Background: The emergency department (ED) disposition and discharge process is a critical period in a

Virtual poster abstracts Results: 16/25 (64.0%) of the gynecologists were IOTA-certified. The IOTA template was used in 83/90 (92.2%) cases. 58/83 (69.9%) descriptions used IOTA terms correctly with adequate information. Conflicting use of IOTA terms were seen in 15/83 (18.1%) cases; with misclassification of uni-/multilocular lesions with solid components being the most frequent pitfall. 10/83 (12.0%) contained inadequate measures only. All 7/90 (7.8%) cases not using the IOTA template lacked information on morphology, colour score, and measures. 39/90 (43.3%) images did not document the findings described (colour score (n = 18) and lesion measures (n = 15) mostly missing). In 25/90 (27.8%) patients, the two external reviewers disagreed with the examinating gynecologist on lesion classification (n = 11), cystic content (n = 8), regularity (n = 11), and shadowing (n = 3). There was no significant association between IOTA-certification status and disagreement by reviewers (22.7% in IOTA-certified vs. 29.2% in non-certified, p = 0.193). Conclusions: Essential pitfalls in using the IOTA terms and definitions were relatively frequent, despite IOTA certification. To perform optimal evaluation and implementation of the IOTA diagnostic tools, methods to maintain IOTA competencies must be developed. VP61.05 Efficient and customised use of IOTA ADNEX model as a clinical management tool in a tailor-made treatment of adnexal tumour suspected of malignancy

Objectives: Various diagnostic models to assist clinicians in the correct characterisation of patients with an adnexal mass are available, based on ultrasound variables, clinical predictors and tumour markers. This study is the first head-to-head comparison of the International Ovarian Tumor Analysis (IOTA) Assessment of Different NEoplasias in the adneXa (ADNEX) model with and without CA125, the Risk of Malignancy Index (RMI) and the Risk of Ovarian Malignancy Algorithm (ROMA). Methods: We prospectively included consecutive women with an adnexal tumour scheduled for surgery at the University Hospitals Leuven between 2015 and 2018, who underwent a standardised preoperative ultrasound examination within the framework of the trans-IOTA study. Blood was drawn before surgery for analysis of CA125 and HE4. The final outcome was defined by the histopathological examination of the surgically removed tumour. For statistical analysis borderline tumours were classified as malignant tumours. Model performance was evaluated with respect to discrimination, calibration, and clinical utility (the latter using decision curve analysis). Results: In total 245 women were included: 125 women with a benign and 120 with a malignant tumour. Discrimination between benign and malignant tumours was better for ADNEX with and without CA125 (AUC 0.93, 95% CI 0.89-0.96 and AUC 0.91, 95% CI 0.86-0.94, respectively) than for RMI (AUC 0.89, 95% CI 0.85-0.93) and ROMA (AUC 0.86, 95% CI 0.80-0.90). All models underestimated the risk of malignancy in this study population. Clinical utility calculated with net benefit was highest for ADNEX with CA125, followed by ADNEX without CA125. Conclusions: ADNEX had better ability to discriminate between benign and malignant adnexal tumours and higher clinical utility than ROMA and RMI. OC03.02 *Ultrasound image analysis using deep neural networks to discriminate benign and malignant ovarian tumours: a comparison to subjective expert assessment

Objectives: Evaluate results, efficiency and safe of the HSSG as HyFoSy, as first diagnostic option for tubal patency from the point of view of the economic analysis based on the minimisation of costs against the HSG, which is presumed to have the same diagnostic efficiency. Methods: Descriptive retrospective observational study, between June 2017 and October 2018. All patients proposals for artificial insemination were included. We evaluated clinical, demographic and cost-efficiency variables. Results: Data were collected from a total of 257 patients. The pregnancy rate was 24.1%; no differences prior to 2016. The average delay to the appointment was 9 days, with an average number of 10 procedures a day. The diagnosis to the patient is inmediate. The cost of the test in our centre, adding direct and indirect costs is 90.85 euros; HSG costs 379.01 euros. The clinical and cost-efficiency variables are shown in figure 1. Conclusions:The HSSG is the first diagnostic option for tubal patency from the approach of minimisation of costs adding criteria of efficacy and safety. Is safe, fast and well tolerated by the patient. It is a very accessible self-managed technique, without waiting list, performed by a specialist with an immediate diagnostic result (effective) and of lower economic cost (efficient). Difficult to quantify but desirable in health that neither radiation nor use of contrasts are used, thus avoiding both possible teratogenic and allergic effects. Waiting time is an indicator of quality of a service. There are chained results of the time needed to perform, recovery time (nonexistent), and the index of potential activity (50/week).

Poster discussion hub abstracts at rest and on PFMC. The size of a defect was defined by measuring sector angles. Results: Of 842 women, mean age was 54 (16-84) years. 89 % (751) were vaginally parous with median parity of 2 (1-8). The mean EAS defect angles at rest and on PFMC were 35.7 o (2.5-142.8) and 34.9 o (1.8-131.3) respectively. Significant EAS trauma was diagnosed in 143 (18%) at rest and 120 (14%) on PFMC. Figure 1 shows a comparison of defect angles at rest and on PFMC for positive slices 1-6. Contrary to expectations, the defect angle showed a reduction by 5-10 degrees on PFMC when comparing defect angle in women who had defects both at rest and on PFMC. Conclusions: Pelvic floor contraction does not enlarge EAS defect angles. On the contrary, defects seem smaller on PFMC. This may be explained by the large proportion of sphincter trauma that is partial, with a defect surrounded by undamaged or repaired muscle. The scar area is likely reduced by contraction of the surrounding intact sphincter muscle.