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Re: Endovaginal vs. TransabdominalFrom: Scotia Phillips, RT, RDMS (scotia@bellsouth.net)Tue Mar 10 04:32:57 1998
At Fri, 6 Mar 1998, Spnglr wrote: > >In a message dated 98-03-04 21:22:18 EST, you write: > ><< I do hope full bladder views are done first. Many times the endovaginal > only views do not adequately penetrate above the uterine fundus and high > ovarian masses as well as pedunculated fibroids are missed too often. I >> > >This opinion, which I admit is shared by many, has always puzzled me. I >simply do not agree that a transabdominal scan be performed first, if at all. >The majority of patients that I see need not endure a full bladder to receive >the best possible evaluation for their complaints. The uterus can most often >be seen in its entirety, and transabdominal rarely provides additional >information when the ovaries are well seen on endovaginal scan. >I am not suggesting that transabdominal gyn scanning does not ever provide >additional information, enlarged fibroid uterus is a prime example. ( I have >actually found that a full bladder is not always necessary for TA in these >cases, either.) I am proposing, however, that the examination be tailored to >suit the circumstances. Without getting too involved in the "turf thing", it >is certainly easier for someone in private office to do this than in a >radiology dept. setting. ex: When the clinician feels a mass on exam, they >know where they are feeling it and can tell me. If it is at the umbilicus, I >can look transabdominally, but more often than not, it is low in the pelvis >and endovaginal is definitely the way to go. ( This is the beauty of U/S in >the office setting) >A transabdominal scan can always be performed after the endovaginal if >sufficient information has not been gained. To me, this makes much more sense >than "torturing" all of my patients for something that benefits a very small >percentage. >IMHO Endovaginal is always the first approach for 1st trimester evaluation, as >well. > >Nancy A. Spangler, RDMS, CNMT Nancy: You said it so well! I also am in private office, no radiologist until images are done, OB/GYN often with me during scanning. I look TAS, but usually get best TVS. Rarely, a patient will arrive with the greatest bladder filling and a 5 mm abdominal wall and anteverted uterus. In that case I may not do TVS if exam is great TAS. Isn't this all about tailoring the exam to the specific patient condition in order to obtain the best possible view of the entire pelvis? As much as I like Terry's retro B-scan images, I shudder to think of going back to the days when we were unable to use our CLINICAL judgement and had to explain whether we were at R3 or R6!
-- Scot
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