imaging

Question 1

What is the biophysics behind ultrasounds?

Answer 1

Ultrasound waves and frequency
* Piezo-Elictric crystals(the ability of the material to develop electric charge in response to the applied mechanical stress)
* Grows and shrinks depending on the voltage run through it
* Running an alternating current through it causes it to vibrate at a high speed and to produce an ultrasound wave
* Sound is then reflected back to the PE crystals converting sound into electrical energy and then to photo energy

Question 2

how is doppler ultrasound different from regular ultrasound?

Answer 2

-doppler estimates the blood flow through vessels by bouncing high frequency sound waves of circulating blood cells, whereas regular ultrasound uses sound waves to produce image and cant show blood flow

Question 3

Doppler Waveform

Answer 3

• Christian Johann Doppler
• Doppler effect-the shift between emitted and
  observed frequency of sound
• Velocity and Angle
• Light moving away—red
• Light moving towards– blue
• Blood cells – scatter—RBC
• Pulsed Doppler pulsed echo system
• defines the rate which data is collected
• Resistance Index – A-B/Mean Difference of the
  highest and lowest value divided by the mean in one
  cardiac cycle
• Pulsatility Index- A/B ratio indicates peripheral
  resistance
• RI absent or reversal – Increase peripheral
  resistance causes diminution and then loss of blood

Question 4

imaging in normal menstrual cycle

Answer 4

1. Endometrial
2. Ovarian
3. Changes during the menstrual cycle

Question 5

Endometrial scan pattern

Answer 5

scans done in two part:
1.pre-ovulation (follicular phase)
2.post ovulation (luteal phase)
measure thickness(mm) and endometrial volume

Question 6

Follicles and corpus luteum - ovary

Answer 6

-follicles are sacs that contain eggs (more follicles = higher reserve)
polcystic ovaries >12 follicles
* Early follicular phase the follicles are small
with less than 8 mm in size and multiple
* Midfollicular phase there is a dominant follicle
ahead of the other follicles
* Periovulatory follicle is about 17-23 mm in size
* Corpus luteum cystic or solid collapsed or full
appearance with irregular edge and shadows
with the the cyst.
* Raised dopplers are classical – roughly day 21.

Question 7

The endometrium after period

Answer 7

-thin endometrium after periods

Question 8

Mid follicular phase

Answer 8

-20 follicles /10 on each ovary
- 19 stop growing and one grows and becomes dominant follicle

Question 9

periovulatory phase - thick white line

Answer 9

almost ovulating - just before day 14

Question 10

Homegenous Hyperechogenic endometrium, corpus luteum with raised dopplers

Answer 10

after ovulation you see this
homogenous means smooth no
hypergogenic is when the endometrium becomes thicker due to hyperplasia so appears more dense and darker.

Question 11

Changes in the endometrium during menstruation:

Answer 11

• (A) shortly after menstruation the endometrium appears as a thin white line
• (B) in the mid and late proliferative phase of the menstrual cycle the endometrium becomes thicker and manifests a “triple-layer” appearance
• (C) on the day before ovulation the endometrium still has a “triple-layer” appearance but there is a thick white line surrounding it; this probably reflects some progesterone production from the dominant follicle
• (D) in the luteal phase of the menstrual cycle the endometrium is thick and homogenously hyperechoic (white)

Question 12

Triple layer

Answer 12

1. menstrual phase
2. proliferative phase
3. secretory phase

Question 13

normal uterine cavity

Answer 13

junctional zone between endometrium and myometrium suggesting cavity is normal

Question 14

systolic and diastolic phase in doppler

Answer 14

• heart contracts = systolic = blood is going to organ
  -diastolic phase = interchange takes place in organ = low pressure

Question 15

In fetal department you do…

Answer 15

resistance index (RI)
systolic flow velocity - diastolic velocity/systolic velocity

Question 16

In the gynaecological department in women we do ..

Answer 16

Pulsitility index (PI)
systolic flow velocity - diastolic velocity / mean velocity

Question 17

Define 3D and 4D

Answer 17

3D = pictures from all slides and get a still image (still image of all different dimension)
4D = 3D in motion

Question 18

What can you do with 3D image?

Answer 18

-coronal plane
-volume for review
-TUI like MRI (tomographic ultrasound imaging)
-SONOAVC

Question 19

What are some abnormalities found in the uterus

Answer 19

-polyps
-fibroids
-uterine
-malformation
-location of pregnancy

Question 20

What is a polyp?

Answer 20

a small soft growth from lining, polyp in nose, endometrium, stomach so the lining thickens and forms a polyp

Question 21

how do you discover a polyp? SIS and HYCOSY catheter

Answer 21

-put a catheter with water inside the uterus, water causes the cavity to expand and polyps can be sen easily (slime infusing sonography)
-HYCOSY is for checking tubes

Question 22

Why are polyps a problem?

Answer 22

-polyp is a structure in the cavity where fetus will grow so polyp can interfere with this and cause miscarriages
-or implantation may not take place in the first place due to the polyp
-bleeding in between periods

Question 23

fibroid

Answer 23

muscle in polyp is a fibroid and you you have to remove it , cut it off not soft tissue but muscle
=>location of fibroid determines what symptoms you have

Question 24

European society hysteroscopic classification

Answer 24

type 0- fibroid polyp
type 1 - less than 50% within the myometrium
type 2- more than 50% within the myometrium

Question 25

endometrium layers

Answer 25

-superficial , spongiosum, basal layer and the superficial and spongiosum layer shreds every month

Question 26

uterus size

Answer 26

3x2x1 inch uterus size muscular oestrogen causes uterus to expand during pregnancy

Question 27

uterine malformations

Answer 27

1. arcuate uterus - depth of uterine muscle in the midline of the cavity indicates the degree of uterine septum or arcute uterus = miscarriages, and premature labour 2. bicornuate uterus - cervix is also separate, found alot in animal kingdom 3. uteriene septum - one half doesn't develop 4. unicornuate uterus

Question 28

What are some appearances on TVS when there are pregnancy complications which cause pregnancy to develop outside the uterus (ectopic pregnancy)?

Answer 28

1. gestational sac(measured from crown to rump length) and CRL (average of measurements of the longest fetal length) 2.visible cardiac activity 3. 'bagel sign' - placenta and sac inside with no fetus 4.inhomogeneous mass 'blob sign' - condous 2003

Question 29

cervical ectopic pregnancy

Answer 29

5/6 successfully treated with methotrexate -single dose -multiple dose -intra-amniotic 1 case then successfully treated with intr-amniotic KCl

Question 30

cornual ectopic pregnancy

Answer 30

-20 interstitial pregnancies -17 treated with single dose methotrexate -94% success =>earlier the pregnancy is found the better the treatment and less problems

Question 31

hetrotopic pregnancy

Answer 31

-2 pregnancy outside the cavity 1 in uterus and 1 in fallopian tube (more common in IVF)

Question 32

surgical management vs medical

Answer 32

surgical indications: * Pain * Haemodynamically unstable * High hCG * Viable ectopic pregnancy * Large ectopic mass * Haemoperitoneum

Question 33

transvaginal ultrasound

Answer 33

-double thickness measurement of both endometrial surfaces at the thickest point in the mid sagittal view -if fluid present = layer individually measured -no oestrogen = post menopusal

Question 34

endometrial cancer?

Answer 34

meta analysis of 85 published studies including 5892 women showed that an endometrial thickness of greater than 5mm identified 96% of endometrial cancer, greater than 5mm biopsy needed => post menopausal women should not bleed at all, need to have a scan id they are bleeding and biopsy if needed.

Question 35

when should sonohysterography be used?

Answer 35

when an endometrial echo is not well visualised or is not thin and distinct.

Question 36

how to distinguish a cancer from a polyp?

Answer 36

polyp has only one vessel going into it but a cancer polyp has scattered vessels

Question 37

What are examples of some ovarian pathology?

Answer 37

* Endometriosis - ectopically present in lungs, bladder, c-section scar, laparoscopic scars but normally present in the ovaries. * Dermoid cyst * Polycyctic ovaries * Cystadenoma * Mucinous cyst

Question 38

POLYCYSTIC ovaries are not cyst

Answer 38

=> polycystic ovary is NOT a cyst but it is an enlarged, soft growth

Question 39

Clinical application

Answer 39

* Assessment of Uterus and ovaries * Assessment of uterine cavity * Tubal patency – hycosy * Follicle growth * Egg retrieval * Embryo transfer

Question 40

hydrosalpnix

Answer 40

dye in the cavity

Question 41

SONOAVC

Answer 41

3D measurement of follicle