A group of well-known obstetricians and gynecologists in the field are recommending the use of ultrasound first, instead of CT and MRI, when imaging the female pelvis. They have published numerous papers in the American Journal of Obstetrics & Gynecology and are in support of the American Institute of Ultrasound in Medicine’s initiative to “put ultrasound first.”

Among that group is Dr. Beryl R. Benacerraf, AIUM president and clinical professor at Harvard Medical School and Brigham and Women’s Hospital, who recently published a clinical opinion article on this topic. For several years now she has been pushing for “ultrasound first” but has not seen much change.

“I think it’s hard to change people’s habits — it takes a long time and it takes chiseling at it little by little, which is what we are doing,” she told DOTmed News.

She believes that CT and MRI are often preferred over ultrasound because they’re automated. “It’s obviously easier to do something automated than to have somebody actually do the scan one-on-one,” she said.

But she explained that’s no excuse because ultrasound is much more cost-effective compared to CT and MRI and doesn’t emit radiation. A study found that 29,000 future cancers may be connected to CT exams done in the U.S. in 2007, and 14,000 of those cancers are attributed to CTs of the pelvis and abdomen.

In addition, many of the advancements made to ultrasound technology in recent years bring it up to par with the other modalities. Those advances include 3-D volume imaging, real-time evaluation of pelvic organs during a physical exam and Doppler blood flow mapping without contrast.

With 3-D volume ultrasound, the acquisition of an entire volume is automated and obtains hundreds of images that can be used to reconstruct any view in any orientation. It’s much less expensive and takes less time compared to MRI but the images are still of comparable quality.

The transvaginal ultrasound transducer allows the clinician to simultaneously image pelvic organs and conduct a physical exam. It has been proven that ultrasound can accurately assess deep infiltrating endometriosis and pain caused by major pelvic adhesions.

Doppler Interrogation gives the clinician information on the location and degree of blood flow in and around the pelvic lesions without requiring contrast injections. Color Doppler mapping can evaluate an adnexal mass and distinguish an endometrioma from an ovarian tumor or ovarian fibroma.

Even though Benacerraf hasn't seen much change, she's still making strides. Right now, she is using a database to determine how often women with pelvic pain have other forms of cross-sectional imaging before ultrasound.

She is also working toward educating practitioners in the field. “We try to get the word out and have as much educational material out there as possible,” she said.

But she knows that change won’t happen overnight. “I think they are willing to use it but it’s hard to break habits," she said.

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