Non-OB Pelvic Imaging

Indications	Pelvic pain Amenorrhea Metrorrhagia IUD localization Symptoms of pelvic infection Excessive bleeding post surgery/delivery/AB Dysmenorrhea Menorrhagia Menometrorrhagia Post menopausal bleeding Abnormal/technically limited pelvic exam Eval of congenital uterine anomalies
Prep	Adult patient to drink 32 oz of water, finishing 60 minutes prior to exam. Patient should not empty bladder until transabdominal exam is completed. ED patients require no prep.
Transabdominal Imaging*	Sagittal uterus in midline with and withoutlength and AP measurement. Sagittal uterus left and right. Sagittal endometrium (no measurement). Transverse uterus inferior to superior with and without measurement at widest point. Sagittal and transverse left ovary with and without measurements. Sagittal and transverse right ovary with and without measurements. Sagittal and transverse left adnexa. Sagittal and transverse right adnexa.
Endovaginal Imaging*	Sagittal uterus in midline (no measurement). Sagittal uterus left and right. Sagittal endometrium with and without measurement. Transverse uterus inferior to superior (no measurement). Sagittal and transverse left ovary with and without measurements. Sagittal and transverse left adnexa. Sagittal and transverse right adnexa.
*Minimum imaging requirements. Must note in tech notes if unable to visualize ovaries. If the uterus cannot be seen secondary to empty bladder in the ED, measure the uterus transvaginally.
Additional imaging to include	Color flow in any area of interest including the endometrial area, masses within the uterus, cysts or masses within the ovaries and masses within the adnexa. Color flow and Doppler with RI of ovarian parenchyma for ovarian torsion,complex cysts or masses: must include both arterial and venous flow to document for limited Dopler charge. 3-5 RI's should be performed to obtain representative values. Measurement in 3 planes of masses within the uterus or adnexa. Measurement in 1 plane to determine greatest diamter of simple ovarian cysts (measure largest cyst of multiple cysts observed). Measurement in 3 planes of complex cysts or masses within the ovaries. Images of any additional pathology including hydrosalpinx, free fluid in the posterior cul de sac, etc. Information must be entered on the patient data page including LMP and Gravida/Parainformation. Reason for the exam must be included in the comment section of the patient data page (or free texted on initial blank imaging page if comment section not available). It is important to ask the patient the reason they are having the exam and the patient information should be shared with the radiologists via the comments section and tech notes. Patient sex/age/exam type should be visible on each image. LMP and Gravida/Para infomration should be visisble on each image. PIP (patient inserted probe) or TIP (technologist inserted probe) should be visible on each endovaginal image. Pelvic exam performed on Philips equipment should include 3D coronal views of the endometrium. The calculation package should be used to store measurements. The worksheet image with measurements should be stored as the last image of the exam. Chaperone initials should be included on each endovaginal image. Male sonographers must have a chaperone for all endovaginal exams. Female sonographers may obtain a chaperone if they believe it would be appropriate. (See UNMH Guideline "Chaperone Services" and Internal Guideline "Radiology Code of Ethics" appendix I). Non latex probe cover must cover the endovaginal transducer for each exam. The endovaginal probe must soak in Cidex OPA following the manufacturer's guidelines after each endovaginal exam. Visibly bloody transducer covers, pads, tampons and chuks must be placed in a biohazard bag and the bag must be placed in a biohazard bin (not sharps container). Bloody linens should be placed in the blue linen bag like all other linens; do not red bag bloody linens. An endovaginal exam should not be performed on a virginal patient. An endovaginal exam should not be perfromed on a non-virginal patient unable to consent. The only exceptionwould be a signed consent from two providers in the event that a non-virginal patient is unable to consent and the proveders state the exam is emergent. When completing the exam, bill only charges must be selected for both the TA and EV portions of the exam (drag 2 charges from the left over to the right). Coronal 3D images (Philips equipment only) should also be charged as a "bill only" 76376 "Render w/o post processing."

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Non-OB Pelvic Imaging