Faculty Bibliography

The understanding of early pregnancy both normal and abnormal as seen by transvaginal ultrasound is an essential skill of any clinician involved in reproductive medicine and infertility. The 'sonomicroscopy' of the vaginal probe results from the high level of magnification and close proximity to the structure being studied. In addition, the ability to detect minute levels of human chorionic gonadotropin, often by over-the-counter home pregnancy tests, has caused patients to present to clinicians earlier then ever before. It is essential that the sonologist or sonographer understand what early pregnancy looks like on transvaginal ultrasound and why it looks like that, so that one can distinguish early pregnancies that are normal from those that are absolutely destined to fail. In addition, understanding the use of ultrasound and human chorionic gonadotropin in the modern diagnosis of ectopic pregnancy as well as a newly emerging category of pregnancies of unknown location is essential to clinical practice. This article will review the fundamental principals outlined above

Tremendous confusion exists concerning the issues of physician certification and practice accreditation in obstetric and gynecologic ultrasonography. Certification speaks to physician competence. All obstetrician-gynecologists who have finished residency training since 1982 are deemed 'competent' to perform obstetric and gynecologic ultrasonography by virtue of their training. Those trained before 1982 need to be able to describe their level of experience in performing obstetric and gynecologic ultrasonography. Accreditation deals with issues of patient safety and quality control, including equipment calibration, transducer cleaning and disinfection, universal precautions and Occupational Safety and Health Administration regulations, ultrasound examination protocols, and qualifications of nonphysician personnel performing ultrasound examinations. A new field of radiology benefit managers has arisen in response to attempts by health insurers to manage care, and reduce their costs and utilization. They have adopted ultrasound accreditation, originally intended to enhance patient safety, to help restrict utilization. Currently two organizations are recognized as accrediting bodies: The American Institute of Ultrasound in Medicine (AIUM), which recognizes obstetric and gynecologic residency training as evidence of competency, and The American College of Radiologists, which does not. Obstetrician-gynecologists should realize that AIUM's accreditation is their 'lifeboat' in this time of increasing interference by health care insurers into decision making in clinical practice