At the end of this lecture The student should be
able to
To demonstrate the scanning protocols, common
pathologies and THIER sonographic appearances
in obs. And gynaecology.
Patient Preparation
A reasonably full urinary bladder is essential
for TAS when it is used as the primary
technique. Patients are instructed to arrive
with a full bladder by drinking 20 to 30
ounces of water or other liquids about one
hour before the scheduled examination.
Patient Position
TAS study is generally
performed with the patient in a
supine or recumbent position.
Transducer Frequency
TAS probes are typically available in the 3 MHz to 5 MHz
range.
Planes of Section
TAS scans are obtained in sagittal (longitudinal) and
transverse (horizontal) planes.
Transducer Manipulations
The basic TAS transducer manipulations are sliding,
rocking, tilting, rotating, and
compression.
Image Presentation
Endovaginal Sonography (EVS)
EVS is also known as transvaginal and vaginal
sonography. EVS is performed by inserting a specialized
endovaginal transducer in the vagina.
Transducers
The success of EVS as a major ultrasound modality is due
to the superior resolution provided by higher frequency
transducers. Endovaginal probes generally operate at
frequencies of 5 to 10 MHz
Transducer Preparation and Care
A small amount of scanning gel is applied to the tip of
the transducer. The transducer is covered with a
disposable barrier prior to insertion. EVS probe
barriers may be specially designed polyethylene covers
(prelubricated with scanning gel), latex condoms, or a
latex surgical glove.
Patient Preparation
For gynecological EVS evaluations, the patient's
bladder should be empty since this allows close
proximity of the vaginal transducer to the body of the
anteverted uterus. With bladder distention, the
anteverted uterus is displaced cranially outside the
effective viewing range of the EVS probe.
Image Presentation
There are no clinical contraindications for the
use of TAS. The patient must be able to
tolerate a distended bladder otherwise the
study may not be adequately performed.
The only significant contraindications for
the use of EVS are patients who have not
been sexually active (virginal patients) and
patients who may not be able to tolerate an
EVS study
Anteflexed Uterus Longitudinal EVS image shows
a mild degree of anteflexion
Retroflexed Uterus Sagittal EVS image of the
uterus shows the body folded behind the cervix
and the fundus directed posteriorly.
Arrow points to the boundary between the cervix
and body
Sagittal and transverse TAS images of a normal
anteverted uterus shows the relationship of the uterus,
bladder, and vagina in both planes. The dashed line
corresponds to the plane of section for the transverse
image.
LEIOMYOMA CLASSIFICATION
1. Intramural Confined to the myometrium
2. Submucosal Projecting into the uterine cavity
3. Subserosal Projecting from the peritoneal
surface
Fibroid containing extensive air after uterine artery
embolization.
In the normal female between the age of 9 and 16, cyclic
changes occur in the ovaries and uterus in response to
endocrinologic activities. These cyclic changes are known as
the menstrual cycle and represent the reproductive phase of a
female's life cycle.
The typical menstrual cycle is 28 days however variations are
very common and normal. For the purpose of description, the
28 day "idealized" cycle is used. The cycle is divided into
phases. It is customary to assign the first day of menstruation
as the first day of the cycle.
