Society News
ISUOG Education Committee
Update on proposed minimum standards for ultrasound
dynamic focus
digitization
l gain compensation,
acoustic output
relationship (may be given in practical
demonstration);
(f) Artefacts, interpretation
and avoidance
l reverberation
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side lobes
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edge effects
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registration
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shadowing
l enhancement;
(g ) Measuring systems
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linear, circumference, area and volume
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Doppler ultrasound - flow, velocity,
spectrum analysis;
(h) Image recording, storage and analysis;
(i) Interpretation
of acoustic output information
and its clinical relevance.
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INTRODUCTION
l
We would expect the trainee to have a basic knowledge of
the following areas: embryology, dysrnorphology,
genetics,
the physiology and pathophysiology
of pregnancy.
The theoretical training program would expect the candidate to understand the full range of diagnostic possibilities of ultrasound. The practical training requirements are
to ensure the candi(date develops sufficient skills to enable
him to establish normal and abnormal fetal development
with the objective to improve fetal outcome; to triage for
gynecological emergencies and to make appropriate referrals to a tertiary (specialist) center for further investigations. There is a difference between the theoretical and
practical training components.
Residents do not have to
accomplish in practice everything that is being taught in
theory.
THEORETICAL
training for residents in Ob/Gyn
TRAINING
The trainee to understand
lowing:
PROGRAM
and be able to discuss the fol-
Basic physical principles of medical ultrasound
(1) The relevant principles of acoustics, attenuation,
absorption, reflection, speed of sound;
(2) The effects on tissues of pulsed and continuous wave
ultrasound beams: biological effects, thermal and
non-thermal;
(3) Basic operating principles of medical instruments:
(4 Pulse echo, scanning principles and 3-D;
(b) Pulse echo instruments, including linear array,
curvilinear, mechanical sector, transvaginal and
rectal scanners;
(4 Velocity ilmaging and recording:
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Doppler principle
continuous wave
pulse wave
color flow mapping
power Doppler
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Color velocity imaging
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Pitfalls, artefacts;
(4 Data acquisition;
(4 Signal processing (may be g:iven in practical
demonstration):
l gray sc:ale
l time gain compensation
l dynamic
range
Obstetrics
(1) Investigation of early pregnancy
(4 Ultrasound features of normal early pregnancy,
including gestational sac and yolk sac, simple
and multiple pregnancy, chorionicity;
(b) Development of fetal anatomy in early
pregnancy including recognition of
abnormalities such as nuchal translucency, cystic
hygroma and fetal hydrops;
(4 Embryonic-fetal biometry, e.g. crown-rump
length;
(4 Fetal viability;
(4 Ultrasound features of early pregnancy failure
including hydatidiform mole;
(f) Ultrasound and biochemical investig,ation of
ectopic pregnancy tumors in early pregnancy;
M Normal appearance of the cervix;
(2) Assessment of amniotic fluid and placenta
(a) estimation of amniotic fluid volume
(b) examination of the placenta and cord
(c) placental location
(d) number of cord vessels;
(3) Normal fetal anatomy at 18-20 weeks
(a) shape of the skull: nuchal skinfold
(b) facial profile
(c) brain: cerebral ventricles, posterior fossa and
cerebellum; cysterna magna, choroid plexus cysts
Ultrasound in Obstetrics and Gynecology
363
Society News
(4
(4
spine: both longitudinally
heart rate and rhythm,
including
(f)
k)
0-4
lungs
shape
of the thorax
abdomen:
abdominal
of the long bones
of abnormalities
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skeletal
system
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central
nervous
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cardiovascular
l
intrathoracic
l
renal
and
and management
( 1)
abdominal
wall and diaphragm
gastrointestinal
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markers
for chromosomal
abnormalities
(b)
Functional
polyhydramnios,
Prognosis
oligohydramnios,
and treatment
hydrops,
(including
intravascular
(2)
Measurements
biparietal
head circumference,
circumference,
Measurements
femur
length)
to aid the diagnosis
of fetal
Estimation
of gestational
Interpretation
ultrasonic
(8)
(9)
and other
investigations
measurements
for
(c)
scoring systems:
of limitations
Fetal body movements
Fetal breathing
Heart rate and rhythm;
measurement
l
assessment
of
(3)
interpretation
appropriate
and
(4)
flow
to obstetric
fibroids
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adenomyosis
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endometrial
endometrial
Appreciation
of problems
in blood flow and
velocity measurements
and waveform
analysis
and complicated
polyps
location
pregnancies
Ultrasound in Obstetrics and Gynecology
in
luteum
fluid;
hyperplasia
cancer
of intrauterine
contraceptive
devices
hydrosalpinx
and other
abnorrnalities
of the
tube
Ovaries
cysts: benign
and malignant,
morphological
systems
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endometriosis
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ovarian carcinoma
differential
diagnosis
of pelvic masses;
of follicular
development
in
and stimulated
cycles
of hyperstimulation
syndrome
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diagnosis
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sonosalpingography;
Invasive
(4
and corpus
lubes
Infertility
(a) Monitoring
(4
(b)
(c)
(4
changes1
of follicles
complications
spontaneous
l
diagnosis
blood
and measurement
of peritoneal
l
l
singly or serially
shape
thickness
Uterus
scoring
of fetal and uteroplacental
Methodology
normal
l
l
investigation
364
procedures.
changes1 in the
morphological
Fallopian
estimation;
(b)
(c)
Evaluation
cyclical
of fetal growth
(a)
(b)
villus
shape and measurement
of endometrial
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of
age assessment;
Fetal weight
Biophysical
appreciation
(a)
and draining
morphological
Ovaries
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size, position,
l
of limitation
Ultrasonic
assessment
of fetal growth:
interpretation
and appreciation
of limitations
standard
(b)
age
and appreciation
gestational
Assessment
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endometrium
measurement
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(b)
(a)
chorionic
size, position,
cyclical
.
skinfold;
(7)
and therapeutic
pelvic anatomy
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anomalies:
anterior/posterior
horn of the lateral
ventricle, transcerebellar
diameter, nuchal
(a)
diagnostic
shunting
Uterus
l
uterine
Gynecological
(a)
to assess fetal size (including
diameter,
abdominal
(6)
Therapeutic:
Normal
(a)
Fetal biometry
(b)
of invasive
Gynecology
system
therapy);
(a)
the
of
dysrhythmias
(5)
in monitoring
fetus and pregnancies
diagnosis,
disorders
l
l
(c)
applications
procedures
(a) Diagnostic:
amniocentesis,
sampling, cordocentesis
(b)
differential
in the
retardation
Structural
l
(b)
history
Clinical
(10) Knowledge
chorionicity;
To study the epidemiology,
(a)
radius
and feet - these to include
‘echogenicity
growth
complicated
by rhesus isoimmunization,
diabetes and fetal cardiac arrhythymias;
and urinary
humerus,
and limitations
of intrauterine
and pre-eclampsia
tract
wall and umbilicus
tibia and fibula,
applications
small-for-dates
liver, kidneys
movement
multiple pregnancy:
natural
view,
outflow
and abdomen
stomach,
limbs: femur,
shape,
(4)
valves,
Clinical
prediction
(4
and ulna, hands
(i)
four-chamber
atrioventricular
bladder,
(i)
(4
and transversely
of polycystic
ovaries
procedures
Oocyte
retrieval
Injection
Aspiration
of ovarian
of ovarian
cysts
cysts
Drainage of pelvic abscesses
Extraction
of intrauterine
contraceptive
device;
Society News
(5)
Doppler in gynecology
(a) Infertility and oncology.
Organization
of ultrasound
Infrastructure,
zation
(4
four-chamber
(f )
k)
04
unit
documentation,
Heart rate and rhythm,
quality
control,
computeri
size and position,
view
Size and morphology
of the lungs
Shape of the thorax
and abdomen
Abdomen:
diaphragm,
umbilical
vein, kidneys,
stomach,
6)
Limbs:
femur,
tibia and fibula,
and ulna, feet and hands
implications
of ultralsound
shape,
(i)
echogenicity
Multiple
(k)
(1)
(4
Ethics and patien.t information
Required
(1)
TR.AINING
The trainee
to 'beable to identify
and emergency
transvaginal
(a)
(3)
skills
gynecological
early pregnancy
problems
and transabdominal
(4)
fetal viability
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description
of the gestational
sac, embryo,
Activity:
radius
and
transfusion
syndrome
fluid
location
and number
circumference,
Early pregnancy
l
of amniotic
Placental
Cord
monochorionic
twin-twin
of vessels;
Fetal biometry
(a) Crown-rump
length, biparietal diameter,
length, head circumference,
abdominal
by
ultrasound
Amount
humerus,
- these to include
and movement
pregnancy:
dichorionic,
PRACTICAL
wall and
umbilicus
and data storage.
Medicolegal
examination
liver and
abdominal
interpretation
recognize
of growth
femur
charts;
and quantify:
(a)
Fetal movements
(b)
Breathing
(c)
Eye movements.
movements
yolk sac
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(b)
(c)
single and multiple
gestation
(chorionicity)
Pathology
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early pregnancy
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ectopic
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gross fetal abnormalities
Certification
failure
pregnancy
(1)
translucency,
hydropic
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hydatidiform
mole
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associated
:such as nuchal
abnormalities
pregnancy
sonography
pelvic tumors
(b)
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normal
uterine
l
measurement
l
pelvic tumors,
pelvic anatomy
size and endometrial
(2)
peritoneal
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intrauterine
(2)
e.g. fibroids,
fluid
contraceptive
by abdominal
(3)
devices;
Shape of the skull; nuchal
(b)
Brain: ventricles
(c)
(d)
Facial profile
Spine: both longitudinally
the full spectrum
of
Examination
(a) General guidelines:
the examination
Iwould be
included as part of the normal Ob-G.yn training.
The options
are to have a multiple-choice
On the practical
skinfold
and cerebellum,
30 cases on one A4 page with ultrasound
picture
- at least 15 anomalies
should be included;
or short written
ultrasound
(a)
200 obstetric scans covering
obstetric conditions;
Logbooks
(a)
cysts,
The trainee to be able to recognize the following
normal fetal anatomical
features from 18 weeks
onwards
by t ransvaginal
experience
also
thickness
of ovaries
hydrosalpinx
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problems
(principally
but transabdominal
required)
Gynecology
l
scanning to include:
One hundred h ours of supervised
(a) 100 gynecological
examinations and early
choroid
plexus
fetal anatomy
examination
side, a transvaginal
scan, 30 minutes
be recommended.
and transversely
ultrasound
paper
pictures
The candidate
and interpret
paper
(3-4 cases).
scan and a
for bloth, would
would
take
the images.
Ultrasound in Obstetrics and Gynecology
365