Reporting templates

ASC normal exam assessment

Sonologist(s):

Findings:

A 2D transperineal exam, with the patient in the dorsal lithotomy position, was performed using a ___ 
5–9 MHz or ___ 6–12 or ___ MHz EV transducer to assess the ASC and reveals a normal ASC, with measurements at three levels as follows:

Proximal level

The IAS measures ___ mm, ___ mm, ___ mm, and 
___ mm at 12, 3, 6, and 9 OC positions.

Midlevel

The IAS measures ___ mm, ___ mm, ___ mm, and 
___ mm at 12, 3, 6, and 9 OC positions.

Distal level

The IAS measures ___ mm, ___ mm, ___ mm, and 
___ mm at 12, 3, 6, and 9 OC positions.

The EAS measures ___ mm, ___ mm, ___ mm, and 
___ mm at 12, 3, 6, and 9 OC positions.

___ Color Power Doppler elicits normal ASC vascularity.

___ With pelvic floor contraction, there is normal shortening of the EAS.

___ 3D reconstruction confirms findings.

___ 3D volume transperineal assessment reveals 
normal PVM/pubic symphysis rami attachment with no evidence of PVM complex avulsion.

Additional comments:

ASC abnormal exam assessment

Sonologist(s):

Findings:

A 2D transperineal exam, with the patient in the 
dorsal lithotomy position, was performed using a ___ 5–9 MHz or ___ 6–12 MHz or ___ MHz EV transducer 
to assess the pelvic floor and reveals an abnormal 
ASC .

This is noted at the ___ proximal ___ mid ___distal level(s), described with measurements as follows:

Proximal level

___ There is no disruption of the proximal IAS.

___ There is a disruption of the IAS from ___to ___ OC, with concomitant elevation of the central mucosa 
toward the defect. Color Power Doppler elicits 
___ normal or ___ abnormal ASC vascularity.

The IAS measures ___ mm, ___ mm, ___ mm, and 
___ mm at 12, 3, 6, and 9 OC positions.

Midlevel

___ There is no disruption of the mid-IAS.

___ There is a disruption of the IAS from___ to ___ OC, with concomitant elevation of the central mucosa toward the defect. Color Power Doppler elicits ___ normal or ___ abnormal ASC vascularity.

The IAS measures ___ mm, ___ mm, ___ mm, and ___ mm at 12, 3, 6, and 9 OC positions.

Distal level

___ There is no disruption of the distal IAS .

___ There is a disruption of the IAS from ___ to 
___ OC, with concomitant elevation of the central 
mucosa toward the defect. Color Power Doppler elicits ___ normal or ___ abnormal ASC vascularity.

The IAS measures ___ mm, ___ mm, ___ mm, and 
___ mm at 12, 3, 6, and 9 OC positions.

___ There is no disruption of the EAS .

___ There is disruption of the EAS noted from ___ to ___ OC. Color Power Doppler elicits ___ normal or ___ abnormal ASC vascularity.

The EAS measures___ mm, ___ mm, ___ mm, and 
___ mm at 12, 3, 6, and 9 OC positions.

___ With pelvic floor contraction, there is normal shortening of the EAS.

or

___ The patient is unable to perform a pelvic floor 
contraction.

___ 3D reconstruction confirms findings.

___ 3D volume assessment reveals normal PVM/
pubic symphysis rami attachment with no evidence 
of PVM complex avulsion.

or

___ 3D volume assessment of the pelvic floor reveals an asymmetric PVM complex. There appears to be an avulsion noted along the ___ left, ___ right, or ___ bilateral aspect of the vaginal wall, measuring approximately ___ cm.

Additional comments: