Lewis Chan1
(1)
Department of Urology, Concord Repatriation General Hospital, Sydney, NSW, Australia
Lewis Chan
Email: lewis.chan@sswahs.nsw.gov.au
Pelvic floor ultrasound is best performed by a clinician with detailed knowledge of the pathophysiology of pelvic floor function and dysfunction. Ultrasound imaging may be considered an extension of clinical examination or part of a functional assessment of voiding and pelvic floor dysfunction.
Nonetheless, as most clinicians (gynaecologists, urologists, colorectal surgeons physiotherapists) may not be performing diagnostic ultrasound imaging on a daily basis the choice of equipment and setup needs careful consideration. Potential environments in which a clinician may perform ultrasound include the office, hospital wards, clinics and formal radiology imaging facilities in a hospital or private setting.
Choosing Ultrasound Equipment
Selection of ultrasound equipment greatly depends on the needs of the user or users. In general, any ultrasound machine with B mode, grayscale scan capacity will be suitable for 2D pelvic floor ultrasound. The availability of color doppler function may be useful to look for flow in pelvic vessels and identify ureteric jets. ‘Higher end’ function such as 3D/4D function and volume analysis are more practical in larger clinical units where clinicians perform different types of scans. This may also be desirable if the clinicians’ practice involves patients with complex voiding dysfunction, pelvic organ prolapse and mesh repairs. These machines are generally cart based but there are now portable ultrasound units with 3D functionality becoming increasingly available and affordable.
Portable Units Versus Trolley/Cart Based Systems
Portable ultrasound machines are advantageous if the clinician delivers care in different practice locations and are especially suitable for bedside ultrasound.
Transducer Selection
The appropriate number and types of transducers depend on the type of pelvic scanning in the clinician’s practice. Most can start with a standard general purpose curved array (for example, a 2–5 MHz transducer for transabdominal and transperineal imaging) and an intracavity transducer for prostate and pelvic organ imaging. An endoanal transducer is important if anorectal sphincteric function assessment is planned.
Upgrade and software options are useful especially in larger units with higher end ultrasound machines where different types of ultrasound scans are performed.
Image recording options include thermal prints, digital output such as CD/DVD/USB recording, or a Picture Archiving and Communication System (PACS).
Equipment Setup, Maintainence and Protection
The most fragile part of the ultrasound unit is the transducer and this must be protected from drop damage (Fig. 3.1). It is also important to protect the electronics of the transducer coupling (Fig. 3.2) especially in the disinfection/sterilization of endocavity probes. No matter how simple the ultrasound equipment is, it is in the clinician’s interest to be fully orientated to the features of the machine and be involved in creating the pre-set functions (see Chap. 2) to ensuring that the best possible images can be obtained during scanning.
Fig. 3.1
The transducer is the most fragile part of the ultrasound unit and should be protected from drop damage during storage and scanning
Fig. 3.2
During sterilization of intracavity transducers the transducer coupling should be protected
Setting Up the Ultrasound Room
The physical environment in which pelvic floor ultrasound is performed can have significant impact on a patient’s or sonographer’s comfort and indirectly affect the quality of images and interpretation of the scan findings. This is especially because pelvic floor imaging is often performed as part of functional/dynamic assessment of pelvic floor dysfunction.
Both the examination table and the sonographer’s chair should ideally be height adjustable. The physical configuration of the scanning room should ensure that the clinician has ready access to the ultrasound machine, examination table, gel, towels and lighting controls (Figs. 3.3 and 3.4). Space for a support person (for the patient) or chaperone is also important especially when performing intracavity imaging.
Fig. 3.3
Bedside ultrasound setup in a consultation room
Fig. 3.4
Dedicated ultrasound room setup for pelvic floor imaging and ultrasound urodynamics
A patient change area and a curtain protecting privacy during the scan are also essential in planning the environment for pelvic ultrasound (see Tips 3.1)
Procedures and Accreditation
The creation of protocols for ultrasound procedures and practice accreditation are increasingly becoming a necessity in clinician performed ultrasound. Guidelines are generally available via national ultrasound associations (see web links). Typical documentation includes:
· Qualifications of personnel performing ultrasound examinations
· Registration/details of ultrasound equipment, updating and maintenance
· Infection control, sterilisation/disinfection procedures for transducers
· Protocols for the common types of scans performed
· Reporting format
· Referral format (if the clinician performs ultrasound scans for external referrers)
· Recording of images
· Availability of chaperones
Tips 3.1 Checklist for Setting Up the Ultrasound Room (Figs. 3.3 and 3.4)
Space and location
Bedside scanning arrangement
Easily accessible lighting and switches
Adjustable height examination couch
Comfortable, height adjustable chair for sonographer
Availability of toilet, change area and curtains
Appendix
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