Spec. study ULTRASOUND, Page 1
Postgraduate specialized study:
ULTRASOUND IN OBSTETRICS AND GYNAECOLOGY
DESCRIPITON
This postgraduate program is designed to train physicians in ultrasound diagnostic in obstetrics and gynecology. The goal of the study is to enable students for ultrasound practice. Ultrasound as a separate subject before graduation on the Medical School does not exist, although it is integrated in diagnosis and therapy procedures in almost every branch of medicine. Therefore, this program is the only possible way of organized education that enables students to get appropriate theoretical and practical knowledge in this field. Licensure for independent practice with ultrasound
is issued by the state authorities (Chamber of Physicians, Ministry of Health....).
The study consists of six basic (obligatory) subjects and the choice of seven elective topics, where the candidate should choose three.
Basic topics are:
- Basic science (physics and technology)
- Ultrasound in infertility
- Ultrasound in gynecology
- Ultrasound in obstetrics
- Ultrasound and breast
- Medical statisticsTOTAL 286 hours (42,9 ECTS)
Elective topics are (3 should be chosen):
- Ultrasound and menopause
- Application of 3D and 4D ultrasound
- Ultrasound in neonatology
- Early Human development
- Interventional ultrasound in O&G
- Ultrasound in adolescence
- EchocardiographyTOTAL 120 hours (18 ECTS)
The course lasts one academic year, offering 406 hours and equivalent in 60.9 ECTS. The program consists of lectures, seminars and practical work, with the point on practical work (more than 50% of the program). After completing full training program, the candidate is completely capable of working in all diagnostic and therapeutic procedures involving ultrasound equipment in obstetrics and gynecology. There are identical studies on Croatian and English
language.
Organizers University of Zagreb, Medical School, Sveti Duh Hospital
Duration of the study 1 academic year 2 semesters
Necessary requirements recognized diploma of completed undergraduate education, resident or specialist of O & G, license
If some of the candidates do not complete the program within the defined period of time for study, they can continue in the next academic year. In these circumstances, they have to attend all missing lectures and pass the separate exams and final exam.
Practical experience assessmentLog book
Practical experience100 examinations under supervision in gynae including early pregnancy
100 examinations in obstetrics
Description of 30 slučajeva with image on 1 A4 page
Minimum 15 fetal malformations and 15 gynae cases
Study leader: Ratko Matijevic, MD, PhD, MRCOG
The content of main subjects
BASIC ULTRASOUND (PHYSICS AND TECHNOLOGY)
Subject leader: Prof. Jasminka Kraljević, PhD
Semester: I
Hours: lectures 8, seminars 8, practical work 16 (ECTS: 4.8)
Content: Definition of ultrasound wave (wave modes, wavelength, frequency, propagation speed, frequency). Interaction of waves with matter (reflection, refraction, scattering, absorption, attenuation). Relation of phenomena in the time and frequency domains. Ultrasound transducer, ultrasound beam, focusing methods, ultrasound probes. Principle of echography (ultrasound scanner). Resolution (methods of manipulation of resolution and sensitivity, optimum scanner adjustment). Ultrasound contrasts. Harmonic imaging. 3D scanners. Tissue characterization, artifacts. Ultrasound measurements and errors. The Doppler effect. Doppler instrumentation. Limitations of various Doppler systems. Measurement errors and scanner adjustment. Ultrasound therapy systems. Safety of ultrasound and possible sources of hazard. Scanner specification. Price - performance relation.
Collaborator: TBA
Literature:
1. B. Breyer, Ž. Andreic: Basic principles of ultrasonic imaging. In: Handbook of ultrasound in obstetrics and gynecology, A. Kurjak, ed. CRC Press, Boca Raton, USA, 1990
2. S.B. Barnett, G. Kossoff: Safety of diagnostic ultrasound, Parthenon Publishing, London-New York, 1998
3. J.B. Fowlkes, C.K. Holland: Mechanical bio effect from diagnostic ultrasound; AIUM Consensus Statements, Journal of Ultrasound in Medicine, 19, 2000
Evaluation: written MCQ examination
ULTRASOUND AND INFERTILITY
Subject leaders: Ass.prof. Biserka Funduk Kurjak, MD, PhD, Prof. Veljko Vlaisavljević, MD, PhD
Semester: I
Hours: lectures 12, seminars 8, practical work 16 (ECTS: 5.4)
Content: Basic principles of human reproduction. Menstrual cycle. Ultrasound monitoring of the ovarian and endometrial changes in spontaneous cycles. Abnormalities of the menstrual cycle. Uterine causes of infertility. Uterine anomalies: diagnosis and treatment. Ultrasound monitoring of ovarian and endometrial changes in stimulated cycle. Ovarian causes of infertility. Polycystic ovarian syndrome. Tubal causes of infertility. The role of ultrasound and Doppler in performing interventional procedures in human reproduction. Hysterosonosalpingography using echo
enhancing contrast and color Doppler ultrasound. The role of ultrasound in “in vitro” fertilization and other assisted conception techniques.
Collaborators: Prof. Asim Kurjak, MD, PhD, Prof. A. Salihagić, MD,PhD, R. Bauman, MD, W Andonotopo, MD, PhD
Literature:
1. S. Kupesic, A. Kurjak. Slide atlas in human reproduction, Parthenon Publishing, London-New York, 1997.
2. A. Kurjak, S. Kupesic: Video tape on transvaginal color Doppler in gynecology and infertility, Parthenon Publishing, London, 1997.
3. A. Kurjak, S. Kupesic: A slide atlas of three-dimensional ultrasound in gynecology and obstetrics. Parthenon Publishing Group, London-New York, 1998.
4. A. Kurjak, S. Kupesic: Color Doppler in obstetrics, gynecology and infertility. Art Studio Azinović-Medison, Zagreb-Seoul, 1999
5. S. Kupesic, D. De Ziegler: Ultrasound and infertility. Parthenon Publishing, London-New York, 2000
6. A. Kurjak, F.A. Chervenak: Donald School Textbook of ultrasound in obstetrics and gynecology, Jaypee Brothers, New Delhi, 2003
Evaluation: practical exam – examination of the patients, description of the images and written MCQ exam
ULTRASOUND IN GYNAECOLOGY
Subject leader: Prof. Asim Kurjak, MD, PhD
Semester: I i II
Hours: lectures 20, seminars 20, practical work 50 (ECTS: 13.5)
Content: Ultrasound imaging of female reproductive system. Endometriosis. Pelvic inflammatory disease. Ectopic pregnancy. Intrauterine device. Benign and malignant uterine tumors. Benign and malignant ovarian tumors. Fallopian tube lesions. Differential diagnosis of pelvic masses. Interventional ultrasound in gynecology. Transperineal ultrasound. Low urinary tract. Gynecologic ultrasound in emergency room. Sonographic pearls and pitfalls.
Color Doppler in gynecology, Normal blood flow. Uterine and ovarian blood flow changes during normal menstrual cycle, Blood flow changes in inflammatory processes, Angiogenesis and neovascularisation Doppler parameters of benign and malignant tumors of female genital tract.
Collaborators: Prof. Ivica Zalud, MD, PhD, Ass.prof. M. Kopjar, MD, PhD, Bauman, MD, B Ujević MD, M Kerner MD, W Andonotopo MD,PhD, I Marton MD,
Literature:
1. A. Kurjak et al: Slide atlas - gynecology, volume 2, Parthenon Publishing, London- New York 1994.
2. A. Kurjak: An atlas of transvaginal color Doppler: the current state of art (the encyclopedia of visual medicine series). Parthenon Publishing, London-New York, 1994.
3. A. Kurjak: Ultrasound and ovary (Progress in obstetrics and gynecological sonography series). Parthenon Publishing, London-New York, 1994.
4. R. Osmers, A. Kurjak: Ultrasound and the uterus (Progress in obstetrics and gynecological sonography series). Parthenon Publishing, London-New York, 1995.
5. I.E. Timor Tritsch, A. Kurjak: Ultrasound and the Fallopian tube (Progress in obstetrics and gynecological sonography series)., Parthenon Publishing, New-York- London, 1996.
6. A.C. Fleischer, A. Kurjak, S. Granberg: Ultrasound and the endometrium. (Progress in obstetrics and gynecological sonography series). Parthenon Publishing, London-New York, 1997.
7. A. Kurjak, S. Kupesic: A slide atlas of three-dimensional ultrasound in gynecology and obstetrics. Parthenon Publishing Group, London-New York, 1998.
8. A. Kurjak, S. Kupesic: An atlas of transvaginal color Doppler, Parthenon Publishing, London-New York, 2000
9. Kurjak A, Chervenak FA, Carrera JM. Donald School Atlas of fetal anomalies. Jaypee Brothers, New Delhi, 2007
10. Kurjak A, Bajo Arenas J. Donald School Textbook of transvaginal sonography. Jaypee Brothers New Delhi, 2005
Evaluation: practical exam – patient examination, description of images; written MCQ exam
ULTRASAUND IN OBSTETRICS
Subject leader: Prof. Snježana Škrablin - Kučić, MD, PhD, Ass.prof. Ratko Matijević, MD,PhD, MRCOG
Semester: I and II
Hours: lectures 20, seminars 20, practical work 50 (ECTS: 13.5)
Content: Estimation of gestational age. Fetal dimensions in estimation of gestational age. Factors influencing fetal growth. Retarded and accelerated fetal growth. Ultrasound in estimation of the fetal growth. Ultrasound estimation of fetal weight and fetal maturity. Causes and classification of congenital anomalies. Ultrasound in detection of fetal
anomalies (vaginal and abdominal approach). Normal fetal anatomy. Anomalies in first trimester of pregnancy. Anomalies of the cranium and its contents, neck, fetal face, spine, fetal chest, heart and great arteries, gastrointestinal and urogenital tracts, abdominal wall and skeletal system. Multiple anomalies. Fetal tumors. Nonimmune fetal hydrops. Polyhydramnios. Oligohydramnios. Genetic counselling. Most frequent syndromes. Mendelian modes of inheritance; multifactorial inheritance; chromosome abnormalities. The methods of antenatal diagnosis (CVS, early amniocentesis, cordocentesis, organ biopsy). Ultrasound markers and biochemical analysis in detection of risk fetuses. Fetal therapy. Medical legal aspects of antenatal diagnosis and fetal therapy. Rights of the fetus. Antenatal care. Influence of ultrasound on perinatal mortality. Development, growth and functions of placenta. Ultrasound estimation of early placentation. Embryology including normal and abnormal development and sonoembryology of major systems. Pathology of early pregnancy. Pathology of the placenta (placenta praevia, abruption of placenta, tumors). Ultrasound examination of placenta. The role of amniotic fluid. Ultrasound examination of amniotic fluid volume. Spontaneous abortion and premature delivery. Transvaginal sonography of the cervix. The role of ultrasound in diabetic pregnancy, EPH-gestosis, multiple pregnancy, RH-immunization. Ultrasound in the treatment of fetal haemolytic disease. Survey of fetus in pregnancy and delivery. Ultrasound in estimation of fetal condition. Fetal activity. Fetal behaviour. Trophoblastic disease and magnetic resonance imaging.
Collaborators: Prof. A. Kurjak, MD,PhD, Prof. Višnja Latin, MD, PhD, Prof. Zarko Alfirević, MD, PhD, Prof. Frank Chervenak, MD, PhD, D. Habek, MD, PhD, W Andonotopo, MD,PhD, M. Kos,MD,PhD, T. Hafner,MD,MSc, B.Mišković, MD,MSc, I Marton MD, PhD
Literature:
1. A. Kurjak: An atlas of ultrasonography in obstetrics and gynecology, ed. A. Kurjak, Parthenon Publishing, London-New Jersey, USA, 1992.
2. A. Kurjak: A slide atlas of ultrasound in obstetrics. Parthenon Publishing, London- New York, 1994.
3. A. Kurjak: Textbook of perinatal medicine. Parthenon Publishing, London-New York, 1998.
4. A. Kurjak, F.A. Chervenak: Donald School Textbook of ultrasound in obstetrics and gynecology, Jaypee Brothers, New Delhi, 2003
5. K.H. Nicolaides, N.J. Sebire, J.M. Snijders. The 11-14-week scan. Parthenon Publishing, New York-London, 1999
6. G. Pilu, K.H. Nicolaides. Diagnosis of fetal abnormalities: The 18-23 weeks scan. Parthenon Publishing, New York-London, 1999.
7. Kurjak A, Chervenak FA, Carrera JM. Donald School Atlas of fetal anomalies. Jaypee Brothers, New Delhi, 2007
9. Kurjak A, Bajo Arenas J. Donald School Textbook of transvaginal sonography. Jaypee Brothers New Delhi, 2005
Evaluation: practical exam – patient examination, description of images; writen MCQ exam
ULTRASOUND AND BREAST
Subject leader: Prof. Boris Brkljačić, MD, PhD
Semester: I
Hours: lectures 6, seminars 4, practical work 12 (ECTS: 3.3)
Content: Anatomy of the breast. The methods of breast examination: clinical, mammography, ultrasound and other methods. Inflammations. Benign and malignant masses.
Collaborators: E. Pichler, MD, PhD, Prof B.Breyer,PhD, Prof. V. Šeparović, MD, PhD, E. Čepulic, MD,MSc
Literature:
1. E. Tohno, D.O. Cosgrove, J.P. Sloane: Ultrasound diagnosis of breast disease Churchill Livingstone, New York, 1994
2. E. Pichler: Sonography of breast tumors. Acta Clin Croat 1997;36:169-72
3. S.Heywang-Kobruner: Diagnostic breast imaging: mamography, senography, MRI and interventional procedures. Thieme, Stuttgart-New York, 1997
4. H. Madjar: The practice of breast ultrasound: Techniques, findings, differential diagnosis. Thieme, Stuttgart-New York, 2000
5. Fact sheet on breast cancer:
Evaluation: practical exam – patient examination, description of images; writen MCQ exam
MEDICAL STATISTICS
Subject leader: Prof.Davor Ivanković, PhD
Semester: I
Hours: lectures 4, seminars 6, practical work 6 (ECTS: 2.4)
Content: Characteristics and peculiarities of statistical data analysis models (experimental design, quasiexperimental design, population surveys, organization functioning). Sampling. Confidence interval. Validity tests of diagnostic procedures, ROC analysis. Risk estimation. Standardization. General linear model. Space reduction. Discriminant analysis. Time series analysis. Quality of health care assessment. Critical analysis of statistical analytical procedures and conclusions applied in selected papers published in medical journals.
Collaborators: Prof.S. Vuletic,PhD Z. Sonicki, MD,MSc
Literature:
1. E.H. Shortliffe, L.E. Perreault: Medical informatics. Computer applications in health care. Addison-Wesley Publishing Company, Reading, Massachusetts, 1990
2. E. Coiera: Guide to medical informatics, the Internet and Telemedicine. Chapman & Hall Medica, London, 1997.
3. J. van Bemmel, M.A. Musen: Handbook of medical informatics. Houten, Bohn Staflen Van Loghum, 1997.
Evaluation: oral exam
Elective subjects
ULTRASOUND AND MENOPAUSE
Subject leader: Prof. Asim Kurjak, MD, PhD; Ass.prof. Biserka Funduk Kurjak, MD, PhD
Semester: II
Hours: lectures 10, seminars 5, practical work 25 (ECTS: 6,0)
Content: Ultrasound assessment of the uterus and ovaries in perimenopausal and postmenopausal period. Transvaginal color Doppler in the assessment of circulatory changes during the menopause. Role of ultrasound in the assessment of the postmenopausal patients with vaginal bleeding. Ultrasound and Doppler findings of endometrial hyperplasia, endometrial polyps and endometrial carcinoma. Detection and staging of endometrial carcinoma by different forms of ultrasound. Adnexal lesions in postmenopausal period. Ultrasound and Doppler assessment of the patients receiving hormonal replacement therapy. Ultrasound and Doppler changes in uterine morphology and circulation in patients undergoing tamoxifen treatment. Role of ultrasound in the assessment of urogynecological disorders. The use of transperineal ultrasound in postmenopausal patients.
Collaborators: Prof. Veljko Vlaisavljević, MD, PhD, R. Bauman, MD, B Ujevic MD, M Kerner MD
Literature:
1. A. Kurjak i suradnici: An atlas of ultrasonography in obstetrics and gynecology, Parthenon Publishing, London-New York, 1992.
2. A. Kurjak i suradnici: Slide atlas - gynecology, volume 2, Parthenon Publishing, London-New York 1994.
3. A. Kurjak: An atlas of transvaginal color Doppler: the current state of art (the encyclopedia of visual medicine series). Parthenon Publishing, London-New York, 1994.
4. A. Kurjak: Ultrasound and ovary (Progress in obstetrics and gynecological sonography series). Parthenon Publishing, London-New York, 1994.
5. R. Osmers, A. Kurjak: Ultrasound and the uterus (Progress in obstetrics and gynecological sonography series). Parthenon Publishing, London-New York, 1995.
6. I.E. Timor Tritsch, A. Kurjak: Ultrasound and the Fallopian tube (Progress in obstetrics and gynecological sonography series)., Parthenon Publishing, New-York- London, 1996.
7. A.C. Fleischer, A. Kurjak, S. Granberg: Ultrasound and the endometrium. (Progress in obstetrics and gynecological sonography series). Parthenon Publishing London-New York, 1997.
8. A. Kurjak, M. Kos: Temelji ultrazvuène dijagnostike u ginekologiji i porodništvu. Art Studio Azinoviæ, Zagreb, 1998.
9. A. Kurjak, S. Kupesic: An atlas of transvaginal color Doppler, Parthenon Publishing, London-New York, 2000
10. S. Kupesic: Color Doppler and 3D ultrasound in gynecology, infertility and obstetrics, Jaypee Brothers, New Delhi, 2003
11. Kurjak A, Bajo Arenas J. Donald School Textbook of transvaginal sonography. Jaypee Brothers New Delhi, 2005
Evaluation: practical exam – patient examination, description of images; written MCQ exam
APPLICATION OF 3D AND 4D ULTRASOUND
Study leader: Prof. Asim Kurjak, MD, PhD
Semester: II
Hours: lectures 10, seminars 5, practical work 25 (ECTS: 6,0)
Content: Basic principles and physics of three-dimensional ultrasound. Threedimensional power Doppler ultrasound. Uterine cavity and myometrium assessed by three-dimensional ultrasound. Uterine anomalies. Role of three-dimensional ultrasound in the diagnosis of the intracavitary lesions (submucous leiomyoma, endometrial polyps, intrauterine synechiae). Role of three-dimensional ultrasound in the assessment of infertility. Assessment of the IUD location by three-dimensional ultrasound. Role of three-dimensional ultrasound in detection of endometrial carcinoma. Staging of endometrial carcinoma by three-dimensional and power Doppler ultrasound. Ovarian lesions assessed by 3D and power Doppler ultrasound. Three-dimensional power Doppler improves detection of the malignant pelvic tumors. Three-dimensional ultrasound of benign and malignant lesions of the Fallopian tube assessed by three-dimensional ultrasound. Three-dimensional ultrasound and power Doppler hysterosonosalpingography. Assessment of urogynecological disorders by three-dimensional multiplanar imaging. Three-dimensional sonoembryology. Gestational sac volume assessed by three-dimensional ultrasound. Volume and vascularity of the yolk sac assessed by three-dimensional and power Doppler ultrasound. Pathology of early pregnancy (missed abortion, blighted ovum) assessed by three-dimensional ultrasound. Ultrasound markers for chromosomopathies assessed by multiplanar imaging and surface rendering. Fetal malformations (abnormalities of the fetal brain and spinal cord, face, heart and great arteries, lungs, diaphragm, gastrointestinal and urogenital tracts, abdominal wall and skeletal system) assessed by three-dimensional ultrasound. Normal and abnormal fetal face assessed by three-dimensional ultrasound. Multiple fetal malformations. The role of three-dimensional power Doppler in the assessment of fetal and placental circulation. Three-dimensional ultrasound improves the accuracy in performing ultrasonically guided procedures. Fetal behaviour and fetal physiology
Collaborators: Prof. B. Breyer,PhD, Prof. I Žalud, MD, PhD, Prof. Aida Salihagić, MD, PhD, M. Stanojević,MD,PhD, W Andonotipo, MD, PhD, R. Bauman,MD, T. Hafner,MD,Msc
Literature:
1. A. Kurjak, S. Kupesic: Slide atlas of three-dimensional ultrasound in gynecology and obstetrics. Parthenon Publishing, London-New York, 1998
2. A. Kurjak: Three-dimensional power Doppler in obstetrics and gynecology. Parthenon Publishing, New York-London, 1999
3. A. Kurjak, S. Kupesic: Clinical application of 3D sonography. Parthenon Publishing, London-New York, 2000
4. A. Kurjak, S. Kupesic: An atlas of transvaginal color Doppler. Parthenon Publishing, London-New York, 2000
5. S. Kupesic, D. De Ziegler: Ultrasound and infertility. Parthenon Publishing, London-New York, 2000
6. A. Kurjak, D. Jackson: An atlas of three- and four-dimensional sonography in obstetrics and gynecology. Parthenon Publishing, London-New York, 2004
7. Kurjak A, Chervenak FA, Carrera JM. Donald School Atlas of fetal anomalies. Jaypee Brothers, New Delhi, 2007
8. Kurjak A, Bajo Arenas J. Donald School Textbook of transvaginal sonography. Jaypee Brothers New Delhi, 2005
9. Kurjak A, Azumendi G. Fetus in three dimensions Informa, London 2007
Evaluation: images description and writen MCQ exam
ULTRASOUND IN NEONATLOGY
Subject leader: M. Stanojević, MD, PhD
Semester: II,
Hours: lectures 10, seminars 5, practical work 25 (ECTS: 6,0)
Content: The use of ultrasound in neonatal surgery. Ultrasound in diagnosis of hip displasia. Hypoxic-ishemic brain damage in pre-term and term neonates. Periintraventricular hemorrhage in pre-term babies. Intracranial malformations. Intracranial ultrasound in early diagnosis of neurodevelopmental handicap in children with perinatal brain damage. Transcranial Doppler in newborns.