SONOGRAPHIC PELVIC ANATOMY Ellen Miller MD Michael Cassara

SONOGRAPHIC PELVIC ANATOMY Ellen Miller, MD, Michael Cassara, DO, John Pellerito, MD, Steven Ostrow, MD, Paul Speer, MD, Brent Thompson, Ph. D, 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 hypothalamicpituitary-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 Round-table Case Discussion Incorporating Menstrual Cycle Physiology 25 students (~60 min. ) Hands-on: Transabdominal with Standardized Patient Hands-on: Transvaginal with Phantom 12 students 13 students (~30 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