Vaginal ultrasound is an extremely useful tool when
evaluating an infertile woman, but it often bothers me because there are some
sonographers who over interpret the scan images. Now, I like the fact that they are careful
and systematic, and document everything they see by taking lots of images. However,
I hate the fact that draw clinical
conclusions based on the black and white images they see on the screen - and
they shouldn't be doing this.
Their reports will say things like, " There are
adhesions between the ovary and the uterus"; " There is a 3 cm endometriotic
cyst";the fallopian tubes are
None of this is true. Endometriosis is a clinical
diagnosis , which can only be confirmed by a clinician when he actually puts a
telescope inside the abdomen. Yes, we
can suspect the diagnosis, but it's not one which a sonographer should be
making ! Thus, you can assume there are
likely to be adhesions, but you can't be sure about this, until you can
actually see them !And finally, no one
in the world can actually see fallopian tubes on an ultrasound scan. To claim
they are thickened is ridiculous !
They take lot of measurements - all of which are
completely bogus because they are all pseudo accurate. So, they will say things
like, " The cyst is 2.56 centimeters." How can an ultrasound machine
possibly measure to the accuracy of 0.01 centimeters ?
Interestingly, these sonographers are very popular with
most doctors, who are happy to refer all their patients only to them. They are
happy to take advantage of these "abnormalities" which the sonographer
has so kindly diagnosed. They then tell the patient they need to evaluate these
findings, and subject the poor patient to even more tests and treatments - most
of which are completely uncalled for, and just a waste of time and money.
I understand the importance of detail, but this kind of
misleading detail actually just ends up backfiring, and creates a lot of
unhappiness both for the good clinician as well as the patient. It causes the
poor patient a lot of unnecessary anxiety , because she then spends hours on google
trying to decipher the report! After this research, she is convinced she has
all the possible medical problems in the world, and will never be able to get
This diagnostic over-labelling causes these sonographers to
lose credibility with good clinicians. They are unhappy with this kind of
reporting, because they have to spend their time reassuring the patient that
ultrasound scans have lots of limitations, and over-interpreting the images often
causes other doctors to jump to the wrong conclusion !