AIUM: Ultrasound Should Be First-Line for Pelvic Imaging

Ultrasound is more cost-effective and safer than other imaging technologies for imaging the female pelvis and should be the first modality used for patients with pelvic symptoms, advocates of the American Institute of Ultrasound in Medicine (AIUM) have proposed. The Clinical Opinion article is published in the American Journal of Obstetrics & Gynecology.

Many women who present with pelvic pain, masses, or flank pain first undergo computerized tomography (CT) scans or magnetic resonance imaging (MRIs) for those that present with Mullerian duct anomalies. However, the CT scans or MRIs of the pelvis sometimes result in indeterminate and confusing findings that require an ultrasound for clarification. Lead author Beryl R. Benacerraf, MD, stated that when an ultrasound is performed and interpreted well, it usually eliminates the need for additional costly and complex cross-sectional imaging techniques.

Authors cited a recent study where most of the patients with suspected kidney stones did not need a CT scan when evaluated first by ultrasound; this also spared them radiation exposure. Also, the transvaginal ultrasound transducer allows the operator to place a probe in close proximity to target pelvic organs, examine, and image the patient simultaneously. In general, ultrasound technology has shown accuracy when evaluating deep infiltrating endometriosis and for patients with pain from extensive pelvic adhesions.

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The modern 3D volume ultrasound technology allows hundreds of images to be generated and utilized to view in any orientation. The team noted it is less costly and less time-consuming than an MRI while still producing comparable image quality and orientation to those of MRI and CT scans without the radiation.

Dr. Benacerraf emphasized the need for educating the medical community to consider adopting 3D ultrasound as the first tool for specific gynecologic indications. Practitioners that are still providing basic 2D ultrasound should also be educated on the new ultrasound technology.

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