Basic EV Tips: Keeping your Bearings in the Pelvis

Once you are all set up to begin the EV scan it’s important to understand the limitations of the pelvis, how to keep your orientation and what plan of attack you will follow to ensure you are thoroughly assessing and imaging all the necessary structures.

1. begin with a clear image

Always begin with a nice clear sagittal midline view of the cervix, uterus and endometrium. Sometimes a little angling up, down or to the side is necessary to bring the face of the transducer into the fornix around the external os where the image will be clearest.

For example, you will need to be angled up slightly into the anterior fornix to see a uterus that is anteverted (your wrist will move down to the bed) and angled down slightly into the posterior fornix to a uterus that is retroverted (your wrist will move up away from the bed).

2. sagittal sweeps

Start assessing in sagittal at the cervix, sweeping through to both the left and right, then angle to the uterus and repeat the sweep.

Keep in mind that not all uteruses are exactly center in the midline, so a little angling to the side may be necessary to image the full length. 

3. Assessing the endo

Always take a moment and put the color Doppler on the endometrium to check for the possibility of polyps.

An EV scan is the best way to visualize these and they can often cause spotting and abnormal bleeding so I take the opportunity to check for a possible echogenic mass and color stalk in the endo which could confirm this.

4. transverse sweeps

From here remain in the midline of the pelvis and rotate the transducer to a transverse orientation.

Make note of how your hand is holding the transducer so you know that you have turned the right way. Sweep anteriorly and posteriorly through the uterus and cervix and image as needed.

5. be firm in the adnexa

Next shift gently to the side and assess the adnexa and ovaries.

You can press further and firmer into the adnexa than you can on the midline because the uterus is a firm muscle without much give, while the adnexa are soft and the contents for mobile.

So remember to pull out a bit and apply less pressure to the midline when you move from left to right across the pelvis.

Handy Tip:

Due to the shape of the EV transducer head, when you turn to assess the left adnexa and left ovary you can turn your wrist to the left (instead of making a normal turn which would be to the right) and push the Reverse Image button on the keyboard (usually a capitalized R inside a box) to flip the image.

Now you have a normalized view of the left adnexa that uses the angle of the head of the transducer to your advantage in seeing a bit further over more easily.

Remember when you are done assessing to turn off the reverse image to return to normal scanning.

Happy Scanning!

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