usg intensif 1. isuog basic obgyn ultrasound training jje 20090126

BASIC OB/GYN BASIC OB/GYN ULTRASOUND TRAINING ULTRASOUND TRAINING

Judi Januadi Endjun

School of Medicine Veteran University – JakartaGatot Soebroto Army Central Hospital

2009

ISUOG Education Committee

MATERI AJAR INI HANYA MATERI AJAR INI HANYA UNTUK DIPERGUNAKAN UNTUK DIPERGUNAKAN

DALAM KEGIATAN DALAM KEGIATAN PENDIDIKAN DAN PENDIDIKAN DAN

KESEHATANKESEHATAN

13/07/200913/07/2009 Hanya untuk pendidikan dan KesehatanHanya untuk pendidikan dan Kesehatan

RSPAD GATOT SOEBROTODITKESAD

JJE-13/07/2009JJE-13/07/2009 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan

Motto :

• Jalani hidup ini dengan sabar, jujur dan ikhlas,

• Mau mengerti dan melaksanakan tatacara (adab) yang benar, dan

• Mempunyai kemauan untuk selalu berbuat baik memperbaiki diri dan

lingkungan, serta membuat orang lain lebih baikJJE-13/07/2009JJE-13/07/2009 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan

KEUTAMAAN ILMU

Barang siapa mengamalkan apa-apa yang ia ketahui, maka Allah SWT akan mewariskan kepadanya ilmu yang belum diketahuinya, dan Allah SWT akan menolong dia dalam amalannya sehingga ia mendapatkan surga. Dan barang siapa yang tidak mengamalkan ilmunya, maka ia

tersesat oleh ilmunya itu, dan Allah SWT tidak menolong dia dalam amalannya sehingga ia akan mendapatkan neraka (sabda Rasulullah Muhammad SAW)

Ilmu lebih utama dari harta, ilmu adalah pusaka para Nabi, sedangkan harta adalah pusaka Karun atau Fir’aun.

Ilmu lebih utama dari harta, karena ilmu akan menjagamu sementara harta malah engkau yang harus menjaganya.

Ilmu lebih utama dari harta karena di akherat nanti pemilik harta akan dihisab, sedangkan orang berilmu akan memperoleh syafaat.

Ilmu lebih utama dari harta karena pemilik harta bisa mengaku menjadi Tuhan akibat harta yang dimilikinya, sedangkan orang berilmu justru mengaku sebagai hamba Tuhan karena

ilmunya.Harta itu jika engkau berikan menjadi berkurang, sebaliknya ilmu jika engkau berikan malahan

semakin bertambah.

Pemilik harta disebut dengan nama kikir dan buruk, tetapi pemilik ilmu disebut dengan nama keagungan dan kemuliaan.

Pemilik harta itu musuhnya banyak, sedangkan pemilik ilmu temannya banyak.Harta akan hancur berantakan karena lama ditimbun zaman, tetapi ilmu tidak akan rusak dan

musnah walau ditimbun zaman.

Harta membuat hati seseorang menjadi keras, sedangkan ilmu malah membuat hati menjadi bercahaya.

(hamba Allah)JJE-13/07/2009JJE-13/07/2009 Hanya untuk Pendidikan dan KesehatanHanya untuk Pendidikan dan Kesehatan

INTRODUCTIONINTRODUCTION Basic knowledge : embryology, dysmorphology,

genetics, the physiology, and pathophysiology of pregnancy

Theoretical training

Practical training

Residents do not have to accomplish in practice everything that is being taught in theory


THEORETICAL TRAINING THEORETICAL TRAINING PROGRAMPROGRAM

Basic physical principles of medical ultrasound

ObstetricsGynecologyOrganization of ultrasound unitMedicolegal implications of ultrasound

examinationEthics and patient information13/07/200913/07/2009 Hanya untuk pendidikan dan KesehatanHanya untuk pendidikan dan Kesehatan

Basic physical principles of medical ultrasound

1. The relevant principles of acoustics, attenuation, absorbtion, reflection, and speed of sound

2. The effects on tissues of pulsed and continuous wave ultrasound beams : biological effects, thermal and non thermal

3. Basic operating principles of medical instruments :


Basic operating principles of medical instruments :

a) Pulse echo, scanning principles and 3-D;

b) Pulse echo instruments, including linear array, curvilinear, mechanical sector, transvaginal and rectal scanners;

c) Velocity imaging and recording :13/07/200913/07/2009 Hanya untuk pendidikan dan KesehatanHanya untuk pendidikan dan Kesehatan

Velocity imaging and recording :

Doppler principles : continuous wave, pulse wave, color flow mapping, and power Doppler

Color velocity imaging

Pitfalls and artefacts



d) Data acquisition

e) Signal processing (may be given in practical demonstration) :

Gray scale, time gain compensation, dynamic range, dynamic focus, digitization, gain compensation, acoustic output relationship (may be given in practical demonstration)



f) Artefacts, interpretation and avoidance : reverberation, side lobes, edge effects, registration, shadowing, and enhancement

g) Measuring systems : linear, circumference, area, and volume; Doppler ultrasound : flow, velocity, spectrum analysis



h)h) Image recording, storage, and Image recording, storage, and analysisanalysis

i)i) Interpretation of acoustic output Interpretation of acoustic output information and its clinical relevanceinformation and its clinical relevance


Obstetrics

1. Investigation of early pregnancy

2. Assessment of AF and placenta

3. Normal fetal anatomy at 18 – 20 weeks

4. To study the epidemiology, differential diagnosis, natural history of abnormalities, and management of structural, functional, and prognosis and treatment


ObstetricsObstetrics

5. Fetal biometry

6. Estimation of gestational age

7. Assessment of fetal growth

8. Biophysical scoring systems

9. Evaluation of fetal and uteroplacental blood flow

10. Knowledge of invasive diagnostic and therapeutic procedures


1. Investigation of Early 1. Investigation of Early PregnancyPregnancy

a) Ultrasound features of normal early pregnancy, including GS and YS, simple and multiple pregnancy, chorionicity

b) Development of fetal anatomy in early pregnancy including recognition of abnormalities such as NT, cystic hygroma, and fetal hydrops


1. Investigation of Early 1. Investigation of Early PregnancyPregnancy

c) Embryonic – fetal biometry, e.g. CRLd) Fetal viabilitye) Ultrasound features of early

pregnancy failure including hydatidiform mole

f) Ultrasound and biochemical investigation of ectopic pregnancy, tumors in early pregnancy

g) Normal appearance of the cervix13/07/200913/07/2009 Hanya untuk pendidikan dan KesehatanHanya untuk pendidikan dan Kesehatan

2. Assessment of AF and 2. Assessment of AF and PlacentaPlacenta

a)a) Estimation of AF volumeEstimation of AF volume

b)b) Examination of the placenta and cordExamination of the placenta and cord

c)c) Placental locationPlacental location

d)d) Number of cord vesselsNumber of cord vessels


3. Normal Fetal Anatomy at 3. Normal Fetal Anatomy at 18 – 20 Weeks18 – 20 Weeks

a) Shape of the skull : nuchal skin fold

b) Facial profile

c) Brain : cerebral ventricles, posterior fossa and cerebellum, cysterna magna, choroid plexus cysts

d) Spine : both longitudinally and transversely

e) Lungs


3. Normal Fetal Anatomy at 3. Normal Fetal Anatomy at 18 – 20 Weeks18 – 20 Weeks

f) Heart rate and rhythm, 4-CV, including atrioventricular valves, outflow tracts

g) Shape of the thorax and abdomen

h) Abdomen : stomach, liver, kidneys and urinary bladder, abdominal wall, and umbilicus

i) Limbs : femur, tibia and fibula, humerus, radius and ulna, hands and feet – these to include shape, echogenicity of the long bones and movements

j) Multiple pregnancy : chorionicity


4. 4. To study the epidemiology, differential diagnosis, natural history of abnormalities, and management of structural, functional, and prognosis and treatment

a) Structural : skeletal system, CNS, Cardiovascular, intrathoracic disorder, renal, abdominal wall and diaphragm, GIT, and markers for chromosomal abnormalities

b) Functional : polyhydramnios, oligohydramnios, hydrops, dysrhytmias

c) Prognosis and treatment (including intravascular therapy)


5. Fetal Biometry5. Fetal Biometry

a) Measurements to assess fetal size (including BPD, HC, AC and FL)

b) Measurements to aid the diagnosis of fetal anomalies : anterior/posterior horn of the lateral ventricle, TCD, and nuchal skinfold (NF)


6. Estimation of Gestational Age6. Estimation of Gestational Age

a) Interpretation and appreciation of limitation of ultrasonic and other investigations for gestational age assessment


7. Assessment of Fetal Growth7. Assessment of Fetal Growth

a) Ultrasonic assessment of fetal growth : interpretation and appreciation of limitations of standard measurement singly or serially

b) Fetal weight estimation


8. Biophysical Scoring Systems8. Biophysical Scoring Systems

Interpretation and appreciation of Interpretation and appreciation of limitations :limitations :

a) Fetal body movements

b) Fetal breathing

c) Heart rate and rhythm


9. Evaluation of Fetal and 9. Evaluation of Fetal and Uteroplacental Blood FlowUteroplacental Blood Flow

a) Methodology appropriate to obstetric investigation

b) Appreciation of problems in blood flow and velocity measurements and waveform analysis in normal and complicated pregnancies


9. Evaluation of Fetal and 9. Evaluation of Fetal and Uteroplacental Blood FlowUteroplacental Blood Flow

c) Clinical application and limitations in the prediction of IUGR and pre-eclampsia

d) Clinical application in monitoring the small for dates fetus and pregnancies complicated by Rhesus isoimmunization, diabetes and fetal cardiac arrhythymias


10. Knowledge of invasive diagnostic and 10. Knowledge of invasive diagnostic and therapeutic procedurestherapeutic procedures

a) Diagnostic : amniocentesis, CVS, cordocentesis

b) Therapeutic : shunting and draining procedures


WORKSHOP SERIES and HANDS ON

6th BASIC ULTRASOUND COURSE IN OBSTETRICS

Approved by ISUOG (International Society of Ultrasound in Obstetric and Gynecology)

Jakarta, November 16 – 17, 2007

TIME SCHEDULE, TOPICS, AND LECTURERS

DIVISION OF MATERNAL AND FETAL MEDICINE

Department of Obstetrics and Gynecology Gatot Soebroto Army Central Hospital / School of Medicine Veteran University

Jl. Abdurachman Saleh nomor 24 Jakarta 10410, INDONESIA Telephone : +6221 - 3441008 Ext. 2310

Telephone / Fax : +6221 - 34833234 Email : [email protected] dan [email protected]


Gynecology

1. Normal pelvic anatomy

2. Gynecological complications

3. Infertility

4. Invasive procedures

5. Doppler in gynecology


Normal Pelvic AnatomyNormal Pelvic Anatomy

a) Uterus :

* size, position, shape and measurement

* cyclical morphological changes in the

* measurement of endometrial thickness

endometrium

b) Ovaries


Normal Pelvic AnatomyNormal Pelvic Anatomy

b) Ovaries :

* size, position, shape & measurement

* cyclical morphological changes

* measurement of follicles and CL

* assessment of peritoneal fluid


2. Gynecological Complications2. Gynecological Complications

a) Uterus : fibroids, adenomyosis, endometrial hyperplasia, endometrial cancer, polyps, location of IUD

b) Tubes : hydrosalpinx and other abnormalities of the fallopian tube

c) Ovaries : cysts (benign and malignant, morphological scoring systems), endometriosis, ovarian carcinoma, differential diagnosis of pelvic masses


3. Infertility3. Infertility

a) Monitoring of follicular development in spontaneous and stimulated cycles

* diagnosis of hyperstimulations

syndrome

* diagnosis of polycystic ovaries

* sonosalpingography


4. Invasive Procedures4. Invasive Procedures

a) Oocyte retrieval

b) Injection of ovarian cysts

c) Aspiration of ovarian cysts

d) Drainage of pelvic abscesses

e) Extraction of IUD


5. Doppler in Gynecology5. Doppler in Gynecology

a) Infertility and oncology


WORKSHOP SERIES and HANDS ON

6th BASIC ULTRASOUND COURSE IN GYNECOLOGY

Jakarta, November 14, 2007

TIME SCHEDULE, TOPICS, AND LECTURERS

DIVISION OF MATERNAL AND FETAL MEDICINE

Department of Obstetrics and Gynecology Gatot Soebroto Army Central Hospital / School of Medicine Veteran University

Jl. Abdurachman Saleh nomor 24 Jakarta 10410, INDONESIA Telephone : +6221 - 3441008 Ext. 2310

Telephone / Fax : +6221 - 34833234 Email : [email protected] dan [email protected]


Organization of ultrasound unit

InfrastructureDocumentationQuality controlComputerizationAnd data storage


Medicolegal implications of ultrasound examination

http://www.mlegal.com/index.2.jpg13/07/200913/07/2009 Hanya untuk pendidikan dan KesehatanHanya untuk pendidikan dan Kesehatan

Ethics and patient information

http://www.siumed.edu/ethics/Images/medical%20ethics.jpg13/07/200913/07/2009 Hanya untuk pendidikan dan KesehatanHanya untuk pendidikan dan Kesehatan

PRACTICAL TRAININGPRACTICAL TRAINING

Required skills

Certifications


Required SkillsRequired Skills

1. Be able to identify early pregnancy and emergency gynecological problems by transvaginal and transabdominal ultrasound

2. Be able to recognized the following normal fetal anatomical features from 18 weeks onwards by abdominal ultrasound

3. Fetal biometry

4. Activity13/07/200913/07/2009 Hanya untuk pendidikan dan KesehatanHanya untuk pendidikan dan Kesehatan


1.a. Early pregnancy : fetal viability; description of the GS, embryo, YS; single and multiple gestation (chorionicity)

1.b. Pathology : early pregnancy failure; ectopic pregnancy; gross fetal abnormalities such as NT, hydropic abnormalities; hydatidiform mole; and associated pelvic tumors



1.c. Gynecology : normal pelvic anatomy; uterine size and endometrial thickness; measurements of ovaries; pelvic tumors, e.g. fibroids, cysts, hydrosalpinx; peritoneal fluid, and IUD


Required Skills : normal anatomyRequired Skills : normal anatomy

2.a. Shape of the skull; nuchal skinfold

2.b. Brain : ventricles and cerebellum, choroid plexus

2.c. Facial profile

2.d. Spine : both longitudinally and transversely

2.e. Heart rate and rhythm, size and position, 4-CV

2.f. Size and morphology of the lungs

2.g. Shape of the thorax and abdomen



2.h. Abdomen : diaphragm, stomach, liver and umbilical vein, kidneys, abdominal wall and umbilicus

2.i. Limbs : femur, tibia and fibula, humerus, radius and ulna, feet and hands – these to include shape, echogenicity and movement

2.j. Multiple pregnancy : monochorionic and dichorionic; twin-twin transfusion syndrome



2.k. Amount of amniotic fluid

2.l. Placenta location

2.m. Cord and number of vessels


Fetal BiometryFetal Biometry

CRL BPD FL HC AC Interpretation of growth charts


Activity : Activity : recognized and quantifyrecognized and quantify

a) Fetal movements

b) Breathing movements

c) Eye movements


CERTIFICATIONCERTIFICATION

1. 100 hours of supervised scanning to include :

a. 100 gynecological examination andearly pregnancy problems (TVS orTAS)

b. 200 obstetric scans covering the full spectrum of obstetrics conditions

1. Logbooks2. Examination


LOOGBOOKSLOOGBOOKS

30 cases on one A4 page with ultrasound picture – at least 15 anomalies should be included


BUKU LOG USG OBSTETRI GINEKOLOGI

PELATIHAN USG DASAR OBSTETRI GINEKOLOGI

Berdasar Kurikulum dari ISUOG

Periode Pelatihan : 14, 16, dan 17 November 2007

Nama Peserta Didik :

……………………………………………………………………

DIVISI KEDOKTERAN FETO MATERNAL

Departemen Obstetri dan Ginekologi RSPAD Gatot Soebroto / Fakultas Kedokteran UPN “Veteran” - J akarta

2007


EXAMINATIONEXAMINATION

MCQ orShort written examination paper ( 3 – 4

cases)Practical side : transvaginal scan and a fetal

anatomy scan, 30 minutes for both, would be recommended

The candidate would take ultrasound pictures and interpret the images


usg intensif 1. isuog basic obgyn ultrasound training jje 20090126

Documents