SONOGRAPHIC PELVIC ANATOMY

Ellen Miller, MD, Michael Cassara, DO, John Pellerito, MD, Steven Ostrow, MD, Paul Speer, MD, Brent Thompson, PhD, Daniel Ohngemach

Goals

Understand the normal anatomy of the female pelvic reproductive tract.

Understand the normal physiologic changes that occur during the menstrual cycle.

Employ appropriate technique and etiquette to perform a transabdominal pelvic sonogram.

Learning Objectives

Identify the transducer used for transabdominal and transvaginal pelvic 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 a transabdominal and a transvaginal sonogram: urinary bladder, vagina, cervix, uterus, ovaries, external iliac vessels.

Describe the sonographic appearance of the following pelvic structures: urinary bladder, vagina, cervix, uterus, ovaries, external iliac vessels.

Learning Objectives

Perform transabdominal and transvaginal ultrasonography 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 changes in hormones of the hypothalamic-pituitary-ovarian axis.

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 axis

Video review of basic principles of ultrasound imaging

Video tutorial of basic pelvic sonogram acquisition, including appropriate communication, patient position, and use of the ultrasound transducer

Logistics - Basics

Suggested time: 2 hours per cohort Suggested number of students/group: 5-8 Suggested materials: labeled ultrasound atlas Suggested scanning faculty: 1 per scanning

station—4 per 50 students Suggested case faculty: 1 per case station—1

per 50 students

Target Learner: preclinical student with a prior introduction to basic ultrasound principles

Logistics – Case

premenopausal patient with amenorrhea review of anatomy, histology and

physiology of the hypothalamic-pituitary-ovarian axis and menstrual cycle

comparison of ultrasound images of the follicular and luteal phase ovaries and uterus

Logistics - Organization

Hands-on: Transabdomin

al with Standardized

Patient

12 students

(~30 min.)

Hands-on: Transvaginal with Phantom

13 students

(~30 min.)

Round-table Case Discussion Incorporating Menstrual Cycle

Physiology

25 students

(~60 min.)

Assessment

Faculty assessing students—formative assessment at end of week Anatomic identification of pelvic structures on

transabdominal and transvaginal ultrasound images Correlation of structures seen on ultrasound with a gross

specimen Correlation of histological images with ultrasound

images of the uterus and ovaries Correlation of ultrasound images of the uterus and

ovaries with hormone levels during the menstrual cycle Planning 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 student

Anonymous assessment of faculty by student

Long-term assessment of medical student acquisition of skills outlined by learning objectives