ORLANDO -- Radiology still dominates when it comes to interpreting gynecologic ultrasound, but there’s more parity now among specialties in providing this service, according to findings presented at the 2025 American Institute of Ultrasound in Medicine (AIUM) annual conference.
In her presentation, Morgan Snow, MD, from the Orlando Health Winnie Palmer Hospital in Florida discussed her team’s research results, showing that radiologists perform nearly 60% of transvaginal ultrasound (TVUS) exams and more than three-fourths of pelvic nonobstetric ultrasound exams in Medicare patients. However, other specialties such as ob/gyn interpreted a greater proportion of exams over time.
“There is a substantial proportion of ob/gyns providing this service, which has important implications for residency training requirements,” Snow said.
Morgan Snow, MD, explains her team's results showing how while radiology is still the dominating specialty in providing gynecologic ultrasound services, ob/gyns are gaining ground.
Ultrasound is a go-to imaging technique for diagnosing various gynecologic and obstetric conditions. Radiologists traditionally lead interpretation for gynecologic ultrasound studies, even though obstetric ultrasound exams are typically interpreted by obstetricians and gynecologists.
Snow noted that there are limited data examining the proportion of gynecologic sonography services by specialty. She added that gynecologic ultrasound is growing as an independent entity.
Snow and colleagues added to the literature, breaking down interpretation services by specialty for TVUS and pelvic nonobstetric ultrasound exams by analyzing Medicare data collected between 2018 and 2022. They then evaluated trends by geographic region.
Overall, radiologists most commonly performed these pelvic ultrasound services, followed by ob/gyn specialists.
| Frequency of pelvic ultrasound services performed by specialty | ||
|---|---|---|
| Specialty | TVUS exams | Pelvic nonobstetric exams |
| Radiology | 59.7% | 76.4% |
| Ob/gyn | 36.7% | 12.8% |
| Urology | 0.1% | 6.9% |
| Advanced practice | 0.6% | 0.4% |
| Other physician specialties | 0.7% | 3.2% |
However, the proportion of radiology-interpreted exams decreased over the five-year study period. The Northeast region experienced the largest decrease in pelvic nonobstetric exams interpreted by radiologists, falling from 75.4% in 2018 to 69.8% in 2022.
Also, the Southern region saw a greater share of ob/gyn specialists interpreting TVUS exams in 2022 than radiologists (49% versus 45.5%). Snow said this finding is of interest for future studies.
She highlighted that these findings could help inform regulations and standardization of performing these services.
“Training and quality monitoring will be key going forward, given the increasing diversity of specialties and provider types engaged in gynecologic ultrasound,” Snow said.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
