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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5782_Библиотеки_им_академика_М_И_Перельмана.pdf
CHAPTER 11 Female Pelvis Scanning Protocol 239
into view. Once the ovary is identified, very slightly rotate/twist
the transducer, first one way and then the other, to resolve its
long axis.
LT
RT
LT
RT
NOTE: If the ovary cannot be seen because of overlying bowel, angle
the transducer right lateral toward the right ovary from the midline of the
pelvic cavity or just to the left of the midline.
2. Now very slowly move or angle the transducer toward the patient’s
right, scanning through and beyond the right lateral margin of the
ovary. Move back onto the ovary and very slowly move or angle
the transducer toward the midline of the pelvic cavity, scanning
through and beyond the medial margin of the ovary.
RT
LT
RT
LT
240 PART IV Pelvic Scanning Protocols
Right Ovary • Axial Survey
Transverse Plane • Anterior Approach
1. Still in the sagittal scanning plane, relocate the long axis of the
right ovary then rotate the transducer 90 degrees into the transverse scanning plane until the small, oval, axial section of the
ovary comes into view.
LT
RT
LT
RT
2. Very slowly move or angle the transducer superiorly, scanning
through and beyond the superior margin of the ovary. Move back
onto the ovary and very slowly move or angle the transducer inferiorly, scanning through and beyond the inferior margin of the ovary.
RT
LT
RT
LT
Left Ovary • Longitudinal and Axial Surveys
Use the same survey steps and scanning methods as those used for
the right ovary.
Female Pelvis Required Images
NOTE: The required images are a small representation of what a sonog-
rapher visualizes during a study. Therefore, the images should provide
the interpreting physician with the most telling and technically accurate
information available.
CHAPTER 11 Female Pelvis Scanning Protocol 241
Anterior
rior
Posterior
ina
Anterior
rior
Posterior
Vagina, Uterus, and Pelvic Cavity • Longitudinal Images
Sagittal Plane • Anterior Approach
Longitudinal images begin with representative images of the pelvic
cavity followed by a long axis image of the uterus.
1. Longitudinal image of the MIDLINE of the pelvic cavity just superior to the symphysis pubis.
Superior
Uterine
fundus
Endometrium
Uterine body
Urinary
bladder
Uterine cervix
Labeled: PELVIS SAG ML
2. Longitudinal image of the RIGHT ADNEXA that may include
part of the uterus depending on its position.
Superior
Urinary
bladder
Infe
Vag
Infe
Section of
endometrium
Lateral margin of
uterine body
Labeled: PELVIS SAG R1
242 PART IV Pelvic Scanning Protocols
Anterior
rior
Posterior
Anterior
rior
Posterior
3. Longitudinal image to include the right lateral wall of the BLADDER
and PELVIC SIDEWALL.
Superior
Lateral margin of
uterine body and cervix
Urinary
bladder
Infe
Labeled: PELVIS SAG R2
4. Longitudinal image of the LEFT ADNEXA that may include part
of the uterus depending on its position.
Superior
Urinary
bladder
Bowel
Infe
Left ovary
Labeled: PELVIS SAG L1
Musculature
CHAPTER 11 Female Pelvis Scanning Protocol 243
Anterior
Posterior
Anterior
rior
Posterior
er
5. Longitudinal image to include the left lateral wall of the BLADDER
and PELVIC SIDEWALL.
Superior
Urinary
bladder
Bowel
Labeled: PELVIS SAG L2
6. LONG AXIS image of the uterus to include as much endometrial
cavity as possible with uterine length (superior to inferior) and height
(anterior to posterior) measurements.
Superior
Urinary
bladder
Inferior
Musculature
Infe
Fundus
Labeled: UT SAG LONG AXIS
Body
Cervix
Vagina
Endometrium
(excluding dark
portion of
myometrium)
244 PART IV Pelvic Scanning Protocols
Anterior
tL
s
muscle
7. Same image as number 6 without calipers.
Labeled: UT SAG LONG AXIS
NOTE: It may be necessary to take an additional image demonstrating
the long axis of the endometrial, endocervical, and vaginal canals. If so
label: UT SAG
Vagina, Uterus, and Pelvic Cavity • Axial Images
Transverse Plane • Anterior Approach
8. Axial image of the VAGINA.
Righ
Rectum
Coccygeus
muscle
Urinary
bladder
Posterior
Labeled: TRV VAG
eft
Vagina
Coccygeus
muscle
Vaginal
canal
Gluteus
maximu
9. Axial image of the CERVIX.
Anterior
Posterior
ical
tL
y
Musculature
Portion of
CHAPTER 11 Female Pelvis Scanning Protocol 245
Labeled: TRV CERX
10. Axial image of the UTERUS BODY.
Obturator
internus
muscle
Musculature
of pelvic floor
right ovary
Pelvic
musculature
Righ
Urinary
bladder
Anterior
Urinary
bladder
eft
Cervix
Cerv
canal
Shadowing
from vaginal
fornices
Left
ovar
LeftRight
Endometrium
Labeled: TRV UT BODY
Bowel
Uterine body
Posterior
246 PART IV Pelvic Scanning Protocols
Anterior
tL
Posterior
11. Axial image of the UTERUS FUNDUS measuring uterine width
(right to left).
Righ
Pelvic
musculature
Uterine fundus
Labeled: TRV UT FUNDUS
12. Same image as number 11 without calipers.
Urinary
eft
bladder
Endometrium
Labeled: TRV UT FUNDUS
CHAPTER 11 Female Pelvis Scanning Protocol 247
Anterior
Right Ovary • Longitudinal Images
Sagittal Plane • Anterior Approach
13. LONG AXIS image of the right ovary measuring length (superior to
inferior) and height (anterior to posterior).
Follicles
Urinary
bladder
InferiorSuperior
Right
ovary
Iliac
vessel
3.50 cm
1.96 cm
Posterior
Labeled: RT OV SAG LONG AXIS
(Courtesy University of Virginia Health Systems Imaging Center.)
NOTE: If this image of the ovary was angled from midline, then the
image is obliqued and must be labeled: RT OV SAG OBL LONG AXIS
14. Same image as number 13 without calipers.
Follicles
Labeled: RT OV SAG LONG AXIS
(Courtesy University of Virginia Health Systems Imaging Center.)
248 PART IV Pelvic Scanning Protocols
Anterior
Right Ovary • Axial Images
Transverse Plane • Anterior Approach
15. Axial image of the RIGHT OVARY with width (right to left)
measurement.
1.94 cm
LeftRight
Follicles
Right
ovary
Urinary
bladder
Follicles
Posterior
Labeled: RT OV TRV
(Courtesy University of Virginia Health Systems Imaging Center.)
NOTE: If this image of the ovary was angled from midline, then the
image is obliqued and must be labeled: RT OV TRV OBL
16. Same image as number 15 without calipers.
Labeled: RT OV TRV
(Courtesy University of Virginia Health Systems Imaging Center.)