Transvaginal sonographic technique: targeted organ scanning without resorting to "planes".

The orientation of the sonographer performing a transvaginal scan is currently based on a concept of anatomical planes, which is customary in transabdominal sonography. We challenge this concept and propose a different approach altogether based on focusing on target organs rather than anatomic planes. The problem of orientation in transvaginal sonography stems from the following: (1) There is a very short distance between the relatively high-frequency transvaginal transducer-probe and the scanned area; a close-up image is generated encompassing a single organ or only part of it. (2) The scanning angle is initially perpendicular to that of abdominal sonography. (3) Transvaginal sonography is an endocavitary dynamic scanning technique. According to the experience in our department (30,000 examinations during the past 4 years) and in two other medical centers, best results from the transvaginal ultrasonographic examination are achieved when the operator searches for every specific organ as the main target, without resorting to pelvic "planes." The guidelines for targeted organ scanning and the associated change in orientation are reported together with the limitations. Targeted organ scanning without resorting to "planes" helps the operator to resolve the problem of orientation during the transvaginal ultrasonographic examination, and to simplify the procedure to a great extent.