Many authors found it easier to use organ-oriented scanning rather

than trying to locate traditional anatomic planes. This approach entails

scanning the target organ from axial, longitudinal, as well as other
planes.
The most common transducer/patient manipulations are the following:
1. Anteroposterior angulation (belly-to-back)
2. Lateral (side-to-side) angulation
3. Depth of penetration (push-pull)
4. Rotation
5. Bimanual maneuvers
ANTEROPOSTERIOR ANGULATION
In the longitudinal plane,
anteroposterior angulation allows
the operator to optimize imaging
of the uterus.
LATERAL ANGULATION
Side-to-side manipulation of the
transducer improves visualization
of a uterus deviated to the right or
left of midline, the cornua of the
uterus, and the ipsilateral ovary,
fallopian tube, pelvic vasculature,
ligaments, bowel, and other
organs or structures
DEPTH OF PENETRATION VS. RESOLUTION
Changes in depth of penetration
created by a gradual advancement
or withdrawal of the vaginal
transducer allows the
sonographer to image an organ or
structure by placing it within the
central portion of the transducers
eld of view.
ROTATION
A 90-degree counterclockwise
rotation of the transducer allows
for imaging in the semicoronal
or oblique transverse planes.
BIMANUAL MANUVER
Another aid in optimizing endovaginal imaging is the bimanual
maneuver. The sonographer places his or her free hand on the
patients pelvic area and gently applies pressure over the site of
interest.
This maneuver displaces bowel and moves organs or structures
located higher in the pelvis into the EVS transducers eld of view.
The bimanual maneuver can also help the examiner discriminate
between a uterine and nonuterine mass.
A uterine mass moves with the rest of the uterus, whereas a non-
uterine mass slides past the uterine wall. This is also bene cial in
ovarian masses
The American Collage of Radiology and The American Institute of
Ultrasound in Medicine (AIUM) provides a pelvic sonogram guideline
for sonographers.
1) Image the cervix in the sagittal and coronal planes. Use the vaginal
canal as a landmark for the cervix
2) Advance the transducer to the fornix of the vagina to examine the
uterus in both the long and short axis planes. Be sure to evaluate and
scan through the entire organ. Measure on three orthogonal planes
3) Image and measure the endometrium on the midline sagittal plane
4) Proceed to evaluate both adnexa by sweeping through each side in
the longitudinal and transverse planes
 5) Use spectral, color, and/or power Doppler to identify vascular
structures within the pelvis
6) Capture images of the ovaries demonstrating both long and short
axis of each organ, documenting any abnormalities detected in both
planes as well. Measure each ovary on three planes
7) Finally, examine and image the pelvic cul-de-sac for the presence of
uid. Normal anatomic structures such as the ovaries and fallopian
tubes, and/or pathology, may be present in this area as well.
FOLLICULAR AND LUTEAL BLOOD FLOW
With endovaginal sonography and
color ow imaging, it is possible to
study subtle vascular changes during
the ovarian cycle in physiological
and pathophysiological conditions.
The ovary receives arterial blood
ow from two sources: the ovarian
artery and the utero-ovarian branch
of the uterine artery. These arteries
anastomose and form an arch
parallel to the ovarian hilum.
Characteristic ow signals from the
ovarian a rtery demonstrate low
Doppler shifts and blood velocity.
UTERINE BLOOD FLOW
The majority of the blood supply
to the uterus is from the uterine
arteries with minimal contribution
from the ovarian arteries. The
uterine arteries give rise to the
arcuate arteries, which orient
circumferentially in the outer third
of the myometrium.