Editorial: Ultrasound bests CT for acute pelvic conditions in women

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“Ultrasound is the established modality of choice to evaluate the female pelvis, so why do patients with pelvic masses or pain get a CT scan? In my opinion, doing a CT scan first for female patients with lower abdominal pain is dangerous and wasteful, a drain of much-needed healthcare dollars,” wrote Beryl Benacerraf, MD, in an editorial published in the March issue of the Journal of Ultrasound in Medicine.

Benacerraf, a professor of radiology and obstetrics and gynecology at Harvard Medical School in Boston, who is also editor-in-chief of the journal, explained that when she began her radiology residency, there was ultrasound equipment but no CT scanner in the emergency radiology room. She noted that currently in the ER, CT has become the means of initial evaluation for patients presenting with abdominal or pelvic conditions, despite “several studies concluding that CT should be the secondary test if ultrasound does not provide the answer.”

In the editorial, Benacerraf said that many patients are referred to her following equivocal or inconclusive results from their CT evaluation.

“How have we evolved to ordering the most expensive imaging technique first for these patients, only to be followed frequently by a far less costly ultrasound examination to clarify the CT findings? Don’t these ordering physicians remember that ultrasound is far better for evaluating the female pelvis than CT and ultrasound has no ionizing radiation?” she asked.

Referencing a recent study in the New England Journal of Medicine, which described the high number of patients receiving imaging studies involving radiation between 2005-2007, Benacerraf wrote that radiation exposure is “cumulative, and each exposure adds incrementally to the long-term danger of cancer.”

“We must remember that ultrasound is safe and free of any radiation,” wrote Benacerraf. “After decades of widespread use, no harmful effects due to diagnostic ultrasound have emerged, even in the human fetus. So why has the medical community moved from ultrasound to CT for evaluation of the female pelvis with acute symptoms?”

Benacerraf mentioned that some physicians prefer CT over ultrasound due to the multiplanar reconstruction that CT offers, compared to ultrasound being a 2D modality.  However, she wrote, ultrasounds now can provide multiplanar reconstruction from 3D volume imaging much like CT.

“Rather than trying to teach the appearance of gynecologic diseases on CT, why not simply order an ultrasound examination first and make the diagnosis more easily and without radiation or high costs.” said Benacerraf. “I doubt that anyone will deny that most if not all cases of gynecologic abnormalities are better evaluated by ultrasound and will rarely need any further diagnostic imaging tests.”