Hysterosalpingogram

What it does

Hysterosalpingogram reads the fluoroscopy images of an HSG, the X-ray test of the uterine cavity and the fallopian tubes in a fertility work-up. Contrast is injected through the cervix while a short series of images is taken; the run follows it from the cavity into each tube and out into the peritoneal cavity.

For each tube it answers the two questions of the test: does contrast fill the tube, and does it spill freely from the fimbrial end? The answer per side is one of four: patent, proximal occlusion, distal occlusion, or hydrosalpinx (a distended, distally blocked tube). The images that show fill and spill are returned with the answer.

Intended use

Decision support for the clinician who performs and reports the HSG, very often a gynaecologist or fertility specialist rather than a radiologist. A structured per-tube answer, tied to the frames that show it, gives every operator's report the same structure and supports the next step in the fertility plan.

Who it is for

Gynaecologists, reproductive endocrinologists and fertility specialists, radiologists who perform HSG, and fertility clinic teams. Developers can connect the run to a fertility clinic record or a fluoroscopy archive to store tubal findings as structured data.

Accepted input

• DICOM X-Ray Radiofluoroscopic images, including Enhanced XRF multi-frame objects and spot images.
• A short series covering the early filling of the cavity, filling of the tubes and the late image showing spill.
• PNG or JPEG exports from a fluoroscopy unit, read without calibration.

Requirements

Requirement	Why
Images from early filling to late spill	Patency is judged from the sequence, not one frame
Both cornual regions and adnexa in the field	Each tube is assessed from its origin to its fimbrial end
Image orientation or laterality marker	The answer is given per side
A late image after injection	Shows whether the spilled contrast spreads freely in the pelvis

Optional context

Age, duration of infertility, previous pelvic infection or surgery and a previous HSG can be given in clinical_context; they shape the guidance in the result.

The result

One JSON result whose patency section holds a per-tube classification, with key images marking fill and spill.

Section	Content
Tubal patency	Per tube: patent, proximal occlusion, distal occlusion or hydrosalpinx, with the key images
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

What each answer means

Answer	Image pattern
Patent	The tube fills along its length and contrast spills freely into the peritoneal cavity
Proximal occlusion	No contrast enters the tube beyond the uterine cornu
Distal occlusion	The tube fills but contrast does not spill from the fimbrial end
Hydrosalpinx	The tube is distended with contrast and blocked at its distal end

Standards

• DICOM: SR with the per-tube classification, GSPS marking each tube on the key images, Encapsulated PDF.
• Terminology: SNOMED CT codes for tubal occlusion and hydrosalpinx, RadLex anatomy terms.