Figure 1. 40-year-old Woman with Pelvic Pain and Enlarged Uterus on Physical Exam. (A) Transabdominal sagittal pelvic ultrasound image performed with extended field of view imaging demonstrates the enlarged uterus with a large (18 cm) fibroid (f). The relationship of this fibroid to the endometrial cavity cannot be determined. (B) Sagittal T2W TSE MRI in the same patient demonstrates that this is a large intramural fibroid (f) which displaces the endometrial cavity (arrow) posteriorly.
WHY A RADIOLOGY SUBSPECIALTY DEVOTED TO WOMEN’S IMAGING?
Women’s Imaging has emerged over the past decade as a distinct subspecialty within diagnostic radiology, devoted to the diagnosis and treatment of diseases and conditions unique to women. Like the subspecialty of Pediatric Radiology, the Women’s Imaging subspecialty evolved in order to address the unique health problems of this large subset of the population. Women have physiologic and pathologic processes which are specific to them, and the imaging evaluation of these problems requires a specialized set of knowledge and imaging skills. Originally, mammography, and obstetric and pelvic sonography formed the cornerstones of this subspecialty. Recent years, however, have seen rapid expansion in the field of Women’s Imaging, which has broadened in scope to include other imaging modalities such as CT, MRI, and Nuclear Medicine. In addition to ultrasound, these modalities play an important role in the evaluation of breast and gynecologic malignancies, infertility, and problems specific to the postmenopausal patient.
A significant factor propelling the evolution of Women’s Imaging as a radiology subspecialty has been a widely perceived need for better health care for women. A major component of this requirement is screening for breast carcinoma, an area where radiologists lead the agenda. Issues relating to mammography, and the need for low-cost, high-quality screening studies, together with pressure for governmental regulation to ensure minimum standards of quality, have increased public awareness of the critically important role of the radiologist in the diagnosis and management of breast cancer. The Mammography Quality Standards Act of 1992, overseen by the U.S. Food and Drug Administration, was an important regulatory step forward, which grew directly from the American College of Radiology’s voluntary quality assurance program. Subsequently, similar accreditation programs within other radiology subspecialties have emerged.
The need for, and importance of, Women’s Imaging as a radiology subspecialty was formally recognized with the formation of the Society for the Advancement of Women’s Imaging (SAWI) in 1993. This society, established to foster the ideals and goals of the subspecialty, is also involved in developing guidelines to support residency and fellowship training in Women’s Imaging, and to sponsor educational and scientific meetings devoted to this subspecialty. The American College of Radiology has further emphasized the importance of this subspecialty by creating a Women’s Imaging Panel as part of its Task Force on Appropriateness Criteria. The role of this panel is to delineate the appropriate sequence of diagnostic tests used to evaluate clinical problems specific to women. Examples include appropriate imaging of vaginal bleeding in the postmenopausal patient, and imaging for staging of gynecologic malignancies. The first Women’s Imaging Fellowship was offered in a radiology department in the United States in 1992, in response to the recognized need to provide the additional training required to practice effectively within this subspecialty. Currently, there are approximately 23 positions in this country for fellowship training in the field of Women’s Imaging.
In addition to promoting better performance of diagnostic imaging services for women, on a more practical level, a Women’s Imaging subspecialty allows for a more complete and comprehensive approach to women’s health care, a “one-stop-shopping” scheme that operates well in both the academic and private practice setting. Consequently, over the past decade, dedicated Women’s Imaging centers have emerged, providing screening services in both breast and gynecologic disorders. Radiologists dedicated to the subspecialty of Women’s Imaging have focused their interest on the distinct problems of the female patient, allowing for greater expertise, and increased research and teaching efforts in this area. This ultimately results in the highest-quality care for our female patients, the goal we continually strive to achieve as clinical radiologists.
>> Next Page
Page:
1
2
3
4
5
Figure 2. Uterine Fibroids at MRI. (A) Gadolinium-enhanced fat-suppressed axial T1W image of the pelvis demonstrates multiple uterine fibroids (f) which demonstrate marked enhancement with contrast. (B) MR performed after uterine artery embolization demonstrates good response to the procedure, with decrease in vascularity of the fibroids as manifested by decreased contrast enhancement.