The General Problem:

Endometriosis is a prevalent gynecological disorder primarily affecting women of reproductive age. It presents with a diverse range of chronic and recurrent symptoms that often necessitate multiple clinical and imaging assessments. Affecting approximately 10% of women and individuals assigned female at birth, endometriosis is also identified in up to 50% of those experiencing subfertility. Clinical case studies estimate that 40%-50% of women and adolescents with persistent pelvic pain and 30%-40% of women with infertility have underlying endometriosis. Common symptoms include severe pelvic pain, dysmenorrhea, dyspareunia, dysuria, subfertility, and chronic fatigue, all contributing to substantial morbidity. 

The management of endometriosis poses a significant clinical challenge due to the variability of symptoms and a widespread lack of standardized knowledge regarding appropriate imaging modalities and expert interpretation. Nevertheless, awareness and recognition of this condition have increased significantly in recent years. The American College of Radiology (ACR) Appropriateness Criteria® for Female Infertility recommends APU-advanced transvaginal ultrasound (A-TVUS) as a primary imaging modality for the evaluation of suspected endometriosis, alongside MRI, and indicates that APU-A-TVUS may surpass MRI in detecting rectosigmoid and retrocervical involvement.

The diagnosis problem:

Historically, laparoscopy has been considered the diagnostic gold standard for endometriosis; however, it carries inherent surgical risks and may not be universally accessible. Additionally, laparoscopy is unsuitable for follow-up evaluations. As a result, current best practices emphasize a combination of clinical assessment and advanced imaging techniques to monitor treatment response. Diagnostic imaging plays a critical role in the accurate diagnosis and management of patients, particularly in cases of deep infiltrating endometriosis. Augmented Pelvic Ultrasound / Advanced pelvic ultrasound (APU-A-TVs) not only confirms the diagnosis but also facilitates ongoing disease monitoring and preoperative planning. Given the complexity of endometriosis, which often involves multiple pelvic organs, it is imperative that imaging studies be conducted and interpreted by highly trained radiologists or gynecologists/sonologists, particularly in the context of ultrasound, to provide the detailed insights necessary for effective clinical management. 

The problem in United States:

In the United States, one of the primary challenges in diagnosing endometriosis via ultrasound lies in the underutilization of the transvaginal ultrasound for the detection of this complex condition. Although APU-A-TVUS has proven to be a valuable tool for identifying deep infiltrating endometriosis (DIE), its widespread adoption across North American imaging centers remains limited. One contributing factor to this gap in care is the typical workflow in many centers, where sonographers perform the ultrasound exams, and the images are later interpreted by radiologists or gynecologists. This separation between the scanning process and the interpretation introduces several barriers to accurate and timely diagnosis, particularly for conditions like endometriosis that require nuanced, real-time assessment and specialized imaging protocols.

In many cases, sonographers lack the training or expertise to recognize subtle findings specific to endometriosis, especially when these findings are not part of standard imaging protocols. They have to know first a detailed anatomy of the pelvic organ, the tridimensional representation, and the specific protocol. While radiologists and gynecologists who review the images are highly trained, they are often distanced from the actual scanning process, limiting their ability to adjust imaging techniques based on patient symptoms or findings observed in real-time. This disconnection can lead to missed or delayed diagnoses, which is particularly problematic in the case of endometriosis, where early and accurate detection is crucial for effective management.

Despite its proven efficacy, this advanced approach to APU A-TVs is not yet the norm across North America. Many imaging centers still rely on general pelvic ultrasound protocols that are not tailored for endometriosis detection. Additionally, a lack of standardized training programs and protocols for sonographers in endometriosis imaging contributes to the inconsistency in diagnosis. 

Why we are different?

Miami Sonogram stands apart from other imaging centers due to our longstanding commitment to the specialized diagnosis of endometriosis. For several years, we have dedicated ourselves to the exploration and detection of this condition, conducting a significant number of evaluations for patients struggling with infertility—one of the most common manifestations of endometriosis. Additionally, many of our patients seek our expertise after experiencing chronic pelvic pain and undergoing multiple diagnostic studies elsewhere without conclusive results.

Miami Sonogram offer Fertility Ultrasound to centers in Panama, Spain, Colombia, Mexico, the Dominican Republic, California, and Greece, as well as to CNY Fertility and Elsa Fertility / CCRM Fertility. We are an official monitoring center for CNY  Fertility in florida, and New Life IVF Greece in United States. 

What truly sets Miami Sonogram apart is our use of APU/Advanced Transvaginal Ultrasound (A-TVUS) mapping, along with additional elements in our personalized protocol. This cutting-edge technique is not yet widely adopted in North American imaging centers. Unlike many practices where sonographers perform the exams and radiologists interpret the results later, we have developed a collaborative approach. Our highly trained APCA-certified sonographers, experienced in endometriosis protocols, work closely with interpreting physicians. This expert-guided approach allows us to offer more comprehensive evaluations, detecting subtle findings that are often missed in traditional ultrasound practices. 

Our APCA-certified sonographers have attained the highest level of education available for this role in the United States, with formal training as MD radiologists who now specialize in sonography, fully embracing the scope of practice as sonographers. They are active members of the Interamerican College of Radiology, the Alliance for Physician Certification & Advancement (APCA), and the Point of Care Ultrasound Certification Academy (POCUS). With over 30 years of experience across multiple countries, they bring a wealth of expertise to the field of sonography. 

Our specialized protocols have allowed us to provide more accurate diagnoses and treatment plans, especially for patients whose symptoms have gone undiagnosed in other settings. This dedication to advanced ultrasound techniques for endometriosis has made Miami Sonogram a trusted center for those in need of answers.

Miami Sonogram is proud to be a National Pioneer in Mapping for Endometriosis and one of the few distinguished regional referral centers in Florida for Ultrasound Mapping Endometriosis.

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