Ultrasound Mapping for Endometriosis. Average Duration

-Routine pelvic ultrasound: ~15–20 minutes
-Mapping ultrasound: ~60 minutes
-Complex/multi-compartment cases: 75–90 minutes

Factors Increasing Exam Duration

A. Expanded Anatomic Survey to different anatomical compartments
B. Pelvic Sidewall Complexity

C. Dynamic Maneuvers. Dense adhesions reduce organ mobility and require repeated maneuvers; and severe pain may necessitate pauses for patient tolerance.

D. Search for Superficial Endometriosis. Lesions are often small, flat, and subtle, demanding:
-Slow, high-resolution sweeps of peritoneal surfaces
-Careful documentation of subtle irregularities, plaques, or peritoneal puckering
-Sensitivity is operator-dependent, and repeated sweeps may be needed.
E. Advanced Techniques:

-Elastography, and sonovaginography add diagnostic accuracy but increase scan length.
-Each step requires acquisition, processing, and storage of large data sets.

Complex Cases: Why Exams Extend Beyond 60 Minutes

-Multi-compartment disease: simultaneous involvement of multiple compartments demands extended scanning and correlation.
-Dense adhesions: poor organ mobility requires repeated maneuvers and cine documentation.
-Severe patient pain: exam interruptions and slower probe manipulation increase exam duration.
-Superficial + deep disease combination: requires both detailed peritoneal sweeps and deep compartment exploration.

-Evaluation of some abdominal structures, such as the abdominal wall and kidneys.

In such cases, the mapping exam may take 75–90 minutes.

This time investment yields significant value. European and Australian guidelines, including ESHRE (2022) and NICE (2024), confirm that diagnostic laparoscopy is no longer the gold standard, reserving it for inconclusive imaging. In this context, dedicating 60–90 minutes to a mapping exam is clinically justified: it avoids unnecessary diagnostic surgeries, improves surgical planning, and supports evidence-based, patient-centered care.