Rebecca Hall

Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels

The purpose of this study was to measure the internal and external anal sphincters using translabial ultrasound (TLU) at the proximal, mid, and distal levels of the anal sphincter complex. The human review committee approval was obtained and all women gave written informed consent. Sixty women presenting for gynecologic ultrasound for symptoms other than pelvic organ prolapse or urinary or anal incontinence underwent TLU. Thirty-six (60%) were asymptomatic and intact, 13 symptomatic and intact, and 11 disrupted. Anterior–posterior diameters of the internal anal sphincter at all levels and the external anal sphincter at the distal level were measured in four quadrants. Mean sphincter measurements are given for symptomatic and asymptomatic intact women and are comparable to previously reported endoanal MRI and ultrasound measurements.

Contribution of the second stage of labour to pelvic floor dysfunction: a prospective cohort comparison of nulliparous women.

Maternal expulsive efforts are thought to damage the pelvic floor. We aimed to compare pelvic floor function and anatomy between women who delivered vaginally (VB) versus those with caesarean delivery (CD) prior to the second stage of labour.

Use of intrauterine device in the setting of uterus didelphys.

BACKGROUND: Uterine anomalies are frequently diagnosed in reproductive-aged women and are generally considered a contraindication to the use of intrauterine contraception. We elected to offer this method to a woman with uterus didelphys and a poorly controlled seizure disorder who wished to avoid hormonal and barrier contraceptives. CASE: A 17-year-old woman (gravida 1, para 1) with a seizure disorder desired an intrauterine device (IUD). She was found to have uterus didelphys and a complete vaginal septum. After obtaining informed consent, an IUD was placed in each uterine horn. The patient retained both IUDs and was satisfied with the method 9 months after IUD insertion. CONCLUSION: Intrauterine contraception should be considered an option for women with uterine anomalies on a case-by-case basis.

A comparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women

This study correlated Doppler resistive indices (RIs) with maximum urethral closure pressures (MUCPs) in women with stress urinary incontinence. We hypothesized that urethral blood flow would be inversely correlated to urethral closure pressures. Fifty-three women underwent spectral Doppler waveform analyses of periurethral vasculature to calculate RI. Urethral morphology including pubovesicular length (PVL) with and without cough was measured. MUCPs were obtained according to International Continence Society guidelines. Physical exam and history were also obtained. Correlation coefficients were calculated for comparisons of Doppler measurements and closure pressures. Fifty patients were required to detect a difference between no correlation and a modest correlation of 0.38 with 80% power and alpha of 0.05. Significance is set at p<0.05. Measurements were reproducible between Doppler waveforms and MUCP measurements (all p=NS). RI was not correlated with age, parity, MUCP, Incontinence Impact Questionnaire-7 scores, urethral length, or urethral width (all p=NS). RI and MUCP were likewise not associated with history of diabetes, hypertension, or anterior vaginal prolapse to or beyond the hymen (all p=NS). MUCP was negatively correlated with age (r=−0.33, p=0.01) even when controlled for hormonal status (ANCOVA, p=0.003) and positively correlated with urethral/bladder neck diameter (r=27, p=0.05), PVL (r=0.30, p=0.03), and PVL with cough (r=0.36, p=0.009).

Ultrasound Practitioner Master's Degree Curriculum and Questionnaire Response by the SDMS Membership

Following publication of the ultrasound practitioner (UP) masters degree educational proposal in August 1999, the UP Commission published a questionnaire to obtain feedback from SDMS membership to the UP concept. This article contains the results of that data collection. Additionally, as progress has been made in the development of UP programs around the country, refinement of the curriculum, as originally proposed, has begun. This article contains a breakdown of required didactic and clinical education for the midlevel provider in diagnostic ultrasound.

Enhancing 2D Cervical Length With 3D Cervix Imaging Emphasizing the Center Reference Point

Use of transvaginal ultrasonography for cervical length measurement at the 20-week anatomic examination has been suggested as a screening method to predict the risk of preterm birth. This article describes a three-dimensional ultrasonographic multiplanar imaging method of cervical length measurement by manipulating the center reference point and volume axes. This methodology should yield a more consistent, accurate measurement of the cervical length compared to conventional two-dimensional ultrasonographic methods. Also described are additional software image manipulation techniques to enhance visualization of the relational anatomy of the cervix. Precise utilization of the center reference point and available image reconstruction software augment current two-dimensional morphologic information of the lower genital tract.

3D Volume Assessment of a Cornual Heterotopic Double Anembryonic Gestation and Response to Methotrexate Treatment

A pregnancy developing in the cornu is rare and accounts for less than 1% to 4% of ectopic pregnancies. This case describes a cornual heterotopic gestation occurring as a first pregnancy where both gestational sacs were anembryonic. Presented are subsequent 2D and 3D sonographic findings with laboratory changes following treatment in an ectopic systemic methotrexate protocol.

The Science of Sonology: The Semantics of the Professional

The field of medical imaging has become more than anyone imagined 30 years ago. An unfortunate evolution in semantics has occurred, however, in the semanticsof medical imaging specialties since their inceptions. There has been a failure to apply appropriate nomenclature to the developing areas of specialization. Perhaps this has occurred simply as a result of phenomenally increased technologic development in a short period of time. It is not expected to discontinue anytime soon, how ever, and now may be the time to review the names and titles used in the field. It is understandable that thescienceof radiology, the original medical imag ing specialty, would have created an umbrella for all types of added subspecialty areas under it— namely, radiography, nuclear medicine, computed tomography (CT), sonography, magnetic reso nance imaging (MRI), interventional, positron emission tomography (PET), and so forth. Still, some specialty areas have evolved in and of them selves to not necessarily be part of the scienceof radiology. At the same time, within the radiology world, residencies have lengthened and fellow ships have been created for each area to accommo date time for the residents and postgraduates in training to learn this burgeoning expanse of infor mation. Radiologists often identify themselves as subspecialists within their practice groups, such as interventional radiologist, neuroradiologist, CT radiologist, and so on. Sonography is only one of a few specialty areas that have not remained exclusively practiced by ra diology. As other medical specialists have taken on sonography as part of their practices, the field has created an enormously sophisticated group of sonographic subspecializations, not just within radiology but also among cardiology, vascular surgery, gastroenterology, urology, obstetrics, gynecology, and ophthalmology practices. The science of sonographic imaging has expanded beyond our wildest early application expectations, evidenced by evolving practices and the enormous amount of literature in the field. The provider interpreting the sonographic examination has appropriately become called a sonologist. It is time for thescienceof sonographic imaging to begin to be calledsonology. Biologists, geologists, zoologists, and psychologists have biology, geology, zoology, and psychology. Sonologists and sonographers should have sonology. Under the umbrella termultrasound, a wide variety of names have been used. It has been labeled by so many names; there is often confusion among patients and professionals alike. Is it ultrasound technology, sonography, ultrasonography, or ultra sound? Patients know what ultrasoundis, but they do not know whatsonographyis. “I had my ultrasound today,” makes the modality the examination. The general public often erroneously thinks sonog raphy is “stenography.” Is a “sonogram” one pic ture, or is it the entire examination? Is the examiner a sonographer, technician, ultrasonographer, ultra sound technologist, medical ultrasound profes sional, or tech? All names are used in a variety of settings. Even the individual examiners do not have a standardized professional title used in their various JDMS 19:337–339 November/December 2003 337