Learning Gynaecological Ultrasound Scans
To learn gynaecological ultrasound, you should complete a structured training pathway that includes 16-24 hours of initial didactic and hands-on instruction, followed by performing and documenting 25-50 supervised scans with systematic quality review. 1
Training Structure
Initial Didactic Education
- Complete a 16-24 hour introductory course covering both transabdominal and transvaginal ultrasound techniques with mandatory hands-on practice sessions 1
- Shorter 4-8 hour CME courses can supplement training for specific applications, but hands-on training must be incorporated for core competencies 1
- Electronic learning (videos, online tutorials, DVDs) may be used for didactic content, but cannot replace hands-on skill sessions 1
Hands-On Skill Development
Simulation-Based Training:
- Ultrasound simulators significantly improve knowledge and comfort with gynaecological ultrasound, with students showing increased correct responses from 11/18 to 14/18 questions after one-hour simulation sessions 2
- Transvaginal ultrasound simulation curricula increase the likelihood of performing TVUS during clinical rotations (32.1% vs 17.1% in controls) and improve recognition of normal anatomy (OR 6.63) and pathology (OR 7.56) 3
- Simulation allows patient-friendly, resource-saving training before live patient encounters 4
Required Case Volume:
- Document and have reviewed 25-50 cases for each core gynaecological ultrasound application you plan to use clinically 1
- Each examination must be reviewed as part of a quality assurance program until you can safely integrate the skill into practice 1
Essential Technical Skills
Systematic Examination Technique
- Examine the uterus in at least two orthogonal planes (short and long axis), tracing completely from fundus to cervix 5
- Position the transducer on the lower abdomen just above the pubic symphysis for transabdominal approach 5
- Ensure adequate bladder distension with the bladder dome just above the uterine fundus to serve as an acoustic window 5
- Align the transducer with the long axis of the uterus, frequently angling to the right or left of midline 5
- Transvaginal approach is preferred when acceptable to the patient 5
Critical Pitfalls to Avoid
- Not examining in two complete planes can miss interstitial pregnancy or fibroids outside the endometrial canal 5
- Not tracing completely from fundus to cervix may result in mistaking a large ectopic pregnancy for the uterus 5
- A full bladder can artificially push a retroverted uterus into an anteverted position, leading to misdiagnosis 6
- Inadequate bladder distension limits visualization in the transabdominal approach 5
Documentation Requirements
For each examination, document: 5
- Date of last menstruation
- Transducer frequency used
- Approach/route (transabdominal vs transvaginal)
- Three dimensions and volume of each ovary
- Endometrial thickness and appearance (3-layer evaluation useful for screening)
- Any ovarian/uterine pathology, cysts, corpus luteum, and dominant follicles ≥10mm
- Note that ovarian volume ≥10ml is considered increased
Quality Assurance and Ongoing Competency
- Establish a quality assurance program where all examinations are reviewed until you demonstrate safe independent practice 1
- Maintain at least 10 hours of ultrasound-specific CME per 2-year credentialing cycle, including conference attendance, online activities, preceptorships, or teaching 1
- For new applications beyond your initial training, complete additional CME and supervised practice before independent use 1
Clinical Context
Gynaecological ultrasound is the preferred imaging modality for detecting and characterizing pelvic masses, evaluating abnormal bleeding, assessing acute pelvic pain, diagnosing ectopic pregnancy, and studying female infertility 7. The technique provides real-time, non-invasive scanning without ionizing radiation 8. Transvaginal ultrasound provides definitive assessment when clinical examination is inconclusive 6.