EDUOG Essential Diploma of Ultrasound in Obstetrics and Gynecology

acquired information to meaningfully contribute to clinical patient management. The holder would usually have diagnostic ultrasound as a major focus of their practice and accept referrals from a range of other medical practitioners as well as self-referrals. Candidates for the EDUOG Obstetrics and Gynecology (O&G) would usually be working in areas of women’s health and imaging where ultrasound imaging and techniques are used for screening and diagnosis in gynecological and prenatal applications. I

In particular, it is important to be able to recognize major image artifacts and know how to minimize them. Aim For the candidate to demonstrate a sound knowledge and understanding of the fundamental physical principles and the instrumentation used in diagnostic ultrasound and how they relate to the quality and accuracy of information obtained in the examination. Learning Objectives:

Physics and Instrumentation (25% Weighting)

• the wave nature of ultrasound and its propagation through tissue;

• the reflection and scattering of ultrasound and how these relate to acoustic impedance;

• the concept of attenuation, its mechanisms and factors affecting it;

• refraction of ultrasound and critical angle of incidence;

• the concept of pulsed ultrasound.

• Transducer and Beam forming Concepts , candidates will be able to describe the:

• purpose and function of a transducer and the construction of a typical probe;

• concept of an ultrasound beam and the importance of controlling beam width;

• methods used to focus the beam, including electronic focusing with array transducers;

• major probe types and the mechanisms used by each to scan the beam;

• concept of slice thickness. Candidates will be able to:

• define beam side lobes;

• explain the factors affecting the choice of transducer for a specific application.

• pulse-echo principle and how it is used in B-mode and M-mode ultrasound;

• basic processing components of an ultrasound imaging machine and their purpose;

• controls associated with each component and their effect on the image;

• methods used to make measurements from images;

• methods available to record images. Candidates will be able to:

• define the major aspects of image quality;

• recognize the principal image artifacts and describe how they occur and how they can be identified and reduced or eliminated. Candidates will be a able to describe the main factors affecting the accuracy of measurements. Doppler Principles and Instrumentation.

• principle of operation and components of continuous wave and pulsed Doppler instrumentation;

• elements of the Doppler spectral display and how it is used to make measurements;

• factors affecting accuracy of measurements, importance of keeping Doppler angle below 60°;

• principle of operation and components of color Doppler;

• color Doppler instrumentation, including power (amplitude) mode. Candidates will be able to:

• explain the Doppler effect and describe how it is used in ultrasound diagnosis;

• recognize the principal Doppler artifacts and describe how they are produced and how they can be identified and/or eliminated. Bioeffects and Safety Candidates will be able to:

• demonstrate an understanding of the potential for bioeffects and biohazards;

• define the parameters used to characterize patient exposure. Candidates will be able to explain:

• the known thermal and mechanical bioeffects and the relative likelihood of these occurring with different modes of examination;

• practical approaches to reducing risk and the relevant policies. Candidates should ensure that they understand the underlying concepts that these equations express. Physical Principles of Ultrasound Describe:

• frequency, wavelength

• propagation speed

• amplitude, energy, power, intensity

• attenuation, relationship between frequency and pe*******on

• acoustic impedance

• reflection, scattering

• refraction, critical angle

• pulsed ultrasound, pulse repetition frequency, pulse duration Relevant equations:

• Relationship between propagation speed (c), frequency (f) and wavelength (λ):

• Definition of intensity:

• Attenuation as a function of tissue attenuation coefficient ( ), distance travelled by the ultrasound (d) and frequency (f):

• Reflection coefficient:

• transducer construction, backing and matching, coupling gel

• focused transducer beam pattern

• electronic focusing using array transducers

• electronic beam steering

• side lobes, slice thickness

• variation of intensity with depth and across width of beam

• major probe types - linear, curved and phased arrays

• scan patterns of major probe types

• matrix array transducers

• factors affecting choice of transducer for given application Relevant equations:

• Near zone length (transition distance) as function of aperture (A) and wavelength (λ):

• Diffraction limit divergence angle (θ) as function of aperture (A) and wavelength (λ):

• Beam width (w) at focus as function of aperture (A) and wavelength (λ) and depth of focus (F): Imaging Principles and Technology Describe:

• pulse echo concept (relationship between echo arrival time and depth)

• image formation, B and M-mode

• meaning of term ‘artifact’ and reasons why artifacts occur

• mechanism of production and typical appearance of: – shadowing – enhancement – edge shadowing – reverberation – comet-tail – ring down – propagation speed artifact – beam width artifact – side lobe artifact – slice thickness artifact – refraction – mirror image – artifacts due to equipment failure and electrical interference

• use of some artifacts as diagnostic signs

• distance and area measurement • limitations on accuracy of measurements • image storage and recording techniques Relevant equations:

• Relationship between echo arrival time (t) and depth (d):

• Relationship between depth of pe*******on (P),

• axial resolution

• lateral resolution

• contrast resolution, improvement through reduction of artifacts

• temporal resolution, factors affecting it and methods to improve Relevant equations:

• Relationship between axial resolution and pulse duration (τ)

• The Doppler effect

• the Doppler angle and its implications

• principles and controls of: – continuous wave Doppler – pulsed Doppler – Doppler spectral display – color Doppler, including power mode color Doppler

• limitations of each Doppler modality

• Doppler artifacts, including: – frequency aliasing and ways to reduce or eliminate it – range ambiguity – intrinsic spectral broadening – spectral mirror artifact – wall thump – twinkle artifact – color Doppler dropout

• standard Doppler measurements: – velocity – spectral broadening, relationship to turbulent flow – Resistance Index and other commonly used indices axial resolution

• Doppler shift (fD) as function of ultrasound frequency (f), blood velocity (v), Doppler angle (θ) and ultrasound propagation speed (c): Bioeffects and Safety Describe:

• importance of bioeffects and safety

• current knowledge based on epidemiology and clinical experience

• difference between bioeffects and biohazards

• known mechanisms and factors affecting them: – thermal effects – cavitations – other mechanical effects

• parameters used to characterize exposure: – pressure, power and intensity – spatial and temporal variation of intensity

• comparison of exposure levels associated with different operating modes: 2D imaging, M-mode, cw and pulsed Doppler etc

• Thermal and Mechanical Indexes - purpose and interpretation

• practical approaches to minimizing risk

• ALARA principle

• Ability to conduct the ultrasound examination in an appropriately effective manner taking into consideration the environment, and the patient’s privacy.

• Understanding of, and skills involved in, producing and recognizing an accurate and valid ultrasound examination and resultant data, including normal ranges of standard measurements and measurement protocols.

• Detailed knowledge of relevant anatomy, physiology and pathology.

• Ability to determine the need for further information such as: extension of the ultrasound examination; other tests; further clinical information; follow-up examinations.

• Competence in the recognition of sonographic appearances and relevant information including: normal anatomy; normal variants; artifacts; abnormalities.

• Competence in determining appropriate provisional diagnosis/diagnoses as a result of the ultrasound examination and in conjunction with other available clinical information as relevant.

• Appreciation of the more rarely seen/uncommon anthologies which may be associated with an organ or system.

• Ability to perform and/or be able to interpret advanced ultrasound techniques such as 3D ultrasound as and when required to aid in the diagnosis.

• Recognition of any limitations of the ultrasound examination, including technical limitations, and the effect of these on diagnosis and clinical management.

• Ability to prepare a detailed report including information on findings/diagnoses, any limitations of the examination, correlation of findings with other relevant information, requirements/suggestions for further testing or follow-up examinations.

• Ability to be able to communicate effectively with the patient/client and/or their accompanying persons in a manner that is timely, relevant and appropriate to the circumstances, where required.

• Ability to identify and act appropriately to ensure timely medical review/intervention where an urgent finding is made. Major Topics Introduction

The EDUOG candidate is expected to have a deep level of knowledge across a broad range of clinical applications of diagnostic ultrasound irrespective of whether or not all topic areas would usually be expected to be covered by the candidate during the course of their professional practice. Candidates are expected to read widely and seek a range of learning opportunities including those focused on theoretical and clinical learning, and practical skills development in order to be able to demonstrate competence across the syllabus. A candidate is expected to be able to competently perform and interpret a gynecological and/or early pregnancy ultrasound examination, including at least the following abilities:


1. Use of any combination of trans-abdominal, trans-vaginal, including Doppler, as required by the presenting circumstances.

2. All required measurements and calculations demonstrating a detailed knowledge of the principles, applications and limitations of all commonly used measurements/calculations and diagnostic criteria (as described by published standards and protocols).

3. Hemodynamic spectral analysis demonstrating a detailed knowledge of the principles, applications and limitations of all commonly used calculations/indices and diagnostic criteria (as described by published standards and protocols) as required. The candidate is expected to be able to demonstrate a detailed knowledge and understanding of the role of ultrasound in assessment of, at least, the following:

1. Normal female pelvic anatomy, including variations that may be expected at different stages of the life-cycle or menstrual cycle

. 2. Benign conditions of the female pelvic and reproductive organs and structures, including inflammatory conditions.

3. Malignant entities involving the female pelvic and reproductive organs and structures.

4. Potentially surgically urgent processes such as ruptured ovarian cyst, ovarian torsion etc.

5. Presentations of pre and postmenopausal bleeding.

6. Presentations of urinary incontinence.

7. Early pregnancy particularly in order to determine if a viable pregnancy is present, including correlation where required with other clinical information such as B-hCG and clinical history.

8. Suspected early pregnancy which is potentially a non-viable intra-uterine pregnancy, ectopic pregnancy or a presentation of trophoblastic disorder, including correlation where required with other clinical information such as B-HCG and clinical history. Causes of female infertility. Obstetric Ultrasound: A candidate is expected to be able to competently perform and interpret an obstetric ultrasound examination, including at least the following:


1. Use of any combination of trans-abdominal, trans-vaginal , as required by the presenting circumstances.

2. Biometric techniques used to establish pregnancy dating, estimation of fetal weight and assessing the interval growth of a fetus and all required other measurements and calculations demonstrating a detailed knowledge of the principles, applications and limitations of all commonly used measurements/calculations and diagnostic criteria (as described by published standards and protocols).

3. Use of Doppler techniques where required. The candidate is expected to be able to demonstrate a detailed knowledge and understanding of the role of ultrasound in assessment of, at least, the following:

1. Anatomy and relevant normal ultrasound appearances of maternal structures in pregnancy.

2. Anatomy and relevant normal ultrasound appearances of embryonic and fetal structures throughout the gestation period, including the fetal environment, placenta and umbilical cord.

3. Early pregnancy and the first trimester including: pregnancy dating; suspected miscarriage; ectopic pregnancy and gestational trophoblast disease

. 4. First trimester ultrasound screening for chromosomal abnormality and major fetal structural abnormality.

5. First trimester interventional procedures for diagnostic testing of chromosomal abnormalities.

6. Second trimester ultrasound screening and diagnostic testing for chromosomal abnormality including at least trisomies 21, 13, 18, Turner Syndrome and triploidy.

7. Second trimester ultrasound assessment of fetal structures, organs and organ systems for diagnosis of fetal abnormality.

8. Fetal environment, placenta and umbilical cord throughout gestation in order to identify abnormalities of: amniotic fluid volume; placental structure, function or location; cord structure, including vasculature, and location; uterus and cervix.



9. Third trimester ultrasound assessment of: fetal structures, organs and organ systems for diagnosis and/or follow-up of abnormalities; fetal interval growth; fetal wellbeing including detailed assessments of fetal environment, biophysical profile parameters and Doppler parameters (umbilical artery, middle cerebral artery, ductus venosus etc).

10. Additional requirements for the assessment of multiple pregnancies including: establishing amnionicity and chorionicity; establishing if any comparative growth and well-being discrepancies are present.

11. Identification of abnormalities of maternal structures in pregnancy or the postnatal period such as: leiomyoma; uterine abnormality; ovarian masses; cervical abnormality; retained products of conception; endometritis.

12. Evaluation of maternal upper abdominal pain during pregnancy such as that involving: maternal kidneys, gallbladder and liver.

13. 3D and 4D in Obstetrics and Gynecology are included.

14. Basic and advanced fetal eco are included.

15. New advances of fetal medicine are included. Module 3 :

25 hours online clinical supervision


General Information :
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Location:
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Online : On Zoom

Language:
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English


President of EDUOG diploma since Jan.1st. 2020
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Dr. Moneer Mabrook
Consultant sonologist.

-Consultant Certified Professional Trainer (CPT) ,(TOT).

-Member of academic board of professional diploma in ultrasound at ESUOG.

- Member of Egyptian Maternal and Fetal Medicine Foundation ,
https://www.facebook.com/profile.php?id=61555881607499

* C.M.E. director and coordinator at the National Center for Human Resources Development, Amman-Jordan
(from 1997 to Dec. 2019).

* Studied at:
Thomas Jefferson University 1988-1989 / Philadelphia (PA)-USA


Dr. Olga Patey MD, PhD
Co-President of EDUOG
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(PhD) Fetal and Neonatal Cardiology,

St George's University of London, London, UK. Specialty Doctor at Royal Brompton and Harefield Hospitals, London, UK
Clinical Research Fellow in Fetal Ca
radiology, University of Oxford, UK


All scientific materials are given by:
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1 American Institute for Ultrasound in Medicine (AIUM)
http://www.aium.org/

2 Thomas Jefferson University

3 isuog : International Society of Ultrasound in Obstetrics and Genecology
http://www.jefferson.edu/jmc/radiology/divisions/ultrasound/. EDUOG diploma director and coordinator:
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Dr. Moneer Mabrook ( Muneer Mabrouk )

[email protected]

Mobile No. : 00962789129819