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The next lesson is IUD, the positioning

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and what you need to look for.

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So intrauterine devices are a contraceptive

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device that are very, very highly

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effective, approximately 98% to 90%.

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Depending on what kind you have,

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it can last for 5 to 10 years.

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Correct positioning, though, is important

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because the correct positioning has

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the highest contraceptive efficacy.

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If it's incompletely placed,

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your contraceptive effectiveness rapidly

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drops, depending on where it is.

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So what you wanna look for is, is their

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abnormal positioning and the risk that

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this would have include risk of pregnancy,

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of course not being effective, but also a

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risk of intrauterine or intra pregnancy,

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but also ectopic pregnancy as well.

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There's also risk of the IUD embedding

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into the myometrium, and if it embeds into

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the myometrium and stays there, it can

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actually perforate through the serosa.

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And if that keeps going, it can actually migrate

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into the abdominal cavity for which you would

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need a surgery to remove it at that point.

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So here are just three different examples

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that you can actually see an MRI,

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an IUD device if you're looking carefully.

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So here's your pre contrast T1.

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You can see it nicely positioned right there.

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Post-contrast, beautifully see it.

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And your subtraction, nice,

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beautiful positioning of your IUD.

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Can even see the strings

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a little bit lower down.

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So when you look for IUD positioning,

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I rely on the transverse uterus imaging

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supplemented by the sagittal imaging.

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The transverse is really helpful for

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the short arms of that T of the IUD.

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In this particular place right here, we can see

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a little bit of shadowing from the long part

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of the IUD here in the endometrium.

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Our next imaging, a little bit

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higher towards the fundus, you can

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see portions of the arms right here.

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They are symmetric and they're

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within the endometrium.

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That's where they should be.

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The sagittal is really useful for

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looking for how far it is from

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the fundus of the endometrium.

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So not the fundal contour, but the

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top of the endometrium right here.

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If it's more than four millimeters from

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that border, which would be right here,

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you have a higher risk of having symptoms

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such as increased or abnormal bleeding,

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pain, and you have an increased risk of

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expulsion or displacement of the IUD.

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So this is an ultrasound artifact.

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The IUD is not this thick, but it's so

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echogenic right here that it creates this

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artifact, and you can see it right here.

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It's important to remember,

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you may not see all parts of the IUD.

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It depends on what kind it is.

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They have different images that

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can be viewed sonographically.

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Some of it may be lucent, some of it

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is very echogenic, like in this case.

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And oftentimes, you can actually see

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the strings coiled in the cervix.

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So just keep that in mind as well.

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Cine clips for these

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are extraordinarily useful.

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I like the transverse to document those

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arms again being in symmetric position,

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and I like the sagittal to document the body

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of the IUD that's in the right spot.

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And if you have 3Ds, they are

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just really, really helpful.

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I definitely recommend them.

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Here's an example of a normal position.

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So in this same patient right here,

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you can see our contour fundus up here,

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the rest of the uterus somewhere around here.

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This is going to be your endometrial

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cavity right here, approximately.

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You can see that the IUD is beautifully

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and perfectly positioned

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within that canal right here.

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Easy imaging to prove that

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it's in the right spot.