Tactile and Ultrasound Image Fusion for Functional Assessment of the Female Pelvic Floor

Abstract

Introduction: The true etiology of pelvic organ prolapse and urinary incontinence and variations observed among individuals are not entirely understood. Tactile (stress) and ultrasound (anatomy, strain) image fusion may furnish new insights into the female pelvic floor conditions. This study aimed to explore imaging performance and clinical value of vaginal tactile and ultrasound image fusion for characterization of the female pelvic floor. Methods: A novel probe with 96 tactile and 192 ultrasound transducers was designed. Women scheduled for a urogynecological visit were considered eligible for enrollment to observational study. Intravaginal tactile and ultrasound images were acquired for vaginal wall deformations at probe insertion, elevation, rotation, Valsalva maneuver, voluntary contractions, involuntary relaxation, and reflex pelvic muscle contractions. Biomechanical mapping has included tactile/ultrasound imaging and functional imaging. Results: Twenty women were successfully studied with the probe. Tactile and ultrasound images for tissues deformation as well as functional images were recorded. Tactile (stress) and ultrasound (strain) images allowed creation of stress-strain maps for the tissues of interest in absolute scale. Functional images allowed identification of active pelvic structures and their biomechanical characterization (anatomical measurements, contractive mobility and strength). Fusion of the modalities has allowed recognition and characterization of levator ani muscles (pubococcygeal, puborectal, iliococcygeal), perineum, urethral and anorectal complexes critical in prolapse and/or incontinence development. Conclusions: Vaginal tactile and ultrasound image fusion provides unique data for biomechanical characterization of the female pelvic floor. Bringing novel biomechanical characterization for critical soft tissues/structures may provide extended scientific knowledge and improve clinical practice.

Comprehensive pelvic muscle assessment: Developing and testing a dual e‐Learning and simulation‐based training program

“…Over the last decade, research has revealed new, expanded knowledge regarding pelvic muscle (PM) complexity, 1 anatomic specificity, physiologic functioning, and potential for specific muscle injury 2 (e.g., tears) or pain 3 (e.g., myofascial). Improved imaging techniques have refined the assessment and identification of the range of PM changes, injuries, and recovery associated with life course events (e.g., childbirth) 4–8 . There remains a need to estimate PM health (optimal to poor) using clinical examination that draws on this new knowledge to support ongoing research and advance clinical care.…”

“…Improved imaging techniques have refined the assessment and identification of the range of PM changes, injuries, and recovery associated with life course events (e.g., childbirth). [4][5][6][7][8] There remains a need to estimate PM health (optimal to poor) using clinical examination that draws on this new knowledge to support ongoing research and advance clinical care. However, standardization of PM assessment including training materials and quality control is lacking.…”