Endometriosis imaging in the community setting: implementation of the SRU consensus recommendations on routine pelvic US

Endometriosis is a common gynecologic disorder with a significant burden of morbidity that is often subject to substantial diagnostic delay. While transvaginal ultrasound (TVUS) is the first-line imaging tool for symptoms like chronic pelvic pain and infertility, it has limitations in detecting deep endometriosis. In 2024, the Society of Radiologists in Ultrasound (SRU) issued recommendations to enhance detection by incorporating additional techniques into standard TVUS. This article outlines practical adaptations to improve diagnostic accuracy with minimal extra scan time in community practices. It covers patient selection, stakeholder involvement, training, and quality assurance while addressing implementation challenges. Community ultrasound practices play a key role in early detection, guiding patients toward appropriate care. Graphical abstract Similar content being viewed by others Data availability No datasets were generated or analysed during the current study.

Mowers EL, Lim CS, Skinner B, Mahnert N, Kamdar N, Morgan DM, et al (2016) Prevalence of endometriosis during abdominal or laparoscopic hysterectomy for chronic pelvic pain. Obstet Gynecol 127:1045–53. De Corte P, Klinghardt M, von Stockum S, Heinemann K (2025) Time to diagnose endometriosis: current status, challenges and regional characteristics-a systematic literature review. BJOG 132:118–30. Mehedintu C, Frincu F, Brinduse LA, Carp-Veliscu A, Bratila E, Hennetier C, et al (2021) Postoperative assessment of the quality of life in patients with colorectal endometriosis. J Clin Med 10:5211. Becker CM, Bokor A, Heikinheimo O, et al (2022) ESHRE guideline: endometriosis. Hum Reprod Open 2022(2):hoac009. Bartlett DJ, Burkett BJ, Burnett TL, Sheedy SP, Fletcher JG, VanBuren W (2020). Comparison of routine pelvic US and MR imaging in patients with pathologically confirmed endometriosis. Abdom Radiol 45:1670–9. Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, et al (2016) Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 48:318–32. Young SW, Groszmann Y, Dahiya N, Caserta M, Yi J, Wasson M, et al (2020) Sonographer-acquired ultrasound protocol for deep endometriosis. Abdom Radiol 45:1659–69. Crivellaro PS, Rehman I, Chang S, Duigenan S, Holmes S, Hurrell C, et al (2024) Current practice patterns, challenges, and need for education in performing and reporting advanced pelvic US and MRI to investigate endometriosis: a survey by the Canadian Association of Radiologists Endometriosis Working Group. Can Assoc Radiol J 75:38–46. Alcázar JL, Eguez PM, Forcada P, Ternero E, Martínez C, Pascual M, et al (2022) Diagnostic accuracy of sliding sign for detecting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 60:477–86. Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V, et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 18:157–61. Young SW, Dahiya N, Yi J, Wasson M, Davitt J, Patel MD (2021) Impact of uterine sliding sign in routine United States ultrasound practice. J Ultrasound Med 40:1091–6. Pang EHT, Lee CE, Lee A, Khalifa EA (2024) Quality improvement report: the sliding sign initiative—facilitating earlier detection of deep endometriosis in an academic US department. Radiographics 44:e240082. Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, et al (2024) Society of Radiologists in Ultrasound consensus on routine pelvic US for endometriosis. Radiology 311:e232191. Salem S, Cargill Y, Fong K (2016) Joint CAR/SOGC statement on performing ultrasound examinations of the female pelvis. J Obstet Gynecol Can 38:84–93. AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Female Pelvis (2020) J Ultrasound Med 39:E17-E23. Fraser MA, Agarwal S, Chen I, Singh SS (2015) Routine vs. expert-guided transvaginal ultrasound in the diagnosis of endometriosis: a retrospective review. Abdom Imaging 40:587–94. Abrao MS, Gonçalves MO, Dias JA, Jr., Podgaec S, Chamie LP, Blasbalg R (2007) Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 22:3092–3097. Ghezzi F, Raio L, Cromi A, Duwe DG, Beretta P, Buttarelli M, et al (2005) “Kissing ovaries”: a sonographic sign of moderate to severe endometriosis. Fertil Steril 83:143–147. Guerriero S, Pascual MA, Ajossa S, Rodriguez I, Zajicek M, Rolla M, et al (2019) Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program. Ultrasound Obstet Gynecol 54:262–269. Tammaa A, Fritzer N, Strunk G, Krell A, Salzer H, Hudelist G (2014) Learning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum. Hum Reprod 29:1199–204. Langley GJ et al. (2009) The improvement guide: a practical approach to enhancing organizational performance, 2nd edn. Jossey-Bass, San Francisco. Author information Authors and Affiliations Contributions J.L.L. and E.H.T.P. wrote the main manuscript text and prepared the figures. C.J.Y.H provided institutional data and relevant tables. Both C.J.Y.H. and J.J. provided community-practice specific input. A.Z.K assisted with literature review. All authors reviewed the manuscript. Corresponding author Ethics declarations Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Li, J., Yong-Hing, C., Jessup, J. et al. Endometriosis imaging in the community setting: implementation of the SRU consensus recommendations on routine pelvic US. Abdom Radiol 50, 4878–4885 (2025). https://doi.org/10.1007/s00261-025-04906-y Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-025-04906-y