IMAGINE METHODS

Matta M.D
HISTORY OF ULTRASOUND
 First introduced to medical world in 1950s

 However, has its beginnings in the 1880s when

Pierre Curie introduced simple echo sounding
methods.
 This led to the discovery of SONAR -(Sound
Navigating and Ranging)
 Early 1970s
 Gray scale static images of internal organs

 Mid 1970s
 Real-time imaging

 Early 1980s
 Spectral Doppler
 Color Doppler

 Also produced was a hand-held “contact” scanner for

clinical use.
COMPONENTS
 Transducer Probe
 Transducer Pulse Controls

 CPU

 Display

 Keyboard/Cursor

 Disk Storage Device

 Printer
AN ULTRASOUND IMAGE IS PRODUCED BY:

 Producing a beam of sound waves

 Transmitting this through the object of interest

 Receiving echoes

 Converting the echoes into electric signals

 Interpreting and displaying those signals

 Can be snapshot or in real time

DIAGNOSTIC ULTRASOUND:

 Typically involves frequencies of 2 – 15 mHz

 Lower frequencies will give greater penetration
 And thereby you can see further
 Higher frequencies allow you to see more detail
 But the penetration is less
 And very high frequencies have the potential for
adverse biological effects
Normal
Appeara
nce
NORMAL APPEARANCE
SO THE ULTRASOUND IMAGE WILL BE:

 White = Area of high acoustic impedance e.g. bone

 Black = Areas of low acoustic impedance e.g fluid

 All shades of grey in between

 Shadowed by area of non penetration or areas

behind those of high acoustic impedance e.g.
behind bone
 POTENTIAL USES FOR ULTRASOUND IN
GYNAECOLOGY:
 Assessment of adnexal pelvic masses
 IUCD and Implanon location
 Treatment of ovarian cysts (aspiration) and ectopic
pregnancy (methotrexate)
 Investigation of postmenopausal bleeding
 Evaluation of pelvic pain
 Investigation of menorrhagia
 Diagnosis of polycystic ovaries
 Tubal patency studies in infertility
 Evaluation of primary amenorrhoea
 Screening for ovarian cancer
 Monitoring of follicle number and growth for IVF
 Egg recovery for IVF and ICSI
GYNECOLOGICAL ENDOSCOPY

 Endoscopy in obstetrics and gynaecology

has many branches:

 Laparoscopy
 Hysteroscopy.

 Colposcopy

 Falloposcopy

 Fetoscopy
LAPAROSCOPY

 Definition :
It is a technique which allows viewing (Diagnostic) and surgical
maneuvers (Therapeutic) to be performed in abdominal organs
through a surgical incision of < 1cm with help of
pneumoperitoneum.
INSTRUMENTS

1. Verres needle:

used to inflate air to the

peritoneal cavity
(pneumoperitoneum)
through the umbilicus
where there is the
thinnest abdominal
wall.
4. VIEWING THE PERITONEAL
CAVITY:
A. The omentum, bowel and bifurcation of pelvic vessels should be
evaluated to avoid injuries caused during the introduction of
Verres needle or trocar.

B. The site of introduction of other

trocars should be verified by finger
palpation and transillumination of
abdominal wall to avoid injury to
epigastric vessels.

C. Identify if there is any bleeding

INDICATIONS
Used as a diagnostic tool

 Infertility: status of the fallopian tube (morphology and

functionality) and any pathological condition e.g.
adhesions.
 Ovarian cysts or tumors.
 Ectopic pregnancy.
 PID: tubal abscess or adhesions.
 Endometriosis: define the sites of implants and
endometrial cysts.
 Ovarian Cyst

Adhesions
between the
omentum and
uterus
Ectopic pregnancy
HYSTEROSCOPY
 Definition:

 It is a technique which allows viewing and

surgical maneuvers to be performed in the
uterine cavity.

 It has many advantages that made it wide

spread and fundamental diagnostic method in
daily gynecological practice.
 INSTRUMENTS

1. Distention media of
the uterine cavity
(CO2 distention)
2. Light source.
xenon light source
gives the best
image quality
3. Camera Equipment

4. Endoscope
flexible: high cost and fragile
cannot be autoclaved.
rigid: gives different direction
of the view.
- 0°, 12°, 30° (best
for diagnostic purpose).
INDICATIONS
Used as a diagnostic tool:

- Abnormal uterine bleeding caused by:

- submucous and intramural myoma.
- endometrial polyps.
- endometrial atrophy.
- Endometrial tumors.
- Infertility related to:
- Intrauterine adhesions (Asherman’s syndrome)
- Submucous fibroids.
- Endometrial polyps.
- Uterine malformation (it cannot differentiate between sepatate
and bicorneate uterus)<- this can be done by laparoscopy.
INDICATIONS

Used as a therapeutic tool

- Removal of foreign bodies and IUCD.
- Fallopian tube catheterization
- to canalize the tube.
- to place intra tubal device for
reversible
sterilization.
HYSTEROSCOPIC SURGERIES AND
ENDOMETRIAL POLYPECTOMY
 Uterine polyp

Uterine anomaly
CONTRAINDICATIONS

 Pregnancy.
 Current or recent pelvic infection.

 Current vaginitis, cervicitis and

endometritis.
 Recent uterine perforation.

 Active Bleeding.
COMPLICATIONS
- Complications related to distention media:
- due to CO2 insufflation:

- Cardiac arrhythmia due to excessive absorption.

- Gas embolism.
- We use hysteroflator that insufflate pressure of 100-
120 mmHg constantly without exceeding the safety
limit.

- due to fluid:

- HMW (dextran)
- Anaphylactic reaction
- Pulmonary edema
- Adult RDS
 COMPLICATIONS

- Late onset:

- Infections: like acute PID, so we give prophylactic

antibiotics.
- Vaginal discharge: common after ablative procedures and
it is self limiting.

- Adhesion formation:

- Common after myomectomy when 2 fibroids are located

opposite to each other in the uterine wall.
- To prevent the adhesions it is better to remove the fibroids
in stages, and give estrogen (to build up the endometrial)
therapy directly after resection. And also we can use IUCD.