MFM Rotation Ultrasound – UNM  PGY1

 

Objectives

 

Basic Principles of Medical Ultrasound

 

• Explain the basic principles of ultrasound physics.
• Understand the different types of ultrasound modalities – 2D , 3D/4D, B mode , M mode, Color and Power Doppler.
• Describe bioeffects of ultrasound ; ALARA.
• Familiarity with relevant official statements from major societies :  American Institute of Medicine (AIUM), American  College of Obstetricians and Gynecologists (ACOG), Society of Maternal-Fetal Medicine ( SMFM),    International Society of Ultrasound in Obstetrics and Gynecology (ISUOG).

 

Basic Characteristics of the Ultrasound Equipment ( Knobology)

 

• Transducer characteristics and applications.
• Describe bio-effects considerations related to acoustic power output.
• Describe the effects of frequency on resolution and penetration.
• Describe the use of depth settings on the field of view and image size.
• Explain how to adjust focal zone depths to achieve the best resolution of structures of interest.
• Identify patient information data to input before starting an ultrasound examination.

 

Aspects of the Ultrasound Examination

 

• Described effecting positioning of patients and application of coupling agents ( gel).
• Describe practices that minimize repetitive stress injuries / ergonomic practices.
• Explain how you label and store images.
• Describe the protocol for transducer cleaning and disinfection.
• Describe appropriate communication of ultrasound findings to the patient and other health care providers.

 

Ultrasound in the First Trimester

 

• Describe indications for a first-trimester ultrasound examination.
• Describe steps for performance of a first trimester ultrasound, transabdominal and transvaginal.
• Recognize the yolk sac, amnion, embryo, fetal number.
• Recognize and record fetal cardiac activity using clips and M-mode.
• Describe criteria for definitive viability in the first trimester.
• Use of ACOG criteria for pregnancy dating in the first trimester.
• Recognize the appearance  of sub-chorionic hematomas.
• Describe the ultrasound evaluation of tubal ectopic pregnancies.
• Recognize the features of a molar pregnancy.
• Describe the association of a thickened nuchal translucency and fetal chromosomal anomalies.

 

Ultrasound in the Second and Third Trimesters  

 

• Describe the components of the standard  ( OB > 14 wks ) ultrasound.
• Identify the components of dating in the second and third trimester according to ACOG criteria.
• Recognize risk factors for abnormal fetal growth.
• Describe how to sonographically document placental location.

 

Placental abnormalities

 

• Recognize risk factors and sonographic diagnosis of placenta previa.
• Recognize  and describe risk factors for placenta accreta.

 

Amniotic Fluid Assessment 

 

• Describe methods for diagnosing oligohydramnios and polyhydramnios.

 

Ultrasound Evaluation of Multi-Fetal  Gestations 

 

• Explain the role of ultrasound in the diagnosis of Twins.
• Describe how to determine placentation ( chorionicity and amnionicity ) in multi-fetal gestations.

 

Ultrasound evaluation of the adnexae

 

• Recognize and describe the sonographic features of the normal ovary.
• Recognize and describe characteristics of a simple cyst and corpus luteal cyst. 

 

Ultrasound of the  non pregnant uterus

 

• Recognize indications for pelvic sonography.
• Recognize and describe the sonographic featuers of the normal uterus.

 

 

 

Week by Week Readings and Scanning Objectives

 

Rotation WEEK	Resources to Complete	Hands on Scanning Objectives
WK 1	Pre- test
	AIUM Practice Parameter for the Performance of Obstetrical Ultrasound Examinations   Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Obstetric Ultrasound Examinations	Approach to the patient and machine. Ergonomic awareness. Basic Knobology. Overall sweep view and transducer manipulation. Documentation of fetal heart rate in clip store,  M mode  and  PW Doppler (2nd-3rd Trimester). Amniotic fluid assessment by MVP/AFI. Fetal presentation. Lower uterine segment and Cervix ( for presentation).   Introduction to AS.   LOG ALL STUDIES
	AIUM Official Statement Limited Obstetric Ultrasound
	AIUM Official Statement Transducer Cleaning
	Chapters 1, 2, 3  and 9 of Albuhamad **: Chapter 1 Basic Physical Principles of Medical Ultrasound Chapter 2 Basic Characteristics of the Ultrasound Equipment Chapter 3 Technical Aspects of the Ultrasound Chapter 9 Amniotic Fluid Assessment  AS  Troubleshooting
WK 2	AIUM Official Statement on the Safe Use of Doppler Ultrasound During 11-14 week scans (or earlier in pregnancy)	Build on Week 1 images.   Add biometry : CRL; BPD; HC; AC; FL; HL; Transcerebellar diameter.   Add placental location, appearance, and cord insertion. Evaluation of the  adnexae.   Do as much transvaginal imaging as possible.   LOG ALL STUDIES
	ACOG Committee Opinion 611 Assigning EDD
	Chapters 4, 5, 6, 8 and 12    of  Albuhamad **   Chapter 4 Ultrasound in the First Trimester  Chapter 5 Ultrasound in the Second Trimester Chapter 6 Ultrasound in the Third Trimester Chapter 8 Placental abnormalities Chapter 12  Dr Albuhamad Ultrasound Evaluation of the Adnexae ACOG IUGR Detection Surveillance Diagnostic Criteria Non Viable 1st Trim
WK 3	Chapters 10 and 15  Dr  Albuhamad ** Chapter 10 Stepwise Standardized Approach to the Basic Obstetric Ultrasound in the Second and Third Trimester Chapter 15 Writing the ultrasound report Taber Scanning Tips Understanding Ultrasound Types and using proper terminology: CPT codes Roy Filly Editorial AS Physician Tutorial	Add fetal anatomy according to AIUM content guidelines. Build image optimization and efficiency. Tailor your ultrasound type to the clinical picture.   Learn how to write a report in AS.   LOG ALL STUDIES
	CLEAR Program Power Point Slides  and Criteria: Criteria The Clear Program How To Measure Cervical Length  Translating Knowledge Into Clinical Practice Why Measure Cervical Length	Do OB Transvaginal Cervical length.
WK 4	ACOG Practice Bulletin 175 Ultrasound in Pregnancy	Completion of the protocol for a standard Ob ultrasound.
	GEVoluson Club Image Quality Fab 4	Continue building image optimization and scanning efficiency.
		Write all the AS reports on your patients.
	AIUM Practice Parameters for Performance of Ultrasound of the Female Pelvis   AIUM Official Statement of Training Guidelines for Interpretation of Ultrasound of the Female Pelvis Chapters 11,13,14 from Dr Albuhamad Chapter 11 Ultrasound of the Non-Pregnant Uterus Chapter 13 Ectopic Pregnancy Chapter 14 Stepwise Approach to the Basic Ultrasound Examination of the Female Pelvis	Transvaginal OB scanning Gyn Scanning.
		LOG ALL STUDIES
	Written test	Practicum with MFM attending.