Re: GYN:Suggestions please
From: Scotia Phillips, RT, RDMS (scotia@bellsouth.net)
Mon Aug 31 05:05:09 1998
Dear Martin:
Thank you for your response. I am sure you recognized that these are
suggestions for the unsually difficult patient.
I also don't think I would try any of this if I were a male sonographer,
however I have been scanning long enough that I remember the horror
expressed by many regarding sonographers performing transvaginal
ultrasound. There are indeed, a few of those folks remaining, male and
female, who would prefer to do any procedure other than TVS!
Fortunately, I practice in an all female office in one location. It
helps a great deal when a woman OB/GYN explains the procedure to the
patient and is present during the exam!
The patient on which this is most helpful is obese with a particularly
long uterus, about 12 to 14 cm in length, where the fundus points back
at about 55 degrees. I have found it difficult to evaluate the
endometrium and it seems that these are invariably the patients who have
cervical stenosis or some other anomaly preventing endometrial biopsy.
My lady doc would prefer not to hysteroscope these patients, or any
others uneccessarily and this manuver can allow the entire endometrium
to be seen.
For those who find this "abhorent", I apologize for offending, however,
my purpose was to suggest what has worked for us after other manuvers
have failed. Is that not one purpose of this forum?
At Mon, 31 Aug 1998, Martin Necas and Tania Keep wrote:
>
>Dear Scotia,
>
>I appreciate your adventurous spirit in performing Gyn sonography using a
>variety of positions. There is something to be said for those who strive to
>do scans in difficult or new positions in order to achieve good images.
>Unfortunately, as a male sonographer, I have a difficult time imagining how
>I would explain the necessity of a "doggie-style" TV sonogram to any of my
>patients. I find most women, though perhaps apprehensive, are quite
>comfortable in the "missionary position". This position is familiar to them
>from other gyn testing (manual exam, pap smear, etc) and is ideal for a TV
>approach as well. I have to admit I am suprized that these positions
>increase your visualization or diagnostic confidence when doing a TV
>sonogram. I am afraid, I will not be able to test their usefulness in our
>practice.
>
>Many Regards,
>
>Martin Necas, RDMS, RVT
>Waikato Hospital, Hamilton, New Zealand.
>
>-----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of Scotia
>Phillips, RT, RDMS
>Sent: Monday, August 31, 1998 12:34 AM
>To: Multiple recipients of list
>Subject: Re: GYN:Suggestions please
>
>It is interesting to me that one office where I scan has the oldest
>sonography equipment and the most modern table so I can trendelenberg at
>that place. However, where I have the best equipment also is the most
>primitive table!!! Go figure that one.
>Anyway, I have had great success in the patients with two manuvers. On
>one, we bring the legs up over the chest as much as possible while
>scanning vaginally. For the other, have the patient get on all fours on
>the table and scan from behind. This can also be accomplished with the
>patient standing beside the table and bending over, particularly in the
>massive obese patient.
>
>There are a few problems with these techniques. You absolutely must
>have a very co=operative and understanding patient who is interested in
>hepling you obtain the best possible view. Many women will not want to
>place themselves in what some may consider a humiliating position. It
>is best to have help with these manuvers. Some women are willing in the
>spirit but unable to do this physically. I prefer to have the doctor
>present to view as I scan so that there is no question about obtaining
>correct images, This is not a procedure that you want to repeat.
>
>If you can try these, you will be surprised at how helpful they are.
>
>At Fri, 28 Aug 1998, yani wrote:
>>
>>At Tue, 14 Apr 1998, J.Tomko wrote:
>>>The trendelenberg position would be of tremendous help definitely. But,
>since you don't have access to such a table, then I would suggest applying
>extra pressure and angling from the side.
>>>I have been seeing many more post-menopausal women lately and am
>>>frustrated with scanning technique when the patient presents with
>>>uterine decensus (and retroverted position.) It seems I cannot
>>>adequately image the detail of the uterus and ovaries with
>>>transabdominal approach and the angle is too perpendicular to the u/s
>>>beam to get a true long axis and coronal view of the uterus with vaginal
>>>views. I tried gently reducing the decensus with the vaginal probe but
>>>cannot move the uterus high enough in the pelvis to work this out. The
>>>pessary of course hinders ultrasound impossible. I do not have a table
>>>to trendelenberg the patient. ~~Any~~ suggestions or technique tips are
>>>welcomed.
>>>
>>>Thanks,
>>>
>>>Janet
>>>
>>>--
>>>Does a Roman EMT call an IV a '4'?
>>>
>--
>Scot
>
--
Scot
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