P02.12: Advances in transvaginal 3D volumetric imaging: potential clinical impact of virtual ultrasound hysteroscopy

Abstract

Introduction: Advances in 3D-TVS have considerably enhanced the diagnostic effectiveness of sonohysterography (SIS) technique. The introduction of “Fly Thru” (Toshiba Medical Systems) has created the concept of “ultrasound hysteroscopy”. Advanced 3D volumetric image processing of the acquired data produces greater depth perception which, together with the animated reconstruction, gives the appearance of virtual endoscopic ultrasound imaging. Aims: To review the diagnostic benefits of advanced 3D-TVS SIS and, in particular, the role of “Fly Thru” technology. Ongoing clinical trials involve SIS procedures to be carried out on 500 patients attending a leading IVF unit or established recurrent miscarriage clinic. Methods and Materials: All patients were referred to Clinical Diagnostic Services, London for SIS assessment. The SIS procedure was carried out utilising Toshiba Aplio MX and Aplio 500 (“Fly Thru”) systems. Detailed 3D-TVS imaging of the uterine cavity were obtained utilising “Fly Thru” technology in the majority of cases. Resection of “minor” intracavital lesions (e.g. polyps, adhesions etc) was carried out when deemed appropriate. Cases presenting with anatomical malformations and intracavital pathology were otherwise referred for hysteroscopic surgery. Ongoing studies. Current work strongly indicates the potential value of advanced 3D-TVS SIS and “Fly Thru” imaging. They relate to (i) increased diagnostic capability and confidence in the examination of the uterine cavity and associated abnormalities (ii) reduced need for conventional diagnostic hysteroscopy (iii) utilisation of ultrasound guided interventional techniques in selected cases. Up to date results and impressions will be outlined to include correlation between SIS ultrasound techniques and endoscopic examination as well as the impact on IVF management.