Gynecologic ultrasound primer: How not to miss the diagnosis

Why are so many diagnoses missed by gynecological ultrasound? Why is there such a disparity in quality of pelvic ultrasound throughout the country? As opposed to other cross-sectional imaging modalities, ultrasound offers the possibility of integrating the imaging into the broader clinical evaluation of the patient. Only by combining the imaging, interview, and physical exam can we accomplish a complete evaluation of the patient’s problem. Appropriately deployed, the ultrasound examination performed in the context of the clinical picture can provide a more complete and comprehensive approach to managing the patient. The combination of imaging, history, and physical examination that comes from direct interaction can minimize the probability of missing clinically important findings.  

Unfortunately, usual practice patterns in the United States can fail to take advantage of these opportunities.^1-4 Gynecological ultrasound often involves a remote encounter with images read out of context by someone who did not speak to or examine the patient and possesses scant case-specific clinical information. In addition, despite attempts to standardize gynecologic ultrasound, the images obtained depend highly on the person who actually performed the scan.¹ This consideration renders gynecological ultrasound much more operator-dependent than computed tomographic or magnetic resonance imaging studies.  

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