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SAFE aims to improve the diagnosis of deep infiltrating endometriosis by TVUS through education and workshops.

SAFE also provides information where expert ultrasound assessments for endometriosis are currently available.

About SAFE

SAFE consists of a team of gynaecologists who specialised in ultrasound. The organisation strives to improve the transvaginal ultrasound diagnosis of deep infiltrating endometriosis through education and workshops for all imaging specialists.

Endometriosis is a common condition affecting 15% of women in the reproductive age group. Because period pain is common and endometriosis requires surgery for definitive diagnosis, the diagnosis and treatment of the disease is often delayed. Not uncommonly patients are told their symptoms are normal, leading to significant frustration when the disease is finally diagnosed often years later.

The ability to diagnose deep infiltrating endometriosis with transvaginal ultrasound has improved dramatically around the world since 2009. A number of Australian sonologists and sonographers have developed an expertise in this area through overseas training. Because ultrasound is a non invasive technique, the barrier for women with symptoms of endometriosis to undergo the test is lower. Unfortunately not all forms of endometriosis can be detected on ultrasound, but deep infiltrating endometriosis, which is the hardest one to treat, can be diagnosed with a high degree of accuracy. The preoperative diagnosis leads to better outcomes for patients through better preoperative preparation and counselling.

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Every woman referred for ultrasound because of pain or infertility should have access to an expert gynaecological ultrasound which should include a thorough assessment for endometriosis. The ultrasound practices where an endometriosis assessment can currently be performed are listed on this website. The aim of the organisation is to make the list longer each year until it is redundant because the assessment is available everywhere.


Endometriosis is the presence of lining of the uterus (known as endometrium), outside the uterus. Endometriosis occurs because some blood flows back through the Fallopian tubes into the pelvis during a period. Approximately 15% of women will allow those endometrial cells to implant in the pelvis. These endometrial cells behave like the cells in the real lining of the uterus and respond to hormones causing pain during periods. Most of the time these cell implants are just superficial deposits. About 20% of women however will not just allow those lining cells to implant, but also to infiltrate mainly into bowel, bladder and ligaments behind the uterus (uterosacral ligaments). This form of the disease is called deep infiltrating endometriosis (DIE). The treatment of DIE is significantly more difficult. DIE can be diagnosed with transvaginal ultrasound with a high degree of accuracy.

Ultrasound for deep infitrating endometriois

The ultrasound for endometriosis is a normal vaginal ultrasound. Rather than just examining the uterus and the ovaries, the examination is extended to include structures that are often affected by deep infiltrating endometriosis such as the ligaments behind the uterus (uterosacral ligaments), the bladder, the bowel and the pouch a Douglas. With increasing expertise this does not take much longer than a regular transvaginal ultrasound.