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Ultrasound examination is now considered as part of almost every clinic setting. The creation of an image from sound is achieved in three steps: producing a sound wave, receiving echoes, and interpreting those echoes. The four different modes of ultrasound used in medical imaging are: A-mode, B-mode, M-mode and Doppler mode. The Doppler frequency shift information can be displayed graphically in various ways that include color Doppler (directional Doppler), power Doppler, and spectral (pulsed) Doppler. The different modes of Doppler waves include: Continuous-wave Doppler (CW) and Pulsed-wave Doppler (PW). The blood flow measurements are performed by calculation of velocity, calculation of absolute flow and flow waveform analysis. Despite its impressive safety record of ultrasound to date, the intensity (or acoustic output) level of ultrasound used to scan the fetus in utero has increased almost eightfold over the level that was allowed in the early 1990s.
This chapter reviews the basic principles of radiologic tests, and describes the basic female anatomy. It provides information for appropriate imaging modalities for each part of the female genital tract. Currently ultrasound plays a role in monitoring the uterus during ovarian stimulation and early pregnancy. Assessment of uterine leiomyoma is historically achieved with ultrasonography, although computed tomography (CT) and magnetic resonance imaging (MRI) also offer detection of uterine fibroids. In reproductive medicine, imaging of the tubes is typically limited to evaluation of patency and distortion of normal anatomy, as in hydrosalpinges and salpingitis isthmica nodosum. Pituitary imaging is mostly performed in reproductive medicine for the infertile patient with persistently elevated prolactin levels or with levels over 100 ng/ml. Imaging is rarely performed in reproductive medicine specifically to evaluate for peritoneal disease. Laparoscopy is considered the gold standard for diagnosis of peritoneal processes such as endometriosis.
The principle of autonomy recognizes that it is the voluntary decision of the patient to authorize or refuse clinical management based on adequate and complete disclosure by the physician about the patient's condition and management with the understanding of this information by the patient. If the patient refuses the ultrasound examination due to the fears of its harmful effects, the physician must clarify the facts to the patient, support her, and illuminate her fears. During obstetric ultrasound scanning and in occasional circumstances where the unborn child may suffer from a condition that needs a treatment and this treatment threatens the mother's life, there must not be any obligation upon her to tolerate this treatment. All fetal treatment necessitates accessing the fetus through the pregnant woman's body, and nonsurgical treatments have long been a part of pregnancy care. Ethics as a subdiscipline of ultrasound examination and intervention has significant clinical implications.