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From: zalel (zalel_y@netvision.net.il)
Mon Mar 26 16:30:10 2001
Dear Terry!
You're talking about "echovist" which is being used instead of HSG for
evaluating the endometrial cavity in addition to the fallopian tubes.
In "regular" sonohysterography, when we need to evaluate only the
endometrial cavity, saline is enough!
Yaron Zalel, MD
>----- Original Message -----
From: DuboseTerryJ@uams.edu
To: Multiple recipients of list ULTRASOUND
<ultrasound@mail.medispecialty.com>
Sent: Monday, March 26, 2001 5:03 PM
Subject: Re: Hysterosonography Protocol
> Sharon, thanks for giving us a framework to begin writing a protocol for
> Hysterosonography at OBGYN.net. Because I do not participate in these
> procedures I will wait for others to comment. My only question is, should
> we advise only using sterile saline and not other contrast agents. I
> realize that most have moved from the more expensive commercial contrast
> agents to sterile saline, but is there never an advantage to the
contrasts?
> I remember seeing Doppler images of contrast moving through the fallopian
> tubes, would this "not replace the HSG"?
>
> I ask this primarily to stimulate discussion, and not to be argumentative.
>
> Once we have had some comment about this topic, I am going to recommend to
> the Ultrasound Section Editorial Advisory Board that we post it as a
> "recommended hysterosonography protocol".
>
> Thanks again for stepping up to bat.
>
> Terry J. DuBose, M.S., RDMS, Assistant Professor
> Director, Diagnostic Medical Sonography Program
> CHRP, University of Arkansas for Medical Sciences
> Little Rock, Arkansas, USA
> 501-686-6510
> http://www.io.com/~dubose/
> http://www.uams.edu/CHRP/dmshome.htm
> http://www.obgyn.net/us/panel/panel.htm
>
> -----Original Message-----
> From: charter.net [mailto:hap@charter.net]
> Sent: Sunday, March 25, 2001 5:22 PM
> To: Multiple recipients of list ULTRASOUND
> 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
> >
>
