Pelvic ultrasound is central to the pre-operative assessment of endometriosis, extending beyond the detection of ovarian endometriomas, which often act as markers of more extensive pelvic disease. This presentation explores the relationship between sonographic findings and laparoscopic outcomes, highlighting how systematic, anatomy-based ultrasound assessment can predict disease distribution, anatomical distortion, and operative complexity. Through case-based examples, key sonographic features; including reduced organ mobility, pouch of Douglas obliteration, uterosacral ligament involvement, deep infiltrating endometriosis, horseshoe-shaped posterior compartment disease, and peritoneal pocket lesions, are directly correlated with intraoperative findings. Integrated surgical videography will include examples of normal pelvic anatomy and a spectrum of endometriosis severity, reinforcing real-time imaging–surgical correlation. The session emphasises the clinical impact of detailed ultrasound assessment and reporting, demonstrating how the quality and depth of imaging directly influence surgical decision-making, operative planning, patient counselling, and ultimately treatment outcomes. This session highlights the evolving role of both the sonographer and sonologist in endometriosis care. It underscores the importance of meticulous scanning, thoughtful image review, and clear communication of findings to produce surgically relevant reports that accurately convey disease extent. High-quality ultrasound, when performed and interpreted with this level of care, directly informs surgical pathways and ultimately improves patient outcomes.

The recently published IDEA consensus addendum on superficial endometriosis diagnosis offers new learning opportunities for sonographers. In this 20-minute talk, we’ll clarify exactly what sonographers are expected to identify, what remains uncertain, and how to communicate findings responsibly in this new area of gynaecological imaging. This session will provide clarity, confidence, and language for sonographers navigating the diagnostic expectations around this subtle but important form of disease. You’ll leave with practical frameworks for your scan, your report, and patient communication.
Objectives:
• Provide an overview of the new IDEA addendum on superficial disease
• Discuss ultrasound features of superficial endometriosis
• Discuss limitations of TVUS in detecting superficial disease and why that matters
• Describe how to document and describe possible findings

Introduction: Endometriosis is a common benign gynaecological condition. However, malignant transformation to endometriosis-associated ovarian cancer (EAOC), though rare, presents a significant diagnostic challenge. Patients typically present with known ovarian endometriomas and may demonstrate new or evolving clinical symptoms, including worsening pelvic pain, increasing mass size, or atypical imaging appearances. Accurate sonographic differentiation between benign endometriosis and malignant transformation remains clinically challenging yet essential for timely management.
Method: This case series reviews pelvic ultrasound examinations of patients with known or suspected endometriosis who demonstrated atypical or concerning imaging features. Ultrasound assessment incorporated pattern recognition, grey-scale morphology, Doppler evaluation of vascularity, and comparison with prior imaging where available. Findings were interpreted in reference to established IOTA and O-RADS criteria.
Results: Key sonographic findings across cases included the development of solid components within endometriomas, papillary projections measuring ≥3 mm, internal vascularity, irregular cyst walls, and rapid interval growth. These imaging features prompted further investigation or surgical referral. The observed sonographic appearances were consistent with features described in the literature as suspicious for, or subsequently confirmed to be, malignant transformation.
Conclusion: This case series highlights the critical role of ultrasound in identifying features suggestive of EAOC when a structured and comparative imaging approach is applied. The findings support existing evidence that papillary projections, vascularised solid components, and architectural change are key sonographic indicators of malignancy.
Take home message: In patients with endometriosis, the presence of new solid, vascularized components, or morphological changes should prompt consideration of malignant transformation and appropriate escalation of care.

Transvaginal ultrasound (TVUS) is a first-line diagnostic method for deep endometriosis (DE). It, however, requires expertise. Typical ultrasound features of DE include hypoechoic, scarce, solid nodules affecting uterosacral ligaments, rectovaginal septum, posterior vaginal fornix, urinary bladder wall, or bowel often accompanied by adhesions between the organs in the pelvic, leading to obliteration
TVUS has demonstrated high pooled sensitivities (around 91%) and specificities (around 98%) for detection of DE in the bowel and high specificity (often > 90%) and good sensitivity (around 75-85%) for DE in other pelvic sites.
The lecture will cover ultrasound diagnostics of deep endometriosis in the pelvic including ultrasound appearance of DE in different locations, systematic scanning based in IDEA consensus, tips and tricks how to search for DE lesions in particular locations.

This presentation provides a practical overview of ultrasound assessment of bowel deep endometriosis, focusing on key sonographic features and common sites such as the rectosigmoid. It outlines a systematic scanning approach, including dynamic techniques to improve detection. Emphasis is placed on recognising disease extent and depth of infiltration. The session also highlights the role of ultrasound in supporting clinical decision-making and surgical planning.

Background: Transvaginal ultrasound (TVUS) is an intimate diagnostic procedure requiring informed, voluntary consent. Professional guidelines mandate clear, patient-centred consent processes; however, anecdotal evidence suggests that consent for TVUS is sometimes rushed, inconsistent, or insufficiently trauma-informed and culturally sensitive. Limited published literature exists on patient experiences of the consent process for TVUS within the sonography profession. Gaps in consent practice may contribute to patient distress, loss of trust, avoidance of care, and ethical or legal risk.
Methods: This clinical audit, funded by the ASA, uses an anonymous online survey in a descriptive cross-sectional design. Adult outpatients undergoing TVUS at SAMI, Repat Health Precinct, SA Health, will be invited to participate between February and August 2026, with follow-up analysis and re-audit planned. The survey aims to evaluate patient-reported experiences of the consent process, focusing on clarity of information, communication of risks, opportunity to decline or withdraw consent, availability of a support person, cultural sensitivity, trauma-informed communication, and overall patient-centredness.
Results: Initial early results of the audit will be presented to help identify strengths and gaps in alignment with ethical standards, clinical guidelines, and best practice principles of trauma-informed and culturally competent care.
Conclusion: Evaluating patient experiences of TVUS consent provides critical insight into whether current practices uphold autonomy, emotional safety, and cultural humility. Findings will inform quality improvement initiatives and support consistent, ethical consent processes.
Take-home message: Strengthening trauma-informed, culturally sensitive consent processes can reduce patient distress, minimise harm, and ensure consistent adherence to professional and institutional standards across services.