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John Crowley, RDMS-RVT Inland Imaging, LLC March 14 th 2013 Slide 2 Agenda Medicalis review 4 th Quarter 2012 Ectopic Pregnancy Scan assistant/DVD Review Accountability plan and the Future.Group Discussion Slide 3 Medicalis QA Review 4 th Quarter 2012 This is actually just a joke and not necessarily the opinion of the ultrasound staff. Slide 4 Excellent work for 4 th Quarter 2012 Slide 5 An abnormal pregnancy that occurs outside the uterus. A tubal ectopic is the most common type of ectopic pregnancy. (93-97% of cases) In rare cases, ectopic pregnancies can occur in the abdomen, ovary, and cervix. Approximately 10% of maternal deaths are related to ectopic pregnancy. Slide 6 o Prior ectopic. o Hx: of PID. o IUD use. o Tubal or other gynecologic surgery. o IVF or fertility drug use. o Over 35 o May present with abdominal pain, vaginal bleeding, and amenorrhea. Risk Factors and Symptoms Slide 7 Ectopic Locations Slide 8 Slide 9 An adnexal mass that is separate from the ovary is the most common finding. (echogenic adnexal ring) o The presence of an adnexal mass becomes more specific for an ectopic when it contains a Yolk Sac or living embryo. o However, an extrauterine mass may not be sonographically detected in up to 35% of patients. There may be evidence of a hematosalpinx,hematoperitoneum, or free fluid. Pseudo gestational sac seen in 20% of cases. The sac can be differentiated from a true gestational sac by its central location, oval shape, and lack of a thick chorionic ring. Low or slowly rising hCG levels. ( should double every two-three days in early pregnancy) With a quantitative beta HCG of 2000, an IUP is normally seen on transvaginal ultrasound. (SRU) Slide 10 Normal Early IUP Slide 11 Pseudogestational Sac Slide 12 Confirmed Right Tubal Pregnancy Slide 13 Cine-loop Right Ectopic Slide 14 Use gentle pressure. Does the mass move with the ovary or separately from the ovary ? Slide 15 At ovulation the follicle ruptures expelling the ovum into the fallopian tube. Remnants of ruptured ovarian follicle that ranges from 2-5 cm.(Corpus Luteum) Produces estrogen and progesterone, maintaining optimum conditions for implantation if the ovum is fertilized. Beware of the Corpus Luteum Slide 16 Maximum size at about 10 weeks gestation and resolves around 16-20 weeks. If ovum is not fertilized, the Corpus Luteum turns into a Corpus Albicans by around two weeks. The CL is thick walled cyst with ring of fire vascularity. (Cannot differentiate from ectopic) CL Continued Slide 17 Ring of fireCorpus Luteum Slide 18 Ring of fireRight Ectopic Slide 19 Slide 20 Slide 21 Slide 22 Scan Assistant / DVD/Report Page Slide 23 Report pages for abdomen, pelvic, thyroid, and scrotal Remember to move report page to the second stack and then SAVE the presentation state. Slide 24 Slide 25 Slide 26 Are you using a DVD or CD ? DVD has a purple hueThis is what you need to use. CD has a rainbow hueWrong. Slide 27 DVD icon should read #0 and 0:00:00 Slide 28 How to start recording.. Slide 29 Record Icon Pause Icon Slide 30 Slide 31 Slide 32 Wilkonski Ring Slide 33 What do we do well ? What do we need to do better? What frustrates you about work or your work environment ? Examples might be: on line forms, vacation schedule, QA process, work load, communication, this meeting, Radiologists etc.. Slide 34 Provide frustrations with potential solutions. Brainstormno right or wrong answers. Slide 35 Happy St. Patricks Day! Happy St. Patricks Day!