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Ultrasound has come a long way since the "black dots on a white screen," they point out. "Currently available 3D/4D volume ultrasound imaging can produce images of the female pelvis of comparable quality and orientation to those of MRI and CT, but without radiation and at relatively lower cost." It's rare a radiologist who would choose CT first for pelvic pain, said Theodore Dubinsky, MD, from the University of Washington School of Medicine in Seattle. "The only circumstance where they might do a CT first is for appendicitis, or maybe a kidney stone, but the vast majority of the time, ultrasound is first," he told Medscape Medical News. For those two exceptions, CT might have a slightly higher sensitivity, but it is still valid to do the ultrasound first and then CT if the diagnosis is still unclear. With ultrasound, "a lot of the joy of it is to be able to see things that CT people think we won't be able to see," said Dr Dubinsky. CTs are often done first in emergency settings, acknowledged Maitray Patel, MD, from the Mayo Clinic in Scottsdale, Arizona. However, that might be less about best practices and more about available resources, he explained. Most hospitals are set up so that CTs are easier to order than ultrasounds, he told Medscape Medical News. Some hospitals, including the Mayo in Arizona, don't have 24/7 availability for ultrasounds. Someone can be called in to do one, but that adds to the wait time, especially in the middle of the night. "CT scans are generally staffed 24/7," Dr Patel said. Doctors in the emergency department "want to do what's right for the patient, but they also want to do it as expeditiously as possible." He added that for women who are obese, it's very difficult to do an ultrasound of the appendix. Ultrasound is also very operator-dependent; if the person available to do the ultrasound lacks the experience you're looking for, a CT might be a better choice, he said. Mr Ohngemach, Dr Benacerraf, and Dr Patel have disclosed no relevant financial relationships. Dr Dubinsky owns shares in Global Cancer Technology. American Institute of Ultrasound in Medicine (AIUM) 2015 Annual Convention: Poster 2069244. |