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This episode is brought to you by Google Chrome. You think you know a browser, but Gemini and Chrome, that's new. It can help you with practically anything on the web, like restoring a vintage motorcycle from a 50 page restoration block. Or finally break down that long article you've had open for weeks. Gemini and Chrome is here for it, ready to make anything online make sense. There's no place like Chrome. Check responses set up, required compatibility and availability various 18 plus. Are all batteries the same? That's like asking if all soccer players are the same. Take Messi, the most decorated player ever. Is there any other player who has achieved that? No, just him. Now take Duracell. Is there any other battery with power boost ingredients inside? No, just Duracell. Remember, goats only trust goats because they're built different. And Messi only trusts Duracell. Foreign. Well, the old saying goes, necessity is the mother of invention. Yeah, I mean, innovation is on the move. That's great. Sometimes you do things out of necessity and it's good. I mean, I'm all for innovation, but sometimes you do something that you're like, we're gonna do what it is. Okay. It is a win. It's a little weird, but it's a real sol to a problem, especially of access to care. Or sometimes patients just don't want to go in and expose their genitals to a complete stranger for something like a transvaginal ultrasound. So I get it. I get it. And this is why the diy. Do it yourself. At home gynecology market has expanded, right? I mean, honestly, it's exploded. There's home screening for STIs. You can use the teal wand. Not a sponsor. We've covered that in the past. That goes up into the vagina, has a little brush and it collects cervical material for at home HPV testing. We've covered that. Now you can send in a sample, somebody can come to your lab, to your, to your lab, to your home and collect a little lab sample For a cancer guard that's got its own issues, that is a multi cancer screening blood test that you can do at your house, like cologuard. But this is through the blood. Using biomarkers for cancer, that's a whole other issue. That's got some accuracy. You know, you gotta know statistics for that thing to work. But my point is the at home market has really expanded. Well, because the at home market is real and because some patients don't have access to sonography, somebody thought. And it's a, it's a good thought. Hey, we need some patients that are in remote centers to have a transvaginal ultrasound, but they can't get to or won't go to where they need to get that care. Why don't we package up an ultrasound, a little handheld device, put it in the mail, have them recruited under a trial, and we'll have them talk to a trained sonographer in real time who has access to the images, and they can collect their at home transvaginal ultrasound themselves. Could you imagine telling somebody, one of your partners, hey, I'm gonna write this protocol or I wrote this protocol of at home transvaginal ultrasound. Yeah, we can do this. It's an at home trans vaginal ultrasound protocol. It's a little out there, but it is a thing. Not only is it a thing, but patients actually participated from 12 different locations in the US and it has been published already in JAMA Network Open. This just came out on July 6, 2026. I am not saying that this is mainstream. I'm saying this is still investigational. Actually, the handheld ultrasound that they used in the Vajuju is, is an investigational model. I'll go over that in a minute. But here's how this is expanded, y'. All. There is now the proposal of DIY at home vaginal ultrasounds. Yeah, I'm not saying again, it's legit and I'm not saying right now it's, it's mainstream. But this is actually a large trial that took place over several years. Again, 12 different locations in the US and this is now published. This was called The Self Defense Gen 1 evaluation. Self Gen 1. Catchy, right? That actually stands for Sonograms enable looking forward, get your information one. Yeah, all of that is Self Gen one. The sonograms Enable looking forward, get your information. We're going to talk about it in this episode. We're just trying to fulfill our life calling and our mission. This is Dr. Chapa's OB GYN no Spin podcast. I like that voice of surprise. You. What is it? I think that's a SpongeBob episode. You what? You what? You sent patients a transvaginal transducer to do their own ultrasound? Yeah, it's exactly what they did. Look, I love this idea. I think this is so weird and wacky and, you know, out of the box thinking that, hey, why not, man? Why not? I still. Obviously there's a lot of questions here and their total N, which was like 263 patients, obviously needs to be reproduced on a larger scale, but why not, man? If there's a way to collect a good image. And I would have been fascinated by this if this was trans abdominal pelvic, I'd have been like, okay, sure. No, no, no. Transvaginal, this is like, hey, I'm gonna send you something. You put it inside the vagina. Not a toy, it's a medical device here. And I'm gonna work with you on a secure iPhone that I'm gonna send you. These are refurbished secure iPhones. And we're going to communicate this with audio only. No video, please, please don't send a video. You know, no FaceTime. And I'm going to guide you through this so we can get some image capture and I can see the images in real time. It's phenomenal. But look, man, I work with medical students and residents and I'm telling you in person. Seeing a resident, a brand new intern or a medical student with patient consent, of course, you know, put the transvaginal transducer in and they can't find the uterus and she has one because they're totally aimed in the wrong direct direction. It's a little frustrating. So I'm amazed that this was done transvaginally. Okay, so I'm going to tell you very quickly the quick little how this thing was done, then I'm going to give you the details of this and if you want to know if this worked. Yeah, I mean it did, but it would take a lot of work to implement because the quote, unquote trained sonographer that is getting this images is not like your office ultrasound. You know, provider, they had a specific many months training, including classroom and other hands on training to do this. So they would be qualified and certified to participate in this basically telemedicine, teleultrasound thing. Now these were not pregnancies. I want to be clear. These are not looking for transvaginal cervical lengths. These are pelvic ultrasounds done vaginally in premenopausal women and they could not have had a hysterectomy. Okay. Because then you don't know what you're looking at. So let me, let me just read you the design, setting, why this was done, and I'm gonna give you the details. Right. The easy, the easiest is why it was done is because we're trying to break through some, some barriers to care, some social determinants of care to see if this works. And the patient ages were 22 to age 50. Okay, so quote, this was a prospective interventional single group non randomized clinical trial with blinded review of Collected images from, from premenopausal women age 22 to 50, end quote. Look at all the different locations where patients came from. Right. There was a total that had ultrasounds completed of 263. I'll tell you those here in just a minute. But these came from Florida, Massachusetts, Maryland, Maine, Minnesota, New Hampshire, Texas, Utah, Virginia, Vermont and Washington D.C. this didn't just happen. This actually was collected for between July of 2022 and July of 2023. So in that span and the data was analyzed from April to September of 2025. And now of course it's published in July of 2026. And, and the take home messages can at home pelvic transvaginal ultrasound, guided by verbal communication, provide images that are worthwhile. That's it. And also, you know, did they, did they think it was tolerable? Would they recommend that? They call that the, the nps, the participant Net Promoter Score. In other words, would the person self promote this to somebody else? I mean, how fancy is that? The nps, the participant Net Promoter Score? Because saying patient satisfaction just is not fancy enough. Right. So number one, where the image quality sufficient enough to come up with some kind of read by a trained physician and would they recommend this to somebody else called the Net Promoter Score, the nps? Now I know you got questions because you should. How are these patients gonna do transvaginal ultrasound by themselves with telemedicine? True. It's a good question and I'm gonna get into this. First of all, remember that these patients came from online advertising. There were social media groups that put this out. Some women's professional networks talked about this or direct physician referral, which means that already there's a potential here for some user because these patients tend to be have been selected and or self selected. They tended to have some kind of higher health literacy. Okay, so let me just be very honest. I don't mean this in a bad way, but I've got some patients who I can't give insulin to when they're pregnant because even on an insulin pen they don't have the health literacy. That insulin pen could be a weapon to themselves as they misinject themselves and run hypoglycemic risk. I have very poor health literacy to a high percentage in my patient population. At the same time, I've got those that are, you know, master's level students or graduate students. So I, I've got the mix. But, but in general this has to be done with somebody who can do this, has some basic idea of where, where Their vagina is where their uterus is and can hold like a 1 pound weight in their hand. That's a small bar. It's only like a 1 pa. A 1 pound weight which is the weight of the transducer. And feel comfortable self putting that into the vagina. All right, the patient ages were between 22 and 50. Now let me give you their recruit so you know who we're talking about here. They had to have a BMI less than 40, they had to manipulate the transducer with one hand. They had to be non pregnant and, and, and, or not postpartum. Right. So nothing have to do with pregnancy. And they had to have no known gynecological malignancy. And if they had a hysterectomy or oophorectomy, they were also excluded. Okay, so you want your run of the mill, otherwise quote unquote, low risk gynecology patient age 22 to 50 with a BMI less than 40 for this transvaginal trial. Okay, now if you're going well, how do they. What kind of transducer is this? Well, it doesn't come with a monitor. It's just a handheld investigational tool. And the name of that is the Turtle Health ultrasound scanner. I would have called it something else, but Turtle, it is what it is and it is investigational. Okay? So you know, they took this questionnaire, they did this kind of, you know, health literacy kind of thing and then they said, yes, you're enrolled. I'm going to send you the investigational Turtle Health ultrasound scanner and a secure eye iPhone so that you can talk to the sonographer. Okay? And so you had to have this thing in place in order for the participant to participate in this. Now, real quick word about the sonographer. The sonographer was invested into this. Let me tell you how they, how this ultrasound sonographer had to be trained to do this remote telehealth transvaginal ultrasound information. Okay, now remember, this is without looking at the patient. This is just audio quote. This training meaning for the sonographer included two months of classroom work followed by involvement in a training trial. The total length of training was five to six months, end quote. So yeah, so you, it's not like, hey, just talk them through it, they'll be fine. No, it's a very structured way to guide these patients to make sure that they are getting the images that they need. Remember, this is in real time with the ability to do cinema, to go back and forth to look at the image. So it's a remarkable, remarkable task. Okay. This episode is brought to you by Google Health. Stop chasing someone else's definition of health. What matters is what's healthy for you. Google Health offers a new kind of coach built with Gemini for effortless tracking, sleep insights and holistic coaching tailored to you. Visit googlestore.com to learn more and start a new relationship with your health. Requires Google Account, Google Health App, Internet and Google Health Premium subscription. Features subject to change. Availability and results vary. Not intended for medical purposes. Works independently of Gemini apps. Check responses for accuracy. Your team just added its 67th AI tool and also your 67th security blind spot. The good news, the Vanta agent works like a GRC engineer in the background, finding every app your team uses, scoring the risk and drafting fixes for you. Vanta is the platform used by over 16,000 fast moving companies like Ramp Cursor and Harvey who are shaping the future with AI and staying ahead of AI risk. Get started@vanta.com now it states' Notably, not all sonographers who began this training achieved the qualification, which highlights the unique skill required for this role. I'm reading directly from. That's not me editorializing. I'm reading directly from, from the manuscript. This is a detailed training issue that the stenographer has to go through. So a total of about 5 to 6 months. QUOTE Sonographers use scripted dialogue to capture the images required for standard gynecological imaging according to AIUM guidelines. Right. So that's the American Institute of Ultrasound and Medicine. So they weren't just doing their own thing. These were AIM protocols. Image were captured in seven cine clips that allowed for separate sagittal and transverse views of the uterus, right ovary, left ovary, cervix and posterior cul de sac, end quote. So this is, I mean this is like doing some work here. So I'll just put it up into the vagina and it scans its own, you know, gives you a 3D rendering. They've got to walk through certain passages here with the patient to make sure that they get the right images, including, you know, taking a look at antral follicles to make sure that they really are looking at the ovary. I mean it's detailed. Okay. So the, my point is the patients had to be vested. The sonographer who's doing the telehealth education and or guiding had to be invested. And this is a detailed deal. Amazing. Now a total of 265 participants participate participated in this with the mean age being 32 and the mean BMI being 27. Okay, now out of the 265, 263 ultrasound scans were completed. All right, so the total N, Even though it's 265, two were excluded. 263 scans were completed. Now remember, these were all red. These are trained physicians who said, are these images valid here? Let me just give you the nuts and bolts here so we can be done with this because again, this is just so novel. Quote, image quality showed that 253 at home ultrasound scans, that's 96.2%. Guys, 96.2 met diagnostic quality while 10 of them, so 3.8% did not. Y', all, 96% had images that are like, yeah, I can read this, I can do something with this. And they did it themselves. Being guided through a phone, secure iPhone, with a trained sonographer who underwent five to six months of training. Remarkable. I mean, honestly, you talk about thinking outside the box. Amazing. I don't know if this is going to take off, but just the ability, the fact that they had this ability to do this, remarkable. Now the nps, the NET Promoter scale score, of course, was higher at home ultrasounds compared with in clinic ultrasounds. Because who wouldn't want to just do this at home? Now I get it. Some patients don't want to do it and they feel kind of wiggy about it. I understand that. But the score was significantly higher when they did it at home compared to in the clinic, which just makes sense. No adverse events were reported. So the brief conclusion was this non randomized clinical trial of at home pelvic ultrasound in premenopausal women demonstrate that broad use of at home gynecologic ultrasound technology is feasible, safe and preferred by participants and sonographers compared with in clinic ultrasound. End quote. Amazing. Amazing. Now, don't tell your high risk OB patient, hey, I'm going to give you an ultrasound probe and you go and do your cervical lengths at home. We're not talking about that. These are non pregnant, non postpartum women. But it does open up the door to who knows what medicine is going to look like in 10 years. Maybe this is going to be a thing. Maybe we only bring our real high risk patients, whatever that means, in for in clinic evaluation. This showed that at home transvaginal pelvic ultrasound, looking at, you know, by trained professionals who know how to read an ultrasound, following AUM protocol said, yeah, this actually seems, this seems to work. This is actually a thing at 96%. Just remarkable. Remember that this was a blinded review of the collected images. But so again, just hey, read these images, let me know what you see. And 96 said, I can come up with something here. It is truly remarkable. This just came out Once again in JAMA Network Open. This was on July 6, 2026. The title of this, I don't think I gave you the official title, is as you would expect, quote, at home transvaginal Pelvic ultrasound and image quality in premenopausal women. A non randomized clinical trial. End quote. And if you remember, this is the self gen one cohort. The sonograms enable. Looking forward, get your information. One cohort, right. Can this work in reproductive age women for both diagnostic quality and participant satisfaction with at home transvaginal ultrasound? And the answer seems to be yes, it can. Remarkable. You know, is this going to take off? Is this going to be a thing? I don't know. I want it to work, but boy, again you've got to take a look at patients with high, somewhat moderate to high health literacy who know what they're doing and have investment in these ultrasound professionals, technicians who would go through five or six months of training to get this image quality. Man, I've tried guiding, you know, medical student and new intern in the room to no go the other way. No up. Nope, no go the other way. Rotate this way. And I don't have the patience for that. I'll just tell you right now. So kudos to these ultra ultrasonographers who did this remotely looking at real time images and say, no, you got to go back and take another look at the ovary because I didn't like that view. It is honestly remarkable. Podcast family, I just want to let you know what is hot in press. This is out again within the first week of July in JAMA Network open. Podcast family, as always, we're thankful for you. We're glad you're part of our podcast community. And now that we've done all that, Michael, let's take it home. This is Dr. Chapma's OBGYN no Spin podcast. Sam.