ABSTRACT Objective To explore the clinical value of combined elastography in evaluating liver injury and monitoring treatment response in patients with hyperthyroidism. Methods A total of 95 patients with hyperthyroidism were included in the study and divided into two groups: the abnormal liver function group and the normal liver function group, based on serum liver function indicators. All patients underwent ultrasound combined with elastography to measure liver elastic parameters, including E , F , A , ATT, and Vs values. In addition, thyroid function and liver function indicators were collected. All patients were monitored dynamically at Weeks 0, 4, 8, and 12 of treatment. Results The values of E , F , A , and Vs in the abnormal liver function group were significantly higher than those in the normal group ( p < 0.05). Correlation analysis revealed that the combined liver elasticity parameters of both patient groups were strongly positively correlated with thyroid antibodies (TGAb and TMAb) ( p < 0.001). Following treatment, as thyroid function improved, the liver fibrosis index ( F value) decreased significantly ( p < 0.05). ROC curve analysis indicated that the E value possessed diagnostic value for liver injury in patients with hyperthyroidism (AUC = 0.752). Logistic regression analysis identified FT3 as an independent predictor of abnormal liver stiffness ( E value) in patients with normal liver function. Conclusion Combined elastography provided a noninvasive method for evaluating liver injury in patients with hyperthyroidism. The E value demonstrated a relatively high diagnostic value, while FT3 served as an early predictor of subclinical liver injury in these patients.
ABSTRACT A 70‐year‐old woman presented to our medical center for evaluation due to abnormal liver function of 1 year's duration with poor response to therapy. Contrast‐enhanced ultrasound (CEUS): The thickened bile duct wall showed isoenhancement during the arterial and early portal phases, becoming hypoenhanced in the middle and late portal phases. No definite space‐occupying lesions were detected within the liver parenchyma. The clinical diagnosis was ultimately primary sclerosing cholangitis. CEUS shows potential value in clinical applications such as monitoring the degree of bile duct inflammation and observing therapeutic efficacy.
ABSTRACT Genomic medicine is advancing rapidly, bringing significant changes to prenatal care and expanding the role of health professionals. As clinicians responsible for performing prenatal ultrasounds which may detect fetal anomalies and ultimately lead to genetic diagnoses, sonographers should have an understanding of genomic concepts to support a timely diagnosis, optimised patient outcomes, and multidisciplinary care. This article provides an introductory overview of genomics for sonographers, outlining key concepts essential to genomic literacy, testing approaches, and practical strategies to support sonographers in delivering genomically informed care.
ABSTRACT Vision threatening conditions require prompt assessment and timely treatment strategies. Ocular ultrasound is a useful diagnostic tool to complement the clinical examination. Its dynamic nature coupled with high accessibility and portability are advantages that are emphasised by its ability to provide a comprehensive assessment of the posterior segment when funduscopic examination is limited. Commonly, an obstruction to ocular light conducting media, or factors secondary to trauma and/or infection inhibit the clinical examination. The use of ocular ultrasound has also evolved to detect elevated intracranial pressure (ICP) through the measurement of widened optic nerve sheath diameter. To achieve positive patient outcomes, however, the operator must understand the sonographic appearances of ocular pathologies and acknowledge the potential differential diagnoses. As such, this article provides a comprehensive summary of emergent ocular conditions appreciated with ultrasound, the sonographic anatomy relative to each, and serves as a guideline for differentiating benign entities from those requiring urgent intervention.
ABSTRACT Pyogenic liver abscesses are uncommon but potentially life‐threatening intra‐abdominal infections requiring prompt diagnosis and source control. Increasing use of point‐of‐care ultrasound (POCUS) enables early bedside detection and immediate therapeutic decision‐making in critically ill patients. We report the case of a 75‐year‐old female with type 2 diabetes mellitus who presented with fever, abdominal pain and sepsis. Bedside POCUS performed within 24 h demonstrated multiple heterogeneous complex hepatic collections involving predominantly segments IVa, IVb, V, VI, VII and VIII, with internal echogenic debris, posterior acoustic enhancement and absent internal vascularity, highly suggestive of pyogenic liver abscesses. Contrast‐enhanced computed tomography could not be performed because the patient was clinically unstable and unable to tolerate transfer outside the intensive care setting. Early ultrasound‐guided percutaneous drainage performed by the hospital percutaneous surgery team with placement of three drainage catheters enabled rapid source control and evacuation of abundant purulent material. Microbiological cultures confirmed Klebsiella pneumoniae infection, and targeted antimicrobial therapy with meropenem was initiated. Serial follow‐up ultrasound examinations demonstrated reduction in collection size, and the patient showed progressive clinical improvement without procedure‐related complications, allowing intensive care unit discharge after 7 days. This report highlights the role of integrated diagnostic and interventional ultrasound in accelerating bedside source control in critically ill patients with intra‐abdominal sepsis, while also discussing the complementary role of conventional cross‐sectional imaging and contrast‐enhanced ultrasound within the broader diagnostic pathway.
ABSTRACT Background Pediatric acute appendicitis is a leading surgical emergency where ultrasound is the preferred first‐line imaging, yet diagnostic performance varies substantially, prompting interest in machine learning (ML) decision support. Objective To synthesize evidence on ML applications using pediatric ultrasound for appendicitis diagnosis and severity stratification. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines and the Prediction model Risk of Bias Assessment Tool for Artificial Intelligence (PROBAST‐AI), we prospectively registered the protocol (PROSPERO CRD BLINDED) and searched multiple databases from inception. From 1475 records, 1248 underwent screening after deduplication, 216 full texts were assessed, and 11 studies met inclusion criteria (Cohen's κ = 0.82). Results Eleven studies (40–780 patients) were included, with only one cross‐site external validation study. Diagnostic models combining structured ultrasound descriptors with clinical/laboratory features achieved high internal discrimination (AUROC up to 0.993). Across tabular models, internal diagnostic AUROC ranged from 0.91 to 0.96. Severity stratification was less consistent (AUPR 0.70 to AUROC 0.931 internally, dropping to 0.783–0.866 externally). External validation demonstrated transportability limits, with diagnostic AUROC decreasing from 0.96 internally to 0.85 externally. Risk of bias was low in 10/11 studies, though the analysis domain was frequently unclear. Conclusions ML‐enhanced pediatric ultrasound demonstrates strong internal diagnostic performance, but severity prediction and cross‐institutional generalizability remain limited, with documented external performance deterioration. Future research should prioritize prospective multi‐institutional evaluation, standardized outcome definitions, calibration reporting, and clinician‐centered interpretability.
ABSTRACT Fibromuscular dysplasia (FMD) is a rare vascular disease that is idiopathic, segmental, non‐atherosclerotic and non‐inflammatory. FMD primarily affects women between 20 and 60 but can occur in patients of all genders and all age groups. It most commonly affects the renal and carotid arteries but can occur in any arteries in the body. Renal artery stenosis (RAS) is the narrowing of the lumen of an artery or arteries supplying blood to the kidneys. RAS can result from either intrinsic narrowing or extrinsic compression, and is the most common cause of secondary hypertension. RAS resulting from intrinsic narrowing is predominantly caused by atherosclerotic renovascular disease. However, FMD can also cause narrowing of the renal arteries and accounts for 10%–20% of all cases of RAS. Renal artery Doppler ultrasound is commonly used as a screening tool for the screening of secondary hypertension and providing initial diagnosis of FMD and related RAS. CTA, MR angiography (MRA) and digital subtraction angiography (DSA) can also be used to detect RAS caused by FMD, with DSA remaining the standard for the confirmation and identification of RAS and renal artery occlusion. Additional knowledge of FMD and renal Doppler ultrasound can help sonographers to make the correct diagnosis in clinical settings.
ABSTRACT Sonographers in Australia and Aotearoa New Zealand (NZ) currently lack a dedicated career framework (CF), despite the existence of such frameworks in other health professions. Distinct from a competency framework, a CF provides a structured model for career progression, capability development and workforce sustainability. This review aimed to identify the core and supporting components of a CF tailored to sonography in Australia and NZ, by analysing frameworks across medical imaging, allied health, nursing and midwifery. A scoping review was conducted between February 2024 and July 2025. White and grey literature searches were performed using academic databases, professional organisation websites and government sources across Australia, NZ, the United Kingdom, Canada and the United States. Frameworks published in English after 2000, aligned with AQF/NZQF level 7 or higher, and endorsed by recognised bodies were included. Data were extracted on profession, publication details, domains of practice, career levels and components relevant to sonography. Nineteen frameworks were identified, with 15 meeting inclusion criteria. Two core components: domains of practice and career levels were consistently present. Supporting components such as capability descriptors, career level descriptors and professional titles were also identified, offering insights for developing a Sonographer Career Framework (SCF). This review provides a foundation for developing a SCF that supports professional growth and workforce sustainability. Future work should focus on co‐designing the framework with stakeholders to ensure relevance and long‐term impact.
Objective This study aimed to develop and validate an ultrasound-based model integrating conventional ultrasound and calcification patterns (US-CAL) for distinguishing benign from malignant calcified soft tissue masses. Methods This retrospective study analyzed 101 pathologically confirmed soft tissue masses (78 benign, 23 malignant) that showed calcification on ultrasound. We developed two models: the US-CAL model (combining conventional and calcification features) and a conventional ultrasound (US) model. Their performance was compared using receiver operating characteristic (ROC) and decision curve analysis. Results The US-CAL model outperformed the US model, with a significantly higher area under the curve (AUC) (0.91 [95% CI: 0.85-0.97] vs. 0.85 [0.77-0.93]; p < 0.05). It also demonstrated superior sensitivity (0.91 vs. 0.83), specificity (0.73 vs. 0.71), positive predictive value (PPV) (0.50 vs. 0.45), and negative predictive value (NPV) (0.97 vs. 0.93). DCA confirmed a greater net clinical benefit for the US-CAL model. Conclusion The US-CAL model significantly improves the diagnostic accuracy for calcified soft tissue masses, offering a clinically valuable tool to enhance early detection and diagnostic confidence.
ABSTRACT Background Cardiac sonographers (CS) are highly susceptible to work‐related musculoskeletal disorders (WMSD) with over 85% reporting symptoms. To guide targeted prevention efforts, this review investigates the WMSD most frequently experienced by CS and their contributing factors. Methods Studies were eligible if they involved CS, outlined WMSD, or investigated contributing factors. Peer‐reviewed research, systematic reviews, meta‐analyses, case studies, and critical opinion pieces in English with full text availability were included; non‐eligible studies were excluded. The review followed PRISMA guidelines: Medline via the Ovid interface was searched from August 14 to 21, 2024. Data were synthesized using a study specific register and risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Results Five hundred fifty three articles were identified: three screening stages excluded 530, resulting in 23 articles, predominately featuring female and right‐handed scanners. The shoulder, neck, and back emerged as the three most frequent sites of WMSD. Ergonomic factors were commonly associated, including suboptimal scanning posture and inadequate workstation setup. Workload, psychosocial, and sonographer‐related attributes were also implicated. The review was limited by mixed sonographer populations in 13 of the 23 articles included. Discussion Disorders most frequently affected the shoulders, neck, and back of CS, with ergonomic factors commonly implicated. Prevention of WMSD is critical and should prioritise ergonomic training to improve scanning posture and workstation design, alongside workload management and targeted strategies for vulnerable groups. These measures should be supported by conducive work environments and access to mental health resources to reduce future burden and promote prevention.
ABSTRACT Subcapsular haematomas (SCHs) are uncommon but critical complications following renal transplant biopsy. These haematomas occur when blood collects beneath the renal capsule, often due to trauma, surgical interventions or vascular injuries. SCHs can range in severity from asymptomatic to causing serious complications, including graft dysfunction. Early detection is crucial to prevent graft ischemia and complications such as ‘Page kidney’, which may necessitate surgical intervention. This case study details a 50‐year‐old female renal transplant patient who developed a subcapsular haematoma following a renal transplant biopsy. Although the haematoma was initially difficult to detect due to its isoechoic appearance, advanced imaging techniques such as B‐flow and high‐frequency ultrasound probes assisted in the accurate diagnosis. Despite concerns about vascular compromise and the potential for Page kidney, the haematoma did not progress to this severe complication. The case underscores the importance of timely diagnosis and tailored management approaches, especially in complex cases where concurrent rejection and vascular changes are present. This study highlights the role of ultrasound, particularly B‐flow imaging, in managing post‐transplant complications.
Muscle stiffness is a critical biomechanical property that influences joint function and neuromuscular control, with deviations often indicating underlying pathology. Two‐dimensional shear wave elastography (2D‐SWE) is a non‐invasive imaging technique that quantifies muscle stiffness and shows clinical promise in musculoskeletal assessment. The pectoralis major and minor muscles are of interest due to their roles in shoulder function and their susceptibility to treatment‐related changes, especially in breast cancer populations. Despite its potential, no systematic review has yet evaluated the reliability and validity of 2D‐SWE for assessing stiffness in these muscles. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, using PubMed and Web of Science to identify relevant studies. The Consensus‐Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used to assess methodological quality. Five studies met inclusion criteria, all evaluating the reliability of 2D‐SWE for pectoralis muscle stiffness. Intra‐rater reliability ranged from moderate to excellent (ICC = 0.57–0.99), while inter‐rater reliability was consistently good (ICC = 0.85–0.89). No studies assessed validity, and most had doubtful or inadequate quality in key COSMIN domains. This review emphasizes that 2D‐SWE demonstrates moderate to excellent intra‐ and inter‐rater reliability for assessing stiffness of the pectoralis major and minor muscles in healthy individuals. However, the validity of SWE for these muscles has not been established. Given limited demographic diversity, future research should focus on validation in broader populations and protocol standardization to support clinical applicability.
Background Currently, Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing meniscal root injuries, but its high cost and certain limitations make ultrasound a potential alternative. This study aimed to investigate the changes in meniscal extrusion using dynamic ultrasound and assess improvement in symptoms following arthroscopic medial meniscal root repair. Methods This prospective observational study involved 15 patients with medial meniscal root tears. Patient demographics (age, sex, height, weight) were collected at the initial assessment. The degree of medial meniscal extrusion (measured using dynamic sonography) and clinical data (symptom duration, Lysholm, and IKDC (International Knee Documentation Committee) functional scores) were recorded both before and 6 months after meniscal root repair. Results Postoperatively, medial meniscal extrusion decreased across all evaluated knee angles, with statistically significant reductions observed in all positions of posterior and 90 degrees flexion position of anterior ultrasound imaging (p < 0.05). While patients with higher Body Mass Index (BMI) and older age exhibited less improvement, these trends were not statistically significant (p > 0.05). The duration of symptoms before surgery also showed no significant correlation with extrusion reduction. Conclusion This study highlights the value of ultrasonography as a tool for assessing postoperative meniscal root extrusion improvement.
Bicuspid pulmonic valve (BPV) is a rare congenital anomaly, often associated with other congenital anomalies, complicating the patient's condition. We present a rare case of concomitant BPV with secundum atrial septal defect (ASD), resulting in mild right ventricular dilation. Three-dimensional transesophageal echocardiography revealed bidirectional shunt direction (with left-to-right predominance), severe valvular pulmonary stenosis, and post-stenotic dilation of the main pulmonary artery. However, the hemodynamic effect on ASD of increased flow through the stenotic pulmonary valve could not be determined, as the patient refused catheterization. The present report on the co-existence of BPV and ASD refers to the need for further investigations for a more accurate diagnosis of the accompanied cardiac anomalies, assessment of the risk of further cardiac complications, and the interventions required to reduce them.
Introduction Patient or visitor violence against healthcare workers is a common occurrence. There is a paucity of research in this area, especially around violence and sexual harassment against Australian sonographers. The aim of this research was to investigate the prevalence and types of patient or visitor workplace violence targeted towards qualified Australian sonographers.Methods An anonymous online survey was used to investigate the prevalence of different types of violence towards Australian sonographers in the 2 years prior to September of 2023. The survey used a validated workplace violence survey as a template and included questions on verbal, physical and sexual harassment.Results Participants (185/311 (59%)) reported at least one type of patient initiated violence over 2 years. Similar to previous research, the most common form of violence was verbal violence.Conclusion We demonstrate continuing occasions of violence against Australian sonographers. There was no evidence of a decline in verbal or physical violence experienced by Australian sonographers, with verbal abuse remaining the most prevalent form of WPV. Although there has been one other study investigating WPV against sonographers in Australia, this is the first to report on sexual harassment against Australian sonographers.
Australia has established important foundations for recognising advanced sonography practice through a defined graduate scope of practice and a national competency framework aligned with Australian Sonography Accreditation Registry (ASAR) accreditation. Emerging work on clinical supervision and a career framework further signals intent to support capability development and workforce progression. However, despite these strong structural foundations, there remains limited clarity around the practical enablers and barriers that determine if sonographer reporting can be implemented safely, consistently, and at scale within the Australian health system. This commentary examines whether Australia is ready for a governed sonographer reporting pathway. Drawing on international reporting models and current Australian policy settings, it explores the conditions under which sonographer reporting may contribute to improved service access, efficiency, and workforce sustainability. It argues that reporting should be framed as a service delivery and health system reform underpinned by defined governance, rather than solely as an issue of professional role expansion and autonomy. Coordinated action is required from governing and professional bodies to establish a framework that enables suitably motivated and prepared Australian sonographers to progress to a formal reporting role.
