Sonographic Pelvic Anatomy

SonographicPelvicAnatomy
Ellen Miller, MD, MichaelCassara, DO, JohnPellerito, MD, StevenOstrow, MD, PaulSpeer, MD, Brent Thompson, PhD, DanielOhngemach
Goals
Understand the normal anatomy of the female pelvic reproductive tract.Understand the normalphysiologicchanges that occur during the menstrual cycle.Employ appropriate technique and etiquette to perform atransabdominalpelvic sonogram.
Learning Objectives
Identify the transducer used fortransabdominalandtransvaginalpelvic ultrasound.Describe proper patient preparation for pelvic sonography, including the use of a chaperone.Demonstrate appropriate transducer orientation to anatomic points of interest.Identify the following pelvic structures on atransabdominaland atransvaginalsonogram: urinary bladder, vagina, cervix, uterus, ovaries, external iliac vessels.Describe thesonographicappearance of the following pelvic structures: urinary bladder, vagina, cervix, uterus, ovaries, external iliac vessels.
Learning Objectives
Performtransabdominalandtransvaginalultrasonography of the pelvis to locate the following structures: urinary bladder, vagina, cervix, uterus, ovaries, external iliac vessels.Describe changes that occur to the uterus and ovaries over the course of the normal menstrual cycle.Correlate the above changes with changesin hormones of thehypothalamic-pituitary-ovarianaxis.Demonstrate appropriate communication and interaction with a patient receiving a pelvic ultrasound study.
Logistics: Pre-work
Pre-reading: review of recommended selections covering: pelvic gross anatomy and microanatomy; physiology of hypothalamic-pituitary-ovarian axisVideo review of basic principles of ultrasound imagingVideo tutorial of basic pelvic sonogram acquisition, including appropriate communication, patient position, and use of the ultrasound transducer
Logistics - Basics
Suggested time: 2 hours per cohortSuggested number of students/group: 5-8Suggested materials: labeled ultrasoundatlasSuggested scanningfaculty: 1 per scanning station—4 per 50 studentsSuggestedcasefaculty: 1 per case station—1 per 50 studentsTarget Learner: preclinical student with a prior introduction to basic ultrasound principles
Logistics – Case
premenopausalpatient withamenorrheareview of anatomy,histology and physiology of the hypothalamic-pituitary-ovarian axis andmenstrualcyclecomparison of ultrasoundimages of the follicular and luteal phase ovaries anduterus
Logistics - Organization
Hands-on:Transabdominalwith StandardizedPatient12 students(~30 min.)
Hands-on:Transvaginalwith Phantom13 students(~30 min.)
Round-table Case Discussion Incorporating Menstrual Cycle Physiology25 students(~60 min.)
Assessment
Faculty assessing students—formative assessment at end of weekAnatomic identification of pelvic structuresontransabdominalandtransvaginalultrasound imagesCorrelation of structures seen on ultrasound with a gross specimenCorrelation of histological images with ultrasound images of the uterus and ovariesCorrelation of ultrasound images of the uterus and ovaries with hormone levels during the menstrualcyclePlanning of an appropriate protocol for pelvic ultrasound examination—transducer selection, communication with patient, patient preparation for exam
Evaluation
Assessment of effectiveness of program format in satisfying learning objectives by studentAnonymous assessment of faculty by studentLong-term assessment of medical student acquisition of skills outlined by learning objectives