Ppds Usg 3. Isuog Basic Obgyn Ultrasound Training Jje 2010

8/14/2019 Ppds Usg 3. Isuog Basic Obgyn Ultrasound Training Jje 2010

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BASIC OB/GYNASIC OB/GYNULTRASOUNDLTRASOUNDTRAININGRAININGJudi Januadi Endjun

School of Medicine University of Indonesia Jakarta

Gatot Soebroto Army Central HospitalDepartment of Obstetrics and Gynaecology

2009

ISUOG Education Committee


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RSPAD GATOT SOEBROTODITKESAD

JJE-2009/11/28JJE-2009/11/28 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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Jalani hidup ini dengan sabar, jujurdan ikhlas,

Mau mengerti dan melaksanakantatacara (adab) yang benar, dan

Mempunyai kemauan untuk selaluberbuat baik memperbaiki diri dan

lingkungan, serta membuat orang lain

lebih baikJJE-2009/11/28JJE-2009/11/28 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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Barang siapa mengamalkan apa-apa yang ia ketahui, maka Allah SWT akan mewariskankepadanya ilmu yang belum diketahuinya, dan Allah SWT akan menolong dia dalam amalannyasehingga ia mendapatkan surga. Dan barang siapa yang tidak mengamalkan ilmunya, maka ia

tersesat oleh ilmunya itu, dan Allah SWT tidak menolong dia dalam amalannya sehingga ia akanmendapatkan neraka (sabda Rasulullah Muhammad SAW)

Ilmu lebih utama dari harta, ilmu adalah pusaka para Nabi, sedangkan harta adalah pusakaKarun atau Firaun.

Ilmu lebih utama dari harta, karena ilmu akan menjagamu sementara harta malah engkau yangharus menjaganya.

Ilmu lebih utama dari harta karena di akherat nanti pemilik harta akan dihisab, sedangkanorang berilmu akan memperoleh syafaat.

Ilmu lebih utama dari harta karena pemilik harta bisa mengaku menjadi Tuhan akibat hartayang dimilikinya, sedangkan orang berilmu justru mengaku sebagai hamba Tuhan karena

ilmunya.Harta itu jika engkau berikan menjadi berkurang, sebaliknya ilmu jika engkau berikan malahan

semakin bertambah.

Pemilik harta disebut dengan nama kikir dan buruk, tetapi pemilik ilmu disebut dengan namakeagungan dan kemuliaan.

Pemilik harta itu musuhnya banyak, sedangkan pemilik ilmu temannya banyak.Harta akan hancur berantakan karena lama ditimbun zaman, tetapi ilmu tidak akan rusak dan

musnah walau ditimbun zaman.

Harta membuat hati seseorang menjadi keras, sedangkan ilmu malah membuat hati menjadibercahaya.

(hamba Allah)



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INTRODUCTIONINTRODUCTION

Basic knowledge : embryology, dysmorphology, genetics,the physiology, and pathophysiology of pregnancy

Theoretical training

Practical training

Residents do not have to accomplish in practiceeverything that is being taught in theory



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TEXT BOOK REFERENCESTEXT BOOK REFERENCES

Judi Januadi Endjun.Judi Januadi Endjun. UltrasonografiUltrasonografi

Dasar Obstetri dan GinekologiDasar Obstetri dan Ginekologi, FKUI,, FKUI,

20092009

Juriy W Wladimiroff, Sturla H Eik-Nes.Juriy W Wladimiroff, Sturla H Eik-Nes.

European Practice in Gynaecology andEuropean Practice in Gynaecology and

Obstetrics:Obstetrics: Ultrasound in Obstetrics andUltrasound in Obstetrics and

GynaecologyGynaecology, Elsevier, 2009, Elsevier, 2009



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THEORETICAL TRAININGTHEORETICAL TRAINING

PROGRAMPROGRAMBasic physical principles of medical

ultrasound

Obstetrics

Gynecology

Organization of ultrasound unit

Medicolegal implications of ultrasoundexamination

Ethics and patient information



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Basic physical principles of

medical ultrasound

1. The relevant principles of acoustics, attenuation,

absorbtion, reflection, and speed of sound

2. The effects on tissues of pulsed and continuous

wave ultrasound beams : biological effects, thermaland non thermal

3. Basic operating principles of medical

instruments :



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https://reader010.{domain}/reader010/html5/0626/5b320bb3a581a/5b320bb9e4


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Basic operating principles of

medical instruments :

a) Pulse echo, scanning principles and 3-D;

b) Pulse echo instruments, including lineararray, curvilinear, mechanical sector,

transvaginal and rectal scanners;

c) Velocity imaging and recording :



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d) Data acquisition

e)

Signal processing (may be given in practicaldemonstration) :

Gray scale, time gain compensation, dynamic range,

dynamic focus, digitization, gain compensation,acoustic output relationship (may be given in

practical demonstration)



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f) Artifacts, interpretation and avoidance :

reverberation, side lobes, edge effects,

registration, shadowing, and enhancement

g) Measuring systems : linear, circumference,

area, and volume; Doppler ultrasound : flow,velocity, spectrum analysis



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h)h) Image recording, storage, andImage recording, storage, and

analysisanalysis

i)i) Interpretation of acoustic outputInterpretation of acoustic output

information and its clinicalinformation and its clinicalrelevancerelevance



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OBSTETRICS

1. Investigation of early pregnancy

2. Assessment of AF and placenta

3. Normal fetal anatomy at 18 20 weeks

4. To study the epidemiology, differential

diagnosis, natural history of abnormalities, andmanagement of structural, functional, and

prognosis and treatment

JJE-2009/11/28JJE-2009/11/28

Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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OBSTETRICSOBSTETRICS

5. Fetal Biometry

6. Estimation of gestational age

7. Assessment of fetal growth

8. Biophysical scoring systems9. Evaluation of fetal and uteroplacental

blood flow

10. Knowledge of invasive diagnostic andtherapeutic procedures

JJE-2009/11/28JJE-2009/11/28

Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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https://reader010.{domain}/reader010/html5/0626/5b320bb3a581a/5b320bbe359


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1. Investigation of Early1. Investigation of Early

PregnancyPregnancy

a) Ultrasound features of normal early

pregnancy, including GS and YS, simple

and multiple pregnancy, chorionicity

b) Development of fetal anatomy in early

pregnancy including recognition of

abnormalities such as NT, cystic hygroma,

and fetal hydrops



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1. Investigation of Early1. Investigation of Early

PregnancyPregnancy

c) Embryonic fetal biometry, e.g. CRL

d) Fetal viability

e) Ultrasound features of early pregnancyfailure including hydatidiform mole

f) Ultrasound and biochemical investigation

of ectopic pregnancy, tumors in early

pregnancy

g) Normal appearance of the cervix



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2. Assessment of AF and2. Assessment of AF and

PlacentaPlacenta

a)a) Estimation of AF volumeEstimation of AF volume

b)b) Examination of the placentaExamination of the placentaand cordand cord

c)c)

Placental locationPlacental location

d)d) Number of cord vesselsNumber of cord vessels



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3. Normal Fetal Anatomy at3. Normal Fetal Anatomy at

18 20 Weeks18 20 Weeks

a) Shape of the skull : nuchal skin fold

b) Facial profile

c) Brain : cerebral ventricles, posterior fossaand cerebellum, cysterna magna, choroid

plexus cysts(ISUOG guideline)

d) Spine : both longitudinally andtransversely

e) LungsJJE-2009/11/28JJE-2009/11/28 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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3. Normal Fetal Anatomy at3. Normal Fetal Anatomy at

18 20 Weeks18 20 Weeks

f) Heart rate and rhythm, 4-CV, including

atrioventricular valves, outflow tracts (ISUOG

guideline)

g) Shape of the thorax and abdomen

h) Abdomen : stomach, liver, kidneys and urinary bladder,abdominal wall, and umbilicus

i) Limbs : femur, tibia and fibula, humerus, radius and ulna,hands and feet these to include shape, echogenicity of the

long bones and movements

j) Multiple pregnancy : chorionicity



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5. Fetal Biometry5. Fetal Biometry

a) Measurements to assess fetal size

(including BPD, HC, AC and FL)

b) Measurements to aid the

diagnosis of fetal anomalies :

anterior/posterior horn of the lateralventricle, TCD, and nuchal skinfold (NF)



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6. Estimation of Gestational Age6. Estimation of Gestational Age

a) Interpretation and appreciation of

limitation of ultrasonic and other

investigations for gestational ageassessment



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7. Assessment of Fetal Growth7. Assessment of Fetal Growth

a) Ultrasonic assessment of fetal

growth : interpretation and

appreciation of limitations ofstandard measurement singly or

serially

b) Fetal weight estimation



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8. Biophysical Scoring Systems8. Biophysical Scoring Systems

Interpretation and appreciation ofInterpretation and appreciation of

limitations :limitations :

a) Fetal body movementsb) Fetal breathing

c) Heart rate and rhythm



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9. Evaluation of Fetal and9. Evaluation of Fetal and

Uteroplacental Blood FlowUteroplacental Blood Flow

a) Methodology appropriate to obstetric

investigation

b) Appreciation of problems in blood flow

and velocity measurements and

waveform analysis in normal andcomplicated pregnancies



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9. Evaluation of Fetal and9. Evaluation of Fetal and

Uteroplacental Blood FlowUteroplacental Blood Flow

c) Clinical application and limitations in the

prediction of IUGR and pre-eclampsia

d) Clinical application in monitoring the

small for dates fetus and pregnancies

complicated by Rhesus isoimmunization,diabetes and fetal cardiac arrhythymias



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10. Knowledge of invasive diagnostic10. Knowledge of invasive diagnostic

and therapeutic proceduresand therapeutic procedures

a) Diagnostic : amniocentesis, CVS,

cordocentesis

b) Therapeutic : shunting and draining

procedures



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1. Normal Pelvic Anatomy1. Normal Pelvic Anatomy

a. Uterus :

* size, position, shape and measurement

* cyclical morphological changes in the

measurement of endometrial thickness

* endometrium

b. Ovaries



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1. Normal Pelvic Anatomy1. Normal Pelvic Anatomy

b) Ovaries :

* size, position, shape & measurement

* cyclical morphological changes* measurement of follicles and CL

* assessment of peritoneal fluid



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2.2. Gynecological ComplicationsGynecological Complications

a) Uterus : fibroids, adenomyosis, endometrialhyperplasia, endometrial cancer, polyps, location ofIUD

b) Tubes : hydrosalpinx and other abnormalities of thefallopian tube

c) Ovaries : cysts (benign and malignant,morphological scoring systems), endometriosis,ovarian carcinoma, differential diagnosis of pelvicmasses



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3. Infertility3. Infertility

a) Monitoring of follicular development in

spontaneous and stimulated cycles

* diagnosis of hyperstimulations

syndrome

* diagnosis of polycystic ovaries* sonosalpingography



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4. Invasive Procedures4. Invasive Procedures

a) Oocyte retrieval

b) Injection of ovarian cysts

c) Aspiration of ovarian cystsd) Drainage of pelvic abscesses

e) Extraction of IUD



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5. Doppler in Gynecology5. Doppler in Gynecology

a) Infertility and oncology



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Organization of ultrasound unit

Infrastructure

Documentation

Quality control

Computerization

and Data storage


M di l l i li ti f


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Medicolegal implications of

ultrasound examination

https://reader010.{domain}/reader010/html5/0626/5b320bb3a581a/5b320bcc81781.jpgJJE-2009/11/28JJE-2009/11/28 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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Ethics and patient information

http://www.siumed.edu/ethics/Images/medical%20ethics.jpg



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Required SkillsRequired Skills

1. Be able to identify early pregnancy and

emergency gynecological problems by

transvaginal and transabdominal ultrasound

2. Be able to recognized the following normal fetal

anatomical features from 18 weeks onwards by

abdominal ultrasound

3. Fetal biometry

4. Activity



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Required SkillsRequired Skills

1.a. Early pregnancy : fetal viability; descriptionof the GS, embryo, YS; single and multiple

gestation (chorionicity)

1.b. Pathology : early pregnancy failure; ectopicpregnancy; gross fetal abnormalities such as NT,

hydropic abnormalities; hydatidiform mole; andassociated pelvic tumors



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Required Skills :Required Skills : normal anatomynormal anatomy

2.a. Shape of the skull; nuchal skinfold

2.b. Brain : ventricles and cerebellum, choroid plexus

2.c. Facial profile

2.d. Spine : both longitudinally and transversely

2.e. Heart rate and rhythm, size and position, 4-CV

2.f. Size and morphology of the lungs2.g. Shape of the thorax and abdomen



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2.h. Abdomen : diaphragm, stomach, liver andumbilical vein, kidneys, abdominal wall and umbilicus

2.i. Limbs : femur, tibia and fibula, humerus, radiusand ulna, feet and hands these to include shape,

echogenicity and movement

2.j. Multiple pregnancy : monochorionic anddichorionic; twin-twin transfusion syndrome



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2.k. Amount of amniotic fluid

2.l. Placenta location

2.m. Cord and number of vessels



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Fetal BiometryFetal Biometry

CRL

BPD

FL HC

AC

Interpretation of growth charts



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ActivityActivity ::recognized and quantifyrecognized and quantify

a) Fetal movements

b) Breathing movements

c) Eye movements



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CERTIFICATIONCERTIFICATION

1. 100 hours of supervised scanning toinclude :

a. 100 gynecological examination and

early pregnancy problems (TVS or

TAS)b. 200 obstetric scans covering the full

spectrum of obstetrics conditions

1. Logbooks

2. Examination



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LOOGBOOKSLOOGBOOKS

30 cases on

one A4 page

with ultrasound

picture at

least 15

anomaliesshould be

includedJJE-2009/11/28JJE-2009/11/28 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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PELJJE-2009/11/28JJE-2009/11/28 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan


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EXAMINATIONEXAMINATION

MCQ or

Short written examination paper ( 3 4

cases)

Practical side : transvaginal scan and a fetalanatomy scan, 30 minutes for both, would be

recommended

The candidate would take ultrasoundpictures and interpret the images



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JJE 2009/11/28JJE 2009/11/28 H t k P didik d K h tH t k P didik d K h t

Ppds Usg 3. Isuog Basic Obgyn Ultrasound Training Jje 2010

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Transcript of Ppds Usg 3. Isuog Basic Obgyn Ultrasound Training Jje 2010