Re: GYN:Suggestions please
From: James S Smeltzer MD (gaperina@mindspring.com)
Mon Aug 31 06:35:15 1998
Martin,
Use Sim's position on side. This is non-threatening and gives good access
to uterus and left side. May need right side down for right adnexa if
probe is not Sieman's steerable.
Jim Smeltzer
At 12:44 AM 8/31/1998 -0500, you 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
>
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