{"id":1243,"date":"2014-12-14T13:16:14","date_gmt":"2014-12-14T13:16:14","guid":{"rendered":"http:\/\/praenatal-zuerich.ch\/?page_id=1243"},"modified":"2016-03-31T13:56:17","modified_gmt":"2016-03-31T13:56:17","slug":"gyn-ultrasound-training","status":"publish","type":"page","link":"https:\/\/praenatal-zuerich.ch\/?page_id=1243","title":{"rendered":"Normal gyn. US imaging"},"content":{"rendered":"
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Back to Pocket Gyn<\/a><\/span><\/strong><\/p>\n

Teaching basic gynecological and obstetric ultrasonography remains a challenge; it typically consists of limited personal instruction by an expert while a patient, having agreed to a \u2018training exam\u2019, is being scanned.<\/p>\n

This website presents\u00a0a simple\u00a0tool that may help to learn and teach gynecological ultrasound, based on a proposed standardized approach\u00a0(Tutschek et al. UOG 2012<\/a>). It uses interactive webpages according to the HTML5 standard that is supported on most modern browsers including Smartphones. These are image files containing stacks of\u00a0parallel sections in a standard orientation optimized to show relevant\u00a0anaomitcal structure or landmarks.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

Transabdominal or transvaginal insonation?<\/h3>\n

The\u00a0combination of both approaches provides most information. For beginners the transabdominal (TA) \u00a0insonation enables\u00a0an easier understanding of the anatomical relationships. However, an echogenic abdominal wall and\u00a0intervening bowel can limit\u00a0image quality. The transvaginal (TV) approach provides better\u00a0resolution due to the higher frequency of the TV\u00a0transducers and the closer proximity to the pelvic organs. However, an extended uterus, large fibroid or ovaries lying\u00a0far cranial to the uterus can often not be seen better with TV insonation.<\/p>\n

Beginning to scan and getting the orientation: the transabdominal approach<\/h3>\n

The abdominal\u00a0transducer\u00a0is positioned in the midline cranial to the\u00a0pubic bone. The landmarks to be included in the starting image\u00a0should be the\u00a0maximum sagittal diameter of the bladder\u00a0and\u001b\u00a0usually a median section of the uterus.<\/p>\n

Then, the transducer is placed\u00a0paramedian plane, retaining the\u00a0longitudinal orientation,\u00a0on\u00a0the right and then\u00a0left side\u00a0and\u00a0just medial to the pelvic bone.\u00a0The landmark to see\u00a0is a\u00a0longitudinal section of the external iliac vessels.<\/p>\n

Orientation in transvaginal scanning<\/h3>\n

When performing an transvaginal scan, the image on the ultrasound system’s screen can be oriented to show the transducer tip on the bottom or the top of the screen (down or up). The position of the bladder can be to the left or the right of the screen. Whichever way is used does not really matter as long as the operator does so consistently and can find the orientation in the images easily. FOr this website, trasvaginally acquired images are displayed with the transducer on the bottom of the screen and ventral (towards the bladder) on the left of the screen (green box in the following image).<\/p>\n

\"vag-tdx-orient\"<\/p>\n

Performing a transvaginal scan<\/h3>\n

The TV transducer\u00a0has limited options\u00a0of spatial positioning (tilting, rotating, partial insertion) and\u00a0requires more skill to obtain diagnostic sections. Lowering the handle of the TV transducer \u00a0directs the viewing angle to the front lifting the handle to the back. Tilting the TV transducer to the sides directs the view towards the pelvic walls and the ovarian fossa; additional rotation to the side often permits viewing of the uterus, the tube and the ipsilateral ovary.<\/p>\n

Different\u00a0orientations for the display of TV images are being used: With the probe on the top or on the bottom of the image, and with the bladder on the left or the right of the image. This orientation does not affect image quality or diagnostic capabilities, but a standardized use is recommended. In this website \/ tutorial for transvaginal scanning the transducer is shown on the bottom of the image and the ventral part to the left, as shown on the green frame:<\/p>\n

\"vag-tdx-orient\"<\/p>\n

When inserting the probe, it should be carefully introduced\u00a0in the axis of the vagina, taking care not to exert pressure to the anterior vaginal wall. Partially insertion into the introitus only allows\u00a0\u00a0examination the urethra , the undistended vagina and the rectum dorsally.<\/p>\n

When the probe is fully inserted its tip is usually placed in the anterior fornix and in contact with the anterior lip of the cervix.<\/p>\n

Assessing the endometrium<\/p>\n

Assessing the ovaries<\/p>\n

 <\/p>\n

Intramural fibroids<\/p>\n

hemorrhagic ovarian cyst \u00a0B-mode only with color Doppler<\/p>\n","protected":false},"excerpt":{"rendered":"

Back to Pocket Gyn Teaching basic gynecological and obstetric ultrasonography remains a challenge; it typically consists of limited personal instruction […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2153,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/full-width.php","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"class_list":["post-1243","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=\/wp\/v2\/pages\/1243","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1243"}],"version-history":[{"count":25,"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=\/wp\/v2\/pages\/1243\/revisions"}],"predecessor-version":[{"id":2207,"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=\/wp\/v2\/pages\/1243\/revisions\/2207"}],"up":[{"embeddable":true,"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=\/wp\/v2\/pages\/2153"}],"wp:attachment":[{"href":"https:\/\/praenatal-zuerich.ch\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1243"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}