1. John Crowley, RDMS-RVT Inland Imaging, LLC March 14 th 2013

2. Agenda Medicalis review 4 th Quarter 2012 Ectopic Pregnancy Scan assistant/DVD Review Accountability plan and the Future….Group Discussion

3. Medicalis QA Review 4 th Quarter 2012 This is actually just a joke and not necessarily the opinion of the ultrasound staff.

4. Excellent work for 4 th Quarter 2012

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.

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

7. Ectopic Locations

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)

10. Normal Early IUP

11. Pseudogestational Sac

12. Confirmed Right Tubal Pregnancy

13. Cine-loop Right Ectopic

14. Use gentle pressure. Does the mass move with the ovary or separately from the ovary ?

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

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…

17. Ring of fire…Corpus Luteum

18. Ring of fire……Right Ectopic

22. Scan Assistant / DVD/Report Page

23. Report pages for abdomen, pelvic, thyroid, and scrotal Remember to move report page to the second stack and then SAVE the presentation state….

26. Are you using a DVD or CD ? DVD has a purple hue…This is what you need to use. CD has a rainbow hue…Wrong.

27. DVD icon should read #0 and 0:00:00

28. How to start recording…..

29. Record Icon Pause Icon

32. Wilkonski Ring

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.….

34. Provide frustrations with potential solutions. Brainstorm…no right or wrong answers.

35. Happy St. Patrick’s Day! Happy St. Patrick’s Day!