Improvements in ultrasound machine technology and the easy access to trained personnel to use them allowed more patients to benefit from this diagnostic modality. This is especially so in our fields of gynaecology and infertility practice after the introduction of transvaginal scanning technology. The close proximity of the uterus and other pelvic organs allowed better probes with higher frequency to be used to give better quality high resolution pictures with less discomfort to the patients as the bladder does not need to be full.
The ability to rotate images in all directions using 3D technology has increased the diagnostic acuity especially in the fields of pelvic pain, abnormal uterine bleeding and during infertility investigations. We are now able to use this 3D technique to obtain coronal views of the uterine cavity which was not possible with older machines. This is especially useful during investigations of recurrent miscarriages to show the presence and extent of any uterine anatomical abnormality. We are now able to save volume examinations for subsequent assessment or to share with another colleague for a second opinion. The 3 main benifits could be summerised as:
abillity to examine pelvic organs in arbitrary sections within the data
easy and accurate volume measurement irrespective of the shape of the organ examined
visually useful reconstruction of anatomy of the area of interest.
The first 3D rendered view shown above demonstrate a complete uterine septume with an intact fundal contour. The second similar view reveals the exact location of a grade 0 submucous fibroid which makes planning for hysteroscopic surgery very easy.
Another advancement is the ability to use different colours during real time scanning. This could help in difficult cases when a clear tissue interface is difficult to see. Furthermore different operators could see things differently in different colours. The 4 pictures below show the same two ovaries in different colours just as examples.
Furthermore the ability to use colour and power Doppler mapping became an essential part of our everyday scanning practice. They added more diagnostic power in different fields including Reproductive Medicine, Oncology and Obstetrics. A simple example in the office would be to switch on the colour Doppler to help in the diagnosis of a suspected endometrial polyp by showing the feeding vessels. The same could be true in suspected fibroids when colour Doppler shows blood vessels around but not into the uterine mass. In adenomyomas radial blood vessesl could be seen running through the mass itself.
The first picture above shows an endometrial polyp with a feeding vessel which is a usual characteristic of such pathology. The second and third pictures show the same uterus with two fibroids without and with power Doppler mapping. Note the basket vasular patten characteristic of fibroids.
