About four years ago, I felt like I had made a massive discovery akin to cracking cold fusion or inventing time travel. Although my revelation didn’t win me a Nobel Peace Prize, it forever changed the course of my medical training and gynecology practice. This discovery came through a podcast on Advanced Imaging for Endometriosis. Thus, my journey into the world of advanced gynecologic ultrasound (AGU) and endometriosis began.
My years of medical school and residency training had never included this kind of diagnostic capability for endometriosis. The axiom that surgery was how endometriosis was diagnosed was firmly established in my mind. Furthermore, I was astonished that ultrasound, something so ubiquitous in obstetrics and gynecology, was the way to achieve this paradigm shift. I remember sitting in my car listening to Dr. Mathew Leonardi talk about the possibility of not just diagnosing endometriosis before surgery but specifically mapping out where the disease was present. My mind was blown. In my new-found passion for endometriosis diagnosis, I took to the internet.
After a brief exchange on Twitter, Dr. Leonardi graciously agreed to let me shadow his practice for a week. Fortunately for me, Hamilton, Ontario, where Dr. Leonardi worked, was just a short drive and a (sometimes) quick border crossing from where I was completing a residency in Buffalo, New York, so I could witness these transformative ultrasound techniques firsthand. What I experienced that week was a game-changing way to care for patients. Patients with pelvic pain and suspected endometriosis could visit the clinic, undergo a comprehensive pelvic ultrasound, and receive an informed management plan. It wasn’t a model of “let’s see what we find” or broad counseling about options. Patients received immediate information about the scan findings and knew what to expect in the management plan. Furthermore, the therapeutic benefit here cannot be understated. Many patients would tear up feeling validated as their experiences were finally reflected in tangible scan results.
Of course, I was impressed by the patient experience side of AGU. What hooked me even further was the amazing amount of information that one could garner from these ultrasound techniques. Cul-de-sac obliteration, deep endometriosis of the bowel, ureteral strictures, uterosacral ligament lesions, ovarian mobility, and the list goes on. With the wealth of information accessible through ultrasound and my sights set on a surgical practice, I had to learn this transformative skill. A few years later, while in my minimally invasive gynecologic surgery fellowship, I was fortunate to be able to travel to McMaster University and complete a month-long elective with Dr. Leonardi to develop my AGU skills. While this experience greatly advanced my ultrasound capabilities, I believe that anyone interested in AGU does not necessarily need a dedicated month of intensive scanning to bring this skill into practice. The journey starts with a single scan.
If you’re interested in starting this journey, enhancing your scanning techniques, or polishing your skills at The Ultrasound Event 2025 conference, I encourage you to sign up for the hands-on training session co-chaired by Dr. Leonardi and me: The UltraSolution Experience: Mastering Next-Gen Endometriosis Ultrasound. In this session, we, along with other experts in AGU, will guide you through simulated endometriosis ultrasounds using the Intelligent Ultrasound ScanTrainer® platform to focus on assessments of findings including bowel and bladder endometriosis. I hope you are as excited to join as we are to share the transformative capabilities of advanced gynecologic ultrasound with you all!
Please feel free to ask any questions about the course or share your journey with gynecologic ultrasound.
I hope to see you at the conference,
Daniel Nassar, DO, MPH
Minimally Invasive Gynecologic Surgery
Dept. of Obstetrics & Gynecology
