Questionable ultrasound
Gynaecological Ca125 practice is complete with ultrasound tests. Ultrasound provides most of the information that a gynaecologist needs. Without ultrasound, you can understand discharge and cervical HPV pathology tests and assess prolapse of the vaginal walls. But even to fully understand a Bartholin gland cyst located at the entrance to the vagina, ultrasound is necessary.
Ultrasound, unlike other diagnostic methods, is an extremely subjective method. During ultrasound, the doctor takes an image with a hand movement, and the quality of the resulting image depends on how he moves the sensor. In X-ray, CT, MRI, and ECG studies, the device itself generates the image, allowing the doctor to focus solely on interpreting the results. However, during an ultrasound, the doctor captures the image and interprets the findings simultaneously. While the decoding of MRI or CT often falls short, at least these images can be shared with another specialist for further evaluation.
Challenges in Ultrasound Reporting
Often, ultrasound protocols lack any attached photos. When they do include a photo, it often shows something completely incomprehensible, like a freeze frame that only someone who watched the entire video live can understand. After more than 20 years in ultrasound, I compare the movement of the ultrasound sensor to the movement of a bow across the strings of a violin. While anyone can move the sensor, only trained professionals can extract music from that movement. And only a few can create music that touches the depths of the soul. I must admit that the quality of ultrasound performed in our country is poor; I would even say it is very poor.
Ultrasound diagnosticians often perform gynaecological ultrasounds, while gynaecologists with additional training conduct them less frequently. However, people often label ultrasounds performed by ultrasound doctors as “expert,” whereas they categorise HPV studies done during test appointments by gynaecologists as “amateur.” It is not uncommon for gynaecologists themselves to position it this way. Let’s figure out why ultrasound is such a controversial method of examination.
How Ultrasound Images Are Created
A camera does not produce the image on the screen; it is not filming. Shades of grey, white and black reflect different densities of tissue from which the sound wave is reflected. The receiver in the sensor collects this information and creates an image from it. Simply put, the sensor produces sound. The different tissues inside reflect sound in various ways, creating an image.
The quality of the resulting image is primarily the result of the doctor’s hand movement and not the device itself, although it is also important.
The doctor’s interpretation of what he sees depends on his innate ability to distinguish shades of grey, knowledge of anatomy and normal HPV type variants, knowledge of gynaecology, “sightedness” (simply the number of test studies performed) and, most importantly, “calibration of the eye” by viewing the real appearance of the pathologies that he describes.
Let me explain the last point. Most often, an ultrasound CA125 diagnostics doctor, after graduating from university, “sees” patients and their pathology only on the screen of his device. Training is conducted using the same ultrasound images and criteria for their evaluation. And only a few doctors working in a hospital have time to go to the operating room and look live at what they saw on the screen, and also take an interest in the further fate of patients. Calibrating the eye is extremely important for drawing “useful” conclusions about further HPV Variant treatment instead of simply providing an excessive “report” on what one saw and did not see.
Common Issues with Ultrasound Reports
Yes, this is exactly what most ultrasound reports look like. Almost every day, I look through dozens of ultrasound forms written by doctors from all over Russia. These forms are written not to help someone understand what the doctor saw, but rather to obscure the meaning behind this set of numbers and words. They measure everything they can, calculate volumes and areas, evaluate blood flow indicators, give a detailed report of what they did NOT find and describe the details of the normal structure. The more is written, the “cooler” the study is done. In other forms, the main type of encryption is the doctor’s handwriting multiplied by a complexly conceived form of an original design. It’s amazing, the same specialty, the same study, but a uniform ultrasound reporting form still needs to be.
Do you know what an ultrasound report looks like outside our beloved country? It is often just a few lines describing the doctor’s impression. For example, I might say, “The uterus appears normal in size without any pathology, and the ovaries remain unchanged; overall, everything looks good,” or “The uterus has enlarged, showing a 5 cm fibroid node on the back wall.” The ovaries are normal, but there is a cyst on the right that closely resembles an endometrioid cyst.” That’s all there is to it. You look at such a form – everything is immediately clear.
The Issue with Current Reporting Practices
I will answer your question about why we format forms like this.
Some departments developed this idea, and the doctor used this development. It is clear that Russian “scientific” science does nothing for practice and convenience since it is based on “scientism.”
They write this way to immediately inform the prosecutor that they examined everything, measured all aspects, noted what remained unchanged, and described any CA125 changes—resulting in a “finished test report.” Such a protocol aims to report to the supervisory authority, not convenience in practical work.
They are unsure of what they see and try to hide a specific description of the picture behind many different descriptions: “Signs of this or that, this cannot be ruled out”, etc. And at the end of any conclusion: “This is not a diagnosis; consult a gynaecologist”. Ok, an ultrasound report is not a CA125 diagnosis. But why did you say so many unpleasant things during the examination. Make so many predictions. And then hand out a piece of paper saying, “I have nothing to do with it. I wrote what I saw, it’s not a diagnosis or test, so go see an HPV gynaecologist.” This is one of my most serious complaints about ultrasound doctors. If you don’t make diagnoses, do the ultrasound silently!
The Role of Gynaecologists in Ultrasound
I believe the gynaecologist should perform an ultrasound in gynaecology, which should be part of his speciality. A patient comes, collects anamnesis, looks at her on the chair, and performs an ultrasound. This is the only way to ensure a full examination and the ability to solve all gynaecological problems.
Ultrasound training must be accompanied by visits to surgeries, where you can see what you see on the screen live. During ultrasound training, instructors need to “train” the student’s hand (a practice not implemented anywhere) to help them display the correct image on the screen, which is a great art. Ultrasound photos of all detected changes must accompany all ultrasound examinations. I consider an ultrasound form without an ultrasound photo an incomplete study.
Also, I have been performing an ultrasound on all my patients for more than 20 years. I know anatomy and pathological anatomy very well. During my studies at the University, I worked as an orderly in the pathological anatomy department and assisted in autopsy work (dissection). I attend all my patients’ surgeries, see what I “saw” there, and thus “calibrate my eye”. Before the ultrasound, I look at the patient in the chair. At first, I feel the problem with my fingers, and then I “know” where to look for it during the ultrasound. This is of great importance for diagnosing HPV related endometriosis.
Issues with External Ultrasound Reports
I need help understanding the ultrasound test results they send me, trying to see behind the description what the HPV doctor meant. Ultrasound photos can help me, but they are often of such poor quality that even this does not help. Often, I see something completely different in the photo than what the doctor described on the form. For example, the photo shows a corpus luteum, but it is not described or is called a follicle. The endometrium looks normal, but on the form, it is “insufficient thickness”. They describe a polyp, but in the photo, there is just a fold of the endometrium. Therefore, during remote CA125 consultations, I ask to shoot a video clip on the phone from the screen during the examination to assess the picture live.
My ultrasound form is simple and clear. There is nothing extra in it. But there are drawings in which I schematically display the nodes of the fibroids in the uterus or the location of endometrioid cysts in the ovaries. These topographic schemes assist surgeons during the operation and also enable me to show the patient what happened to her during the consultation. They help me explain how she can be treated. And why certain HPV treatment methods may not be suitable or why her pregnancy might proceed with test difficulties.
Conclusion: The Need for Improved Practices
This is clear and simple CA125 medicine. This is how it turns out in my performance because I understand what I am dealing with. And do not try to hide my confusion from uncertainty behind many scientific words and conclusions. Ask to do an ultrasound for you silently, do not read your ultrasound form. Wait for a CA125 appointment with a doctor, or better yet, find a test gynaecologist who is confident in ultrasound.
Have ultrasound and diagnostic CA125 doctors intimidated you during the examination? Have they given you any “advice” that later became complete nonsense?