Transvaginal Ultrasound for the Diagnosis of Endometriosis: Current Practices and Barriers in Australian Sonographers

Introduction/Purpose

The 2016 consensus statement from the International Deep Endometriosis Analysis group (IDEA) outlined a transvaginal ultrasound (TVUS) approach specific for the sonographic assessment of endometriosis (eTVUS). However, eTVUS remains a nonroutine sonographic examination, and the reasons for this are not fully understood. This study aimed to explore the current performance of eTVUS among Australian sonographers and the barriers and facilitators encountered when learning and implementing eTVUS into routine practice.

Methods

An online cross-sectional survey was disseminated to Australian sonographers. Quantitative and qualitative questions were asked regarding demographic information, eTVUS performance and experiences encountered when learning and implementing eTVUS. Statistical and thematic analyses were performed.

Results

In total, 127 responses were analysed, with 47.8% of respondents performing a full or partial eTVUS routinely. When a gynaecological ultrasound is referred, 18.4% of participants reported performing a full assessment of eTVUS, and 29.8% reported performing a partial assessment of eTVUS. When a partial eTVUS was performed, respondents indicated this mostly included an assessment of the sliding sign (94.6%) and ovarian mobility (97.3%), rather than a search for endometriotic nodules. Only 41.5% of all participants reported confidence in performing eTVUS.

The main barriers that limited the uptake of eTVUS were limited supervision/mentors (42.3%), limited reporting of eTVUS (39.6%) and its steep learning curve (38.7%). The main facilitators included sonographers' desire to answer the clinical question for suspected endometriosis (84.0%), external education (38.7%), local department protocols (30.7%) and colleagues who perform eTVUS (30.7%).

Conclusion

While eTVUS, or aspects of it, are being performed in most imaging practices, inconsistency exists for the anatomical structures assessed as part of an eTVUS. Although barriers exist, more education surrounding eTVUS for sonographers, reporting doctors, and referrers could help increase uptake into routine practice.