Khaled Sakhel

Imaging for uterine myomas and adenomyosis.

Uterine myomas and adenomyosis are common findings, in particular in patients with symptoms of abdominal enlargement, pelvic pressure, abnormal uterine bleeding, dysmenorrhea, and dyspareunia. Diagnosis and differentiation between the 2 entities are critical in establishing treatment options and the operative approach for surgical management. Herein are reviewed diagnostic options, their relative accuracy, and the effect of accurate diagnosis on treatment. A review was performed using PubMed, MdConsult, OVID, and reviews including cross-referenced articles and prospective and retrospective studies published from 1980 to 2013. Also reviewed are use of ultrasound with its various methods, magnetic resonance imaging, computed tomography, and positron emission tomography in the diagnosis, pretreatment evaluation, and differentiation of myomas and adenomyosis.

Sonography of adenomyosis.

The Sound Judgment Series consists of invited articles highlighting the clinical value of using ultrasound first in specific clinical diagnoses where ultrasound has shown comparative or superior value. The series is meant to serve as an educational tool for medical and sonography students and clinical practitioners and may help integrate ultrasound into clinical practice.

Thyroid and parathyroid ultrasound examination

These guidelines are an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the American College of Radiology cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

Begin With the Basics Role of 3-Dimensional Sonography as a First-line Imaging Technique in the Cost-effective Evaluation of Gynecologic Pelvic Disease

hree-dimensional (3D) and 4-dimensional (4D) volume sonography of the female pelvis is one of the most important advances in women’s imaging in recent years—in most centers and practices, it has already replaced magnetic resonance imaging (MRI) and computed tomography (CT) for many pelvic imaging indications. Three-dimensional sonography has enabled the user to move sonography into the new era of rapid, automated, and comprehensive imaging, with displays similar to volume imaging that has been an integral part of CT and MRI for several decades. Currently available 3D/4D volume sonography can generate images of the female pelvis that are very similar in orientation and quality to those of MRI and CT. Patients now referred specifically for 3D sonography would previously have required MRI, a far more costly and time-consuming procedure. This article will demonstrate the necessity of 3D sonography as a diagnostic procedure for many pelvic conditions previously requiring MRI or CT. At the same time, it will call on the insurance industry in the United States to reevaluate the current reimbursement policies for 3D sonography, as they currently remain spotty at best, preventing many practitioners from ordering these studies. Since CT and MRI can also provide a diagnosis of many pelvic conditions, referring physicians are often forced to order these costly imaging studies rather than the more patient-friendly imaging now possible with 3D sonography often because of reimbursement.

Native renal artery duplex sonography

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. To promote this mission, the AIUM is pleased to publish, in conjunction with the American College of Radiology (ACR), the Society for Pediatric Radiology (SPR), and the Society of Radiologists in Ultrasound (SRU), this AIUM Practice Guideline for the Performance of Native Renal Artery Duplex Sonography. We are indebted to the many volunteers who contributed their time, knowledge, and energy to bringing this document to completion. The AIUM represents the entire range of clinical and basic science interests in medical diagnostic ultrasound, and, with hundreds of volunteers, the AIUM has promoted the safe and effective use of ultrasound in clinical medicine for more than 50 years. This document and others like it will continue to advance this mission. Practice guidelines of the AIUM are intended to provide the medical ultrasound community with guidelines for the performance and recording of high-quality ultrasound examinations. The guidelines reflect what the AIUM considers the minimum criteria for a complete examination in each area but are not intended to establish a legal standard of care. AIUM-accredited practices are expected to generally follow the guidelines with recognition that deviations from these guidelines will be needed in some cases, depending on patient needs and available equipment. Practices are encouraged to go beyond the guidelines to provide additional service and information as needed.

To forget is human: the case of the retained bulb

The scenario of a forgotten instrument or foreign body has plagued surgical procedures from the early days. It has been estimated that the incidence of retained foreign bodies is around one in every 1,000–1,500 intra-abdominal operations and can be expected to occur at least once per year in hospitals where 8,000–18,000 major surgeries are performed annually. We report a case of a forgotten asepto bulb in the vagina following a robot-assisted total laparoscopic hysterectomy.

Knowledge gap of recommendations in ACOG practice bulletins: a survey of members of the Central Association of Obstetricians and Gynecologists.

Abstract The purpose of this survey was to assess the knowledge gap of recommendations in practice bulletins (PBs). A survey consisting of three questions for 12 selected PBs (six obstetric and six gynecologic) was developed and sent to members of the Central Association. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Of the 385 active members, 100 (26%) returned the survey. The overall correct score was 49%. Respondents were significantly more likely to know recommendations in obstetric PBs (60%) than gynecologic PBs (39%; OR 2.45, 95% CI 2.12–2.81). Maternal-fetal medicine sub-specialists (n=27), compared with obstetricians-gynecologists (n=66), did significantly better with obstetric PBs (67% vs. 59%; OR 1.42, 95% CI 1.32–1.77) and substantially worse with gynecologic topics (34% vs. 39%; OR 0.79, 95% CI 0.63–0.98). In conclusion, since members of the Central Association have a substantial knowledge gap, there are ample opportunities to educate and reinforce PB recommendations.

The Normal Uterus

The uterus as a reproductive organ undergoes changes in response to ovarian hormones in preparation for implantation of the fertilized ovum and maintenance of pregnancy. Most changes are at the level of the endometrium and can be detected by pelvic sonography. Ultrasound is the modality of choice for pelvic organ imaging. Early proliferative endometrium appears as a thin echogenic line. Under the influence of increasing estradiol hormone levels (secreted by the growing ovarian follicles), the endometrial proliferation occurs. Sonographically, this is visualized as thickening of the lining into the trilaminar layer with an anterior and posterior hypoechoic layers bordering the myometrium separated by hyperechogenic central line. The post-ovulatory endometrium is under the influence of progesterone secreted by the corpus luteum, and the lining is characterized by loss of the trilaminar appearance and the development of a uniform echogenic stripe. The cervix also undergoes cyclical changes that are detectable on sonography.

Orientation of the uterine fundus in reference to the longitudinal axis of the body: a 3-dimensional sonographic study.

The aim of this pilot study was to measure the angle of rotation of the uterus at the fundus from horizontal using 3‐dimensional sonography in women presenting for annual gynecologic examinations.

OP03.01: Evaluation of the uterine fundus orientation in relation to the longitudinal axis of the body by 3‐D ultrasound

W. Hofmann1, M. Stumm2, K. Haug3, C. Blank3, M. Wüstemann4, B. Schulze5, G. Raabe-Meyer5, M. Hempel6, M. Schelling7, E. Ostermayer8, S. Langer-Freitag6, T. Burkhardt9, R. Zimmermann9, M. Beck10, T. Schleicher10, Y. Kumar10, D. Schöner1, S. Grömminger1, M. Entezami2 1LifeCodexx AG, Konstanz, Germany; 2Zentrum für Pränataldiagnostik und Humangenetik, Berlin, Germany; 3Praenatal-Medizin und Genetik, Düsseldorf, Germany; 4Zentrum für Pränatalmedizin, Hannover, Germany; 5Praxis für Humangenetik, Hannover, Germany; 6Institut of Human Genetics, Technische Universität München, München, Germany; 7Praxis für Pränatale Diagnostik, München, Germany; 8Department of Obstetrics and Gynecology, Technische Universität München, München, Germany; 9Klinik für Geburtshilfe, Universitätsspital Zürich, Zürich, Switzerland; 10GATC Biotech AG, Konstanz, Germany