing a TV scan, tilting the transducer anteriorly will bring what into view?

Answer 42

The fundus

Question 43

When doing a TV scan, tilting the transducer posteriorly will bring what into view?

Answer 43

Cul-de-sac

Question 44

Be sure to ALWAYS do what when finished with a TV scan?

Answer 44

Clean the probe

Question 45

When is a TRANSLABIAL scan done?

Answer 45

When a patient has PROM, cervical incompetence, or prolapsed uterus/cervix

Question 46

How is a TRANSLABIAL scan done and what transducer is used?

Answer 46

Considered a transperineal Use a 3.5-5.0 MHz or TV probe Cover probe & place in perineal area towards vagina

Question 47

When scanning, how do you know you're imaging a muscle?

Answer 47

It will be hypoechoic structures with echogenic striations

Question 48

How are muscles seen when imaging? What type of transducer is used?

Answer 48

With a full bladder | Sector/vector or Linear transducer

Question 49

What is the Obturator Internus muscle?

Answer 49

Posterior lateral corners of bladder at vagina/cervix level

Question 50

What is the Pelvic Floor muscles?

Answer 50

Transverse inferior aspect of bladder

Question 51

What is the Piriformis muscles?

Answer 51

Posterior lateral to upper half of uterine body/fundus

Question 52

What muscles are scanned with a sector or vector transducer?

Answer 52

Obturator Internus muscles Pelvic floor muscles Piriformis muscles

Question 53

What is the Rectus Abdominus muscles?

Answer 53

Anterior abdominal wall

Question 54

What muscles are scanned with a linear transducer?

Answer 54

Rectus Abdominus muscles | Iliopsoas muscles