Ask any woman who has had a baby and she likely will be familiar with abdominal ultrasound, which evaluates the growth and development of the fetus.
So how can you tell whether you are in the hands of a skilled person with good equipment or someone who just came out of a weekend course? The best thing to do is ask questions.
- How many procedures has the doctor performed?
- Who in the community is considered the expert?
Compare that answer with the number performed at your local teaching hospital. Do not be shy. Be inquisitive and well-informed. That is the best way to make sure you are getting the best treatment.
Women are becoming increasingly familiar with another kind of ultrasound. It is called transvaginal ultrasound. With this technique a small wand is placed in the vagina and sound waves are able to pick up diseases in the uterus and surrounding areas.
Because it is easy to perform and relatively inexpensive (anywhere from $75 to $200), many gynecologists are using it in the office as a way to assess possible uterine problems. But now there is concern that the procedure may be used too often and may be imprecise.
A recent study in The New England Journal of Medicine investigated the use of this procedure in post-menopausal women. The study included women taking estrogen alone, some taking estrogen-progesterone in combination, and some taking placebo. The researchers found that in women with no complaints and no evidence of uterine disease, the technique indicated the possibility of uterine disease too often, and that half of these women went on to have a uterine biopsy. However, only 4 percent of these women actually had serious disease like cancer that warranted a biopsy.
The obvious concern is that if the ultrasound hints at the presence of disease, an invasive uterine biopsy is then performed. Although a relatively safe procedure when done by a competent gynecologist, a biopsy can be complicated by bleeding or uterine perforation. Since so many of the women in this study had abnormal ultrasounds but no real disease, this is a warning to gynecologists and women that the technique may not be specific enough to warrant being used as a routine screening tool.
This is not to say that transvaginal ultrasound is useless. In fact, it is a handy tool in the hands of an experienced ultrasonographer. But it should also be used judiciously in those women who have no complaints, and it is more likely reliable in women who are present with abnormal uterine bleeding, where uterine fibroids or cancer may be suspected.
Ultrasound is easy to perform, but doctors’ techniques vary widely. Just manipulating the probe a few millimeters can make a huge difference in what is seen on the screen and how it is interpreted. Also, there is also no real certification for ultrasound and some machines are better than others.