The examination of choice is a pelvic US with endovaginal imaging, since this defines subtle soft tissue characteristics of the adnexa and uterus more effectively than CT. Ovarian torsion and other vascular abnormalities can also be assessed utilizing the Doppler component of the examination. If a potential ovarian, endometrial, or cervical neoplasm is identified the next examination is a CT of the abdomen and pelvis with IV and oral contrast to assess the nodal sites and other potential locations of metastatic disease and stage the tumor preoperatively. MRI may have a role in endometrial and cervical cancer as a second line examination. PET/CT may also have a role; please discuss these situations with the NM physician for guidance.