Pelvic Protocol

Use same protocol for Transvaginal

Protocol
 Patient should have a full bladder for transabdominal & empty bladder for transvaginal
 If transvaginal examination order, do a brief survey of the pelvis with a transabdominal approach first
 Scan through the entire pelvis in both planes prior to storing any images:
 Begin in the transverse plane starting at the symphysis pubis
 Scan upward through the fundus, evaluating the uterus and surroundings
 DO NOT ANGLE the probe while scanning up, your transducer should move up the body
 Return to the mid body of the uterus and turn into the sagittal plane
 Scan right to left and evaluate the uterus and surrounding structures fluid.

Structure Scan Plane Label Landmarks Identified
UT SAG ML  Vaginal Canal (not included on endovaginal exam)
 Uterus-cervix, body (with endometrium) and fundus
 Vaginal Canal (not included on endovaginal exam)
UT SAG ML  Uterus-cervix, body (with endometrium) and fundus with
AP and Length uterus measurement
UT SAG ML ENDO  Enlarge UT SAG ML image on endometrium in the areas
of the upper uterine body
 Enlarge UT SAG ML image on endometrium in the area of
Uterus Sagittal UT SAG ML
the upper uterine body
ENDO
 Measure AP diameter of endometrium
UT SAG RT  Uterine body and fundus just to the right of midline
UT SAG RT  Uterine body and fundus far right lateral
ADNEXA SAG RT  Lateral to the uterus in the right adnexa region
UT SAG LT  Uterine body and fundus just to the left of midline
UT SAG LT  Uterine body and fundus far left lateral
ADNEXA SAG LT  Lateral to the uterus in the left adnexa region
UT TX VAGINA  Vaginal Canal (not taken on endovaginal exam)
UT TX CX  Uterine Cervix
UT TX BODY  Uterine mid-body
Uterus Transverse
UT TX BODY  Uterine mid-body with width measurement
 Uterine fundus (Scan completely out of uterus, then scan
UT TX FUNDUS
back down toward the fundus)
RO SAG  Right ovary
RO SAG  Right ovary enlarged
Sagittal
RO SAG  Right ovary enlarged with AP and Length measurements
RT Ovary RO SAG  Right ovary enlarged with color Doppler
RO TX  Right ovary
Transverse RO TX  Right ovary enlarged
RO TX  Right ovary enlarged with width measurements
LO SAG  Left ovary
LO SAG  Left ovary enlarged
Sagittal
LO SAG  Left ovary enlarged with AP and Length measurements
LT Ovary LO SAG  Left ovary enlarged with color Doppler
LO TX  Left ovary
Transverse LO TX  Left ovary enlarged
LO TX  Left ovary enlarged with width measurements

MR: Foundations\OBGYN\Lab\Protocols\ Pelvis Protocol r16.docx
Pelvic Protocol
Use same protocol for Transvaginal

Normal Measurements

Structure Area of Plane Measureme Comments
Interest nt
Uterus Length Sagittal 6-8.5cm  Includes Vaginal canal and Uterine-Fundus, Body and
 Measurements nulliparous Cervix
given are average 8-10cm  Be careful on transvaginal scanning the cervix must
measurements multiparous be included or measurements will be off
 Uterus will be AP dimension Sagittal 3cm  Widest portion of the uterine body from the anterior
smaller for or depth to posterior wall
premenarche  Calipers should be placed perpendicular to length
& postmenopausal Width Transverse 2-3cm  Widest portion of the uterine body (level of cornua)
uterus
Endometrium AP Sagittal 4-8mm  Early Proliferative-Days 5-7
 Thin bright echogenic line
 Only measure 6-10mm  Late Proliferative-Days 10-14
echogenic area  3-line sign
 Do not include the 7-14mm  Secretory-Days 15-28,
hypoechoic halo  Thick echogenic stripe
Less than  Post Menopausal-Asymptomatic
8mm  Varies with hormone therapy
Less than 5  Post Menopausal-Symptomatic
mm  Varies with hormone therapy
Ovaries Length Sagittal 2.5-5cm  Measure longest axis
 Size varies w/ age, AP or depth Sagittal 1.5-3cm  Calipers should be placed perpendicular to length
menstruation Width Transverse .6-2.2cm  Measure from left to right in the mid portion
phase &
menstrual status

Tips
 You should scan through the pelvis and abdomen to perform a brief survey of the pericolic recesses and
hepatorenal and splenorenal spaces to look for fluid.
 You may need to apply pressure to the pelvis with the transducer in order to see ovaries. If transducer pressure is
not working, pressure can be applied with your hand or by having the patient press down on themselves
 Look for free fluid in the posterior cul-de-sac
 Utilize 3D or 4D imaging to aid in pathology and endometrium shape details
 Ovaries are located between the uterus and the iliac vessels
 Pelvic muscles may mimic ovaries, evaluate structures in both planes prior to storing the image

Patient Information
 Document first day of the last normal menstruation cycle
 Document if postmenopausal patient is currently on hormone therapy
 Document all symptoms in detail—area of pain, length of pain or bleeding, amount of bleeding, etc.
 Document clinical history of pregnancies, surgeries, or previous pathologies
Pathology
 Gray scale sagittal and transverse images
 Gray scale sagittal and transverse images with 3 measurements (length x width x A/P)
 Use Color Doppler to document the presence of blood flow and Spectral Doppler to document type and velocity
of blood flow
MR: Foundations\OBGYN\Lab\Protocols\ Pelvis Protocol r16.docx