As for all technical professions, learning how to perform ultrasound scan examinations should be started as an apprenticeship, under a well-trained colleague. It is essential to attend courses and seminars about the subject, but these are only adequate to discuss the theoretical aspects, and new applications. If you look around, most ultrasound scanning courses, even those conducted or hosted by reputable organisations, are show-off mantels for certain personnel to deliver the same lectures again and again. It is the same faces, in different venues, delivering the same lectures, signifying nothing for most of the attending candidates, other than gaining more CME or CPD points. I will not apologise for saying that. I once attended an ultrasound meeting, for CPD purposes, allegedly covering the use of ultrasound in different aspects of reproductive medicine. Two different lecturers speaking about amenorrhoea and recurrent miscarriages did not show a single ultrasound image, although it was an ultrasound meeting. The first lecturer gave an advanced endocrinology talk, and the second one presented intricate immunology data. The problem about most of these prestigious courses is that no basic hand-on training was on offer, which matters a lot by the end of the day. 

I am not against courses, but I noticed that they are becoming social venues more than training sessions. There is no point in teaching a candidate the value, or otherwise, of Doppler imaging in the diagnosis of malignant tumours, if he or she can not acquire and optimise an image in the first place. Ultrasound scanning is a dextrous skill which should be learned on the machine, preferably first on a dummy, or models. One must learn the trade from a skilled performer. Basic ultrasound skills are very important hand-on experience, and take time to learn properly. This is especially so for mastering image optimisation, which improves with time, if learned properly in the first place. I had the privilege of offering one or a couple of days hand-on training sessions to many gynaecologists in the past. Most of them attended many courses beforehand. They were very impressive theoretically, always referring to certain courses and certain experts, with pride. Practicality was totally a different issue, though they contacted me to 'fine tune their techniques'. It was noticeable that monitor orientation, acquiring the best images, correct use of the knobs, and even correct use of the terminology was deficient. The concepts of depth, focusing, dynamic range, contrast, time gain compensation, harmonic imaging, thermal or mechanical indices were all alien terms. The only knob used, and misused liberally was for total gain. 

I also believe that gynaecological ultrasound examinations should be performed by trained gynaecologists. Having such examinations done by personnel not trained in gynaecology, is the most inefficient way of using the technology. The probe is the gynaecologist's eye in the pelvis, as usually said. We should know what we are looking for, after taking the medical history, and performing the appropriate examination. I can not understand, how the probe can be a gynaecologist's eye for non gynaecologists performing gynaecological ultrasound examinations. Cardiologists went about this problem, by using the term Echocardiography instead of cardiac ultrasound, to make it a Cardiologists' domain. May be, it is time we use the term Echogynaecography to make gynaecological ultrasound a Gynaecologists' domain. 

One further point to mention is that, most of the ultrasound books currently available are theoretical, and under illustrated. I thought a practical book, showing the readers how to conduct proper ultrasound scan examinations, and how to acquire good images, is needed to fill this gap, hence the thought about this manuscript. I hope it proves to be useful.

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