[Hygiene in endovaginal gynecologic and obstetrical ultrasound in 2008]. / Hygiène en échographie endocavitaire gynécologique et obstétricale en 2008.

Hygiene of ultrasound probes is a hot topic in obstetric and gynecologic ultrasound. The issue concerns mainly the risk of contamination and the need for specific procedures to ensure a high degree of protection against infectious diseases, even if a disposable barrier cover is used. As there are no referenced quality criteria for these disposable probe covers, it is crucial to verify that they are CE marked. The use of condoms as probe covers is not recommended even though they present a lower rate of disruption compared to commercial probe covers. The global rate of probe cover perforation is of 1 to 9%. To date, there are no case reports of contamination by ultrasound examination, be it vaginal or abdominal. Nevertheless, every patient must be regarded as a potential source of infection. The French recommendations consider endovaginal ultrasound probes as semi-critical instruments and thus require intermediate-level disinfection. Because of the risk of disruption, American as well as Canadian and Australian recommendations insist on high-level disinfection of the probe. Every operator should follow reasonable hygiene rules and appropriate precautions should be taken in order to reassure the patients about the risks of contamination during any ultrasound examination.

[Study on the management of patients following detection of a "probably benign" mammographic abnormality (ACR BI-RADS category 3): a review of 176 radiologists]. / Une étude exploratoire des pratiques et des comportements radiologiques devant la découverte d'une anomalie "probablement bénigne" sur la mammographie: à propos de 176 radiologues.

OBJECTIVES: To evaluate mid-term management of patients with category 3 findings (probably benign, ACR BI-RADS) at mammography three months after a CME course on breast cancer. METHODS: A questionnaire (33 items) was sent to 529 radiologists, three months after the CME course (May-December 2002). The answers were analysed using the chi-square test. RESULTS: A total of 176 radiologists completed the questionnaire; 63 were part of an organized screening mammography program; 162 used the BI-RADS classification. In the presence of a class 3 finding, 158 radiologists recommended short term follow-up, 28 recommended biopsy, 9 upgraded the level of abnormality, 116 consulted another radiologist, 42 consulted an expert mammographer, 36 submitted the case to a multidisciplinary committee and 12 asked for an overread. Management with short term interval follow-up was worrisome to 91 radiologists for fear of unfavorable outcome, and to 47 radiologists because of possible litigation. Twenty-six radiologists had difficulty explaining to patients the need for short term follow-up. The median score for perceived stress by the radiologists was 3 (0=low and 10=high). CONCLUSION: The practices of this sample of French radiologists are consistent with the recommendations presented during the CME course and by the ANAES. They may have some difficulty in communicating with patients the need for follow-up. The ethics of radiology are based on "primum non nocere".