Advanced visualization powers uterine ultrasound reconstruction

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In the time-crunched world of clinical practice, one of the considerations to introducing a new technology is its impact on patient throughput. A team of researchers from a group of Boston-based hospitals has found that adding 3D coronal reconstructions to standard 2D uterine ultrasound uterine workups provides a valuable adjunct to the procedure, with a minimal impact on exam time.

“The addition of a 3D coronal view is not a time-consuming addition to a pelvic sonography examination, and this view can easily be added to the protocol when needed,” wrote the authors of a multi-institution study published in this month’s American Journal of Roentgenology.

Researchers from the departments of radiology and obstetrics and gynecology at Brigham and Women’s Hospital, Massachusetts General Hospital, and Diagnostic Ultrasound Associates in Boston recently conducted a study of 66 consecutive patients undergoing gynecologic sonography examinations in order to determine which patients would derive benefit from an additional reconstructed view.

The protocol used by the team consisted of standard 2D sonography followed by a 3D volume acquisition obtained longitudinally along the length of the uterus and saved on a PACS (Viewpoint, GE Healthcare). The exams were performed by sonographers using an automated 4-8–MHz transvaginal transducer (Voluson Expert, GE Healthcare); and the coronal volume was centered on the region of the endometrium and taken longitudinally.

“This study did not change our routine scanning protocol, which normally includes both 2D and 3D imaging of all patients, and therefore was considered a review of medical records,” the authors noted.

Results from the exams were initially read using the information from the 2D scans. The interpreting physician then reviewed a 3D coronal reconstruction and determined if the additional view was critical in making a diagnosis that could not be made with 2D information, helpful in increasing the diagnostic certainty of their 2D diagnosis, or if it did not provide any additional information.

Thirty-one-year-old woman who presented with infertility. A, Transverse view through uterus shows no abnormality. B, Reconstructed coronal view of uterine cavity shows arcuate uterus. Image and caption by permission of the American Roentgen Ray Society.

The scientists reported that a 3D coronal view of the uterus and endometrium added information to standard 2D scanning in 16 (24 percent) of the 66 patients.

“Three types of patients benefited from the 3D reconstructed coronal view,” the authors wrote. “The first type was patients with a history of infertility or a question about the presence of a uterine abnormality. The second type was patients with an endometrium ≥ 5 mm. The third type was patients with uterine fibroids.”

The group found that adding a reconstruction of the 3Dcoronal plane of the uterus took less than a minute when performed by an operator without special training and less than 30 seconds when performed by an operator who had completed a short training session.

“Adding this 3D coronal view to the standard 2D sonography protocols is therefore unlikely to add considerable time to the pelvic sonography examination,” the authors observed.

The researchers hope their work will stimulate further research at multiple institutions, both to confirm their results and further study the benefit of adding 3D volume scanning to pelvic scanning protocols.