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Tests October 15, 2021 or later:
(Outline Summary)
| # | Domain | Subdomain | Percentage |
| 1 | Gynecology - Pelvic Anatomy and Physiology | ▪ Normal Anatomy and Physiology ▪ Abnormal Physiology and Perfusion | 19% |
| 2 | Obstetrics - First Trimester | ▪ Normal Anatomy and Physiology First Trimester ▪ First Trimester Abnormalities and Complications | 12% |
| 3 | Obstetrics Second/Third Trimester | ▪ Normal Anatomy and Physiology - Second/Third Trimester ▪ Fetal Abnormalities - Second/Third Trimester ▪ Placental and Umbilical Cord Abnormalities ▪ Cervix and Maternal Pathology | 37% |
| 4 | Protocols and Procedures | ▪ Clinical Standards and Guidelines ▪ Measurement Techniques - Gynecology ▪ Measurement Techniques - Obstetric ▪ Sonographer Role in Procedures | 24% |
| 5 | Physics and Instrumentation | ▪ Hemodynamics - Gynecology ▪ Hemodynamics - Obstetric ▪ Imaging Instruments | 8% |
(Detailed Outline)
| 1. | Gynecology - Pelvic Anatomy and Physiology 19% |
| 1.A. | Normal Anatomy and Physiology |
| 1.A.1. | Assess the uterus (i.e., size, position, orientation, contour, echogenicity) |
| 1.A.2. | Assess the myometrium |
| 1.A.3. | Assess the endometrium (i.e., cyclic changes) |
| 1.A.4. | Assess the vagina and cervix |
| 1.A.5. | Assess both adnexa (i.e., ovaries, fallopian tubes, pelvic musculature) |
| 1.A.6. | Assess the anterior and posterior cul-de-sacs |
| 1.A.7. | Assess premenarcheal, reproductive, and postmenopausal patients |
| 1.B. | Abnormal Physiology and Perfusion |
| 1.B.1. | Evaluate for Müllerian duct developmental anomalies (e.g., septated, subseptate, arcuate, bicornuate, unicornis uterus) |
| 1.B.2. | Evaluate for abnormal fluid collections (e.g., hydrometra, pyometra, hydrometrocolpos, hematometrocolpos, free fluid) |
| 1.B.3. | Evaluate for uterine leiomyomas (e.g., intramural, submucosal, subserosal, pedunculated) |
| 1.B.4. | Evaluate for adenomyosis and endometriosis (e.g., endometrioma) |
| 1.B.5. | Evaluate for endometrial pathology (e.g., endometrial fluid, polyps, endometrial hyperplasia, endometrial carcinoma) |
| 1.B.6. | Evaluate for cervical pathology (e.g., polyps, nabothian cysts, cervical stenosis, cervical carcinoma) |
| 1.B.7. | Evaluate other uterine findings (e.g., caesarean-section scar, leiomyosarcoma) |
| 1.B.8. | Evaluate for functional ovarian cysts (e.g., follicular, corpus luteum, theca-lutein) |
| 1.B.9. | Evaluate for benign ovarian neoplasms (e.g., paraovarian, cystadenoma [serous, mucinous, papillary], cystic teratoma, fibroma, thecoma, arrhenoblastoma) |
| 1.B.10. | Evaluate for malignant ovarian neoplasms (e.g., serous carcinoma, mucinous cystadenocarcinoma, papillary cystadenocarcinoma, metastatic, Krukenberg) |
| 1.B.11. | Evaluate other ovarian findings (e.g., ovarian torsion, ovarian hyperstimulation syndrome, polycystic ovarian disease) |
| 1.B.12. | Assess for pelvic inflammatory disease (e.g., endometritis, pyosalpinx, tubo-ovarian abscess) |
| 1.B.13. | Assess for intrauterine contraceptive device (IUCD) location |
| 2. | Obstetrics - First Trimester 12% |
| 2.A. | Normal Anatomy and Physiology First Trimester |
| 2.A.1. | Identify structures in the first-trimester obstetric examination at less than 10 weeks’ gestation (i.e., decidual reaction, gestational sac, yolk sac, embryo, amnion) |
| 2.A.2. | Identify fetal anatomy in the first trimester obstetrical examination between 10-14 weeks’ gestation (i.e., calvarium, brain, stomach, cord insertion, limbs) |
| 2.A.3. | Identify multiple gestations (i.e., fetal number, chorionicity/amnionicity) |
| 2.B. | First Trimester Abnormalities and Complications |
| 2.B.1. | Evaluate for gestational trophoblastic disease |
| 2.B.2. | Evaluate for ectopic and heterotopic pregnancy |
| 2.B.3. | Evaluate for embryonic/fetal demise |
| 2.B.4. | Evaluate for anembryonic pregnancy |
| 2.B.5. | Evaluate for abnormal yolk sac |
| 2.B.6. | Evaluate for increased nuchal translucency |
| 2.B.7. | Evaluate for subchorionic hemorrhage |
| 2.B.8. | Evaluate for intrauterine contraceptive device (IUCD) with pregnancy |
| 2.B.9. | Evaluate for incomplete/missed abortion, and retained products of conception |
| 2.B.10. | Assess for first trimester congenital anomalies and aneuploidy markers (e.g., Trisomy 13, 18, 21, Turner syndrome, triploidy) |
| 3. | Obstetrics Second/Third Trimester 37% |
| 3.A. | Normal Anatomy and Physiology - Second/Third Trimester |
| 3.A.1. | Assess the placenta (i.e., size, location) |
| 3.A.2. | Assess the umbilical cord (e.g., placental insertion, vessel number, fetal insertion) |
| 3.A.3. | Assess amniotic fluid volume |
| 3.A.4. | Assess fetal lie, presentation, and situs |
| 3.A.5. | Assess the cranial anatomy (e.g., choroid plexus, lateral cerebral ventricles, midline falx, corpus callosum, cisterna magna, posterior fossa, cavum septi pellucidi, cerebellum, posterior fossa, and nuchal fold) |
| 3.A.6. | Assess the neck |
| 3.A.7. | Assess the face (e.g., nose, lips, chin, palate, nasal bone, orbits, frontal bone, profile view) |
| 3.A.8. | Assess the fetal heart (i.e., size, position, axis, chambers, valves, four-chamber view, left ventricular outflow tract [LVOT], right ventricular outflow tract [RVOT], aortic arch, ductal arch, three vessel view [3VV] and three-vessel trachea [3VT] view) |
| 3.A.9. | Assess the thorax (i.e., thymus, lungs) |
| 3.A.10. | Assess the diaphragm |
| 3.A.11. | Assess the abdomen and gastrointestinal system (i.e., gallbladder, stomach, bowel, adrenal glands, liver, spleen) |
| 3.A.12. | Assess the genitourinary system (e.g., kidneys, bladder) |
| 3.A.13. | Assess the skeletal system (e.g., skull, cranial contour, long bones, ribs, ossification) |
| 3.A.14. | Assess the vertebral spine (e.g., ossification centers, curvature, skin covering) |
| 3.A.15. | Assess the upper and lower extremities (i.e., number, position, digits and spacing) |
| 3.A.16. | Assess the genitalia |
| 3.B. | Fetal Abnormalities - Second/Third Trimester |
| 3.B.1. | Assess abnormal multiple gestations (e.g., discordant growth >20%, twin to twin transfusion syndrome, selective intrauterine growth restriction [SIUGR], twin reversed arterial perfusion sequence [TRAP], twin anemia polycythemia sequence [TAPS], conjoined twins) |
| 3.B.2. | Evaluate for 2nd and 3rd trimester congenital anomalies and aneuploidy markers (e.g., Trisomy 13, 18, 21, Turner syndrome, triploidy) |
| 3.B.3. | Evaluate for abnormal amniotic fluid volume |
| 3.B.4. | Evaluate for abnormal fetal growth (e.g., macrosomia, fetal growth restriction [FGR], small for gestation age [SGA]) |
| 3.B.5. | Evaluate for abnormal central nervous system (e.g., ventriculomegaly, anencephaly, acrania, hydranencephaly, holoprosencephaly, Dandy-Walker malformation, Chiari II malformation, agenesis of corpus callosum, encephalocele, meningocele, myelomeningocele, sacrococcygeal teratoma) |
| 3.B.6. | Evaluate for abnormal neck (e.g., goiter, cystic hygroma) |
| 3.B.7. | Evaluate for abnormal face (cleft lip/palate, hyper-/hypotelorism, micrognathia, frontal bossing) |
| 3.B.8. | Evaluate for abnormal fetal heart (e.g., atrial and ventricular septal defects, atrioventricular canal defect, tetralogy of Fallot, transposition of the great vessels, pentalogy of Cantrell, pericardial effusion, rhabdomyoma) |
| 3.B.9. | Evaluate for abnormal diaphragm (e.g., congenital diaphragmatic hernia, eventration) |
| 3.B.10. | Evaluate for abnormal thorax (e.g., hydrops, pleural effusion, congenital pulmonary adenomatoid malformation, pulmonary sequestration, bronchogenic cyst) |
| 3.B.11. | Evaluate for abdominal wall defect (e.g., omphalocele, gastroschisis) |
| 3.B.12. | Evaluate for abnormal abdomen and gastrointestinal system (i.e., ascites, hydrops, neuroblastoma, echogenic bowel, bowel obstruction, esophageal and duodenal atresia, mesenteric cyst) |
| 3.B.13. | Evaluate for abnormal genitourinary system (e.g., hydronephrosis, cystic renal dysplasia, hydroureter, renal agenesis, bladder outlet obstruction, ureterocele, ambiguous genitalia, ovarian cyst) |
| 3.B.14. | Evaluate for abnormal skeletal system (e.g., vertebral spine, skeletal dysplasia, demineralization, limb reduction, agenesis) |
| 3.B.15. | Evaluate for abnormal extremities including hands and feet (e.g. polydactyly, talipes, syndactyly, clinodactyly) |
| 3.C. | Placental and Umbilical Cord Abnormalities |
| 3.C.1. | Evaluate for placenta previa (i.e., complete, low-lying) |
| 3.C.2. | Evaluate for placenta abruption and infarction (i.e., retroplacental, marginal) |
| 3.C.3. | Evaluate for abnormal placental attachment (i.e., placenta accreta, increta, percreta) |
| 3.C.4. | Evaluate for abnormal placental membrane attachment, insertion, or shape (e.g., circumvallate, succenturiate, velamentous, accessory lobe, vasa previa) |
| 3.C.5. | Evaluate for other placental and membrane abnormalities (e.g., thickened placenta, chorioangioma, amniotic bands, synechia, premature rupture of membranes) |
| 3.C.6. | Evaluate for abnormal umbilical cord (e.g., single umbilical artery, nuchal cord, allantoic cysts, length) |
| 3.D. | Cervix and Maternal Pathology |
| 3.D.1. | Evaluate for cervical incompetence (e.g., shortening, funneling, and cerclage) |
| 3.D.2. | Evaluate for maternal pelvic pathology (e.g., ovarian cysts, cystic teratoma, pelvic kidney) |
| 4. | Protocols and Procedures 24% |
| 4.A. | Clinical Standards and Guidelines |
| 4.A.1. | Verify accuracy of physician order and obtain pertinent clinical history from the patient and/or medical records |
| 4.A.2. | Correlate ultrasound findings with clinical presentation, previous imaging, and lab results (e.g., hCG levels, genetic testing, CA 125) |
| 4.A.3. | Utilize appropriate scanning technique and patient preparation (i.e., transabdominal, transvaginal, and translabial) |
| 4.A.4. | Recognize ultrasound findings that require immediate action (e.g., ovarian torsion, fetal demise, ectopic pregnancy) |
| 4.B. | Measurement Techniques - Gynecology |
| 4.B.1. | Measure endometrium thickness |
| 4.B.2. | Measure uterus and ovaries |
| 4.C. | Measurement Techniques - Obstetric |
| 4.C.1. | Measure first trimester structures (i.e., crown rump length, mean sac diameter, yolk sac) |
| 4.C.2. | Measure nuchal translucency |
| 4.C.3. | Measure biparietal diameter |
| 4.C.4. | Measure head circumference |
| 4.C.5. | Measure cisterna magnum |
| 4.C.6. | Measure transverse cerebellar diameter |
| 4.C.7. | Measure lateral cerebral ventricle |
| 4.C.8. | Obtain cephalic index |
| 4.C.9. | Measure nuchal fold between 15 and 20 weeks' gestation |
| 4.C.10. | Measure abdominal circumference |
| 4.C.11. | Measure long bones (i.e., femur, humerus, fibula, radius, ulna, tibia) |
| 4.C.12. | Measure renal pelves |
| 4.C.13. | Measure amniotic fluid (i.e., amniotic fluid index, maximum vertical pocket) |
| 4.C.14. | Perform biophysical profile |
| 4.C.15. | Measure maternal cervix |
| 4.D. | Sonographer Role in Procedures |
| 4.D.1. | Provide ultrasound assistance and documentation for sonohysterography |
| 4.D.2. | Provide ultrasound assistance for amniocentesis after 15 weeks’ gestation |
| 4.D.3. | Provide ultrasound assistance for chorionic villus sampling |
| 4.D.4. | Provide ultrasound assistance for intrauterine contraceptive device placement |
| 4.D.5. | Provide ultrasound assistance and documentation for infertility examinations and procedures |
| 5. | Physics and Instrumentation 8% |
| 5.A. | Hemodynamics - Gynecology |
| 5.A.1. | Assess pelvic vasculature with Doppler (e.g., ovarian perfusion, uterine varices) |
| 5.A.2. | Assess arteriovenous malformations using Doppler |
| 5.B. | Hemodynamics - Obstetric |
| 5.B.1. | Assess embryonic and/or fetal heart rate and rhythm with M-mode or cine clip |
| 5.B.2. | Identify the middle cerebral artery with Doppler |
| 5.B.3. | Identify the ductus venosus with Doppler |
| 5.B.4. | Assess the umbilical cord vessels with Doppler |
| 5.C. | Imaging Instruments |
| 5.C.1. | Utilize M-mode |
| 5.C.2. | Utilize Doppler (i.e., color, power, pulsed-wave) |
| 5.C.3. | Utilize 3-D imaging |
| 5.C.4. | Apply ALARA principle (e.g., thermal index, mechanical index) |
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