Re: Hysterosonography Protocol
From: Ann Polin (apolin@bcc.ctc.edu)
Sun Mar 25 22:40:56 2001
Sharon - Thanks so much - This is great! Would anyone else care to comment?
--
Ann Polin, BS, RDMS
Aninwah Medical Center
PO Box 5203
Kumasi, Ghana, West Africa
E-Mail: charna@africaonline.com.gh
Telephone Home: 011-233-51-39226
Telephone Mobile: 011-233-24-371999
Telephone Hospital: 011-233-51-60107
Program Chair (1998-2000), Currently on Sabbatical
Diagnostic Ultrasound Program, B243
Bellevue Community College, 3000 Landerholm Circle SE
Bellevue, WA 98007-6484 USA
-----Original Message-----
From: charter.netTo: Multiple recipients of list ULTRASOUND
Sent: 3/25/01 3:21 PM
Subject: Re: Hysterosonography Protocol
Greetings,
I will give it a shot, by enumerating the steps we use in doing the
procedure. I hope it is helpful.
Sharon Durbin RDMS
SONOHYSTEROGRAM
POLICY
Physician to be assisted with procedure by sonographer
DEFINITION
Instillation of sterile saline through a catheter into the uterus under
real-time vaginal transducer observation for enhancement and assessment
of
endometrial cavity. This procedure is done on day 3 - day 7, near end of
menstrual bleeding, when endometrium is thin (Day 6 is generally the
"ideal
day.")
EQUIPMENT
1. Tray with barrier drape (approx. 16"x29")
2. Sterile container (i.e. sterile urine specimen container).
3. Hibiclens in specimen container
4. 60 cc syringe
5. Sterile saline solution (100 cc bag)
6. Three OB/GYN swabs
7. Open-sided speculum
8. KDF 2.3 intrauterine cannula
9. Ring forceps
10. Tennaculum
11. Portable light source
12. Stool (for physician)
13. Catch basin positioned in leg rest on exam table.
PROCEDURE
1. Set out sterile gloves for physician. Have flashlight or another
light
source available for use during procedure.
2. Arrange blue Chux (tripads) on both exam table and step.
3. Explain procedure to patient to allay any anxiety. Have patient void
to
assure an empty bladder. Be sure patient has taken Ibuprofen before
coming
to appointment.
4. Assist patient in assuming lithotomy position and follow procedure as
described under endovaginal scans, obtaining views of cervix. Uterus,
both
ovaries and cul-de-sac. This is the baseline study ---an unenhanced
pre-instillation pre-evaluation.
5. Once physician is gloved, he/she draws the sterile saline solution
into
the 60 cc syringe, attaches the catheter and flushes saline solution
through
catheter. Syringe and catheter are set on sterile field.
6. Physician is ready to begin sonohysterogram: Open-sided speculum is
inserted.
7. Cervix is cleansed with a betadine solution (HIBICLENS)
8. An intrauterine catheter is then threaded into the endometrium
9. Speculum is removed carefully so as not to dislodge the intrauterine
catheter.
10. Vaginal transducer is re-inserted.
11. Using a 60 cc syringe, saline solution is instilled under direct
real-time observation. (One should have had flushed the catheter prior
to
using it, to get rid of echogenic artifact.)
12. Obtain hard copy views from cornua to cornua, coronal plane; cervix
to
fundus. Continue obtaining views to reconstruct a 3-dimensional anatomy
of
the intrauterine cavity.
COMMENTS:
This procedure is useful in any case where better endometrial detail
will be
helpful. For example, to distinguish dysfunctional uterine bleeding
from
patients with myomas or polyps, thus dismissing or allowing appropriate
surgical intervention. Infertility patients' endometrium can be
evaluated
for the presence of polyps. It does not replace the HSG, but the
presence
of free fluid in the cul-de-sac proves, at least, unilateral tubal
patency.
Sonohysterography is also useful in women on Tamoxifen therapy,
especially
if they have a history of vaginal bleeding. (Tamoxifen is used
extensively
in women with breast cancer, with reports of it causing hyperplasia or
even
adenocarcinoma of the endometrium).
>----- Original Message -----
From: "Terry J DuBose" <tjdubose@juno.com>
To: "Multiple recipients of list ULTRASOUND"
<ultrasound@mail.medispecialty.com>
Sent: Sunday, March 25, 2001 4:50 PM
Subject: Re: Hysterosonography Protocol
> Hi Ann, glad the African educational trip it going well. To my
knowledge
> there are no published protocols for sonohystrography, or
> hystrosonography, what ever. I do believe that this forum can provide
a
> protocol or guidelines.
>
> So what say folks, can we organize and write a set of protocols for
this
> procedure in virtual association?... I am quite sure the AIUM, SDMS or
> ISUOG could do it very well, but they are so slow, meeting only once
or
> twice a year.
>
> Shall we begin by enumerating the basics of the procedure... unless
> someone can point us to a URL where they are already published?
>
> If you perform sonohystrography, please list in concise English the
steps
> involved... then we will start discussing and arriving at some kind of
> final list.
>
> Peace, Terry J. DuBose, M.S., RDMS, APS
> Chair, Ultrasound OBGYN.net
> Little Rock, Arkansas USA
>
> --------------------------------------
>
> --------------------------------------
> On Sun, 25 Mar 2001 15:28:04 -0600 charna@africaonline.com.gh (Ann
> --------------------------------------
Polin,
> BS, RDMS) writes:
> > Dear Ultrasound Colleagues: It is my pleasure to let you all know
> > that
> > "Project Africa" is well on its way to being an overwhelming
> > success. My
> > 19
> > ultrasound students here in Kumasi, Ghana, West Africa are the best
> > I
> > have
> > ever had - And it is truly the experience of a lifetime. My
> > question:
> > My students have asked for a "protocol" for the performance of
> > hysterosonography. I have explained the procedure to them, but do
> > not
> > have a detailed protocol in print. Do any of you? If you are
> > interested
> > in more detailed updates about the first comprehensive ultrasound
> > training program in sub-Saharan Africa,
> > you may visit my website at:
> > http://www.obgyn.net/yw/articles/africa/project_africa.htm.
> > --
> > Ann Polin, BS, RDMS
> > Aninwah Medical Center
> > PO Box 5203
> > Kumasi, Ghana, West Africa
> > E-Mail: charna@africaonline.com.gh
> > Telephone Home: 011-233-51-39226
> > Telephone Mobile: 011-233-24-371999
> > Telephone Hospital: 011-233-51-60107
> >
> > Program Chair (1998-2000), Currently on Sabbatical
> > Diagnostic Ultrasound Program, B243
> > Bellevue Community College, 3000 Landerholm Circle SE
> > Bellevue, WA 98007-6484 USA
> >
> > --
> > Ann Polin, BS, RDMS
> > Aninwah Medical Center
> > PO Box 5203
> > Kumasi, Ghana, West Africa
> > E-Mail: charna@africaonline.com.gh
> > Telephone Home: 011-233-51-39226
> > Telephone Mobile: 011-233-24-371999
> > Telephone Hospital: 011-233-51-60107
> >
> > Program Chair (1998-2000), Currently on Sabbatical
> > Diagnostic Ultrasound Program, B243
> > Bellevue Community College, 3000 Landerholm Circle SE
> > Bellevue, WA 98007-6484 USA
>
