BACKGROUND & AIMS:Point-of-care (POCUS) ultrasound measurement of the rectus femoris is a useful tool for diagnosing myopenia. Current literature indicates Dietitians are completing these measurements in research settings with high methodological heterogeneity. We aim to determine the reliability and accuracy of dietitians using ultrasound to measure rectus femoris muscle, after rapid training, compared to sonographers. METHODS:A training program was designed by sonographers and completed by two study dietitians in 12 h. In this prospective cohort study, patients with a diagnosis of chronic liver disease (CLD) were recruited from the outpatient clinics and heathy participants (HP) were opportunistically recruited on-site. Two dietitians and two sonographers marked the ultrasound picture. Thickness, width, circumference and surface area were measured. Inter-rater reliability was presented as an intra class correlation (ICC, 95%CI) for reliability, and Bland-Altman assessment for bias and accuracy. RESULTS:42 HP and 18 patients with CLD were recruited. ICC across the four raters, four ultrasound measurements and across BMI and sex ranged from minimum 0.73 (good) to 0.96 (excellent) in accuracy. For rectus femoris thickness, ICC was similar across both groups: 0.88 (95 % CI: 0.82-0.93) in HP and CLD patients 0.86 (95%CI: 0.71-0.94). Bland-Altman for thickness systematic error of differences between dietitians and sonographers was not statistically significant (0.032 cm, p = 0.554). CONCLUSION:With a standardised training protocol, ultrasound-naïve dietitians achieved both reliable and accurate ultrasound measurements when compared to sonographers in both healthy participants and patients with CLD. Future research should determine the scalability and generalisability of this training protocol.

OBJECTIVES:Sarcopenia and malnutrition have detrimental health related outcomes not limited to falls, weakness, fractures, increased hospital length of stay, increased risk of infections, morbidity and mortality. Ultrasound is an establishing imaging modality that can be utilized at point-of care to measure muscle mass and quality. It is cheaper, less invasive, and more accessible than other gold-standard measurements of muscle mass. It is proposed that dietitians can utilize this measurement in clinical practice to support both diagnosis and monitoring of malnutrition and sarcopenia, however current evidence has not been synthesized. METHODS:The search was completed in May 2024. MEDLINE, EMBASE, PubMed and Cochrane databases were searched. Search terms and search procedures were transposed across different databases based on known Booleen operators. Due to paucity of evidence in the area, a broad search strategy was employed. Simply the combination of synonyms of ultrasound and dietitian within any field was used to ensure any kind of ultrasound measured by a dietitian was captured. RESULTS:The initial search identified 946 titles for review from which 228 duplicates were removed, leaving 718 for screening. After screening, 55 papers remained for full-text review. Ten papers were included for appraisal. All peer-reviewed papers were observational, 441 participants in total were included (both healthy participants and patient cohorts). Study quality was low, with study design, documentation of training, timing of measurement and blinding poorly defined. The reference standard (if any) was inconsistent. All studies were basic research, none were translated into clinical practice. Quad muscle thickness was the most common measurement. Reliability of dietitians was reported in most, with intra-rater ICC ranges from 0.63 to 0.95 between dietitians and 'experts' (intensivists, trained clinicians or sonographers). Training undertaken was reported in half the papers reviewed but details were limited. CONCLUSION:Emerging evidence suggests dietitians have potential to develop skills in measuring muscles with ultrasound. Overall, there remains a paucity of publications in the area, particularly when considering dietitian training and reliability in various ultrasound measurements. There should be progress in Further studies with regard to verifying necessary training for dietitians to ensure accurate readings as an advanced scope of practice for dietitians.

OBJECTIVES:The primary aim of this study was to determine the visualization rate of the corpus callosum (CC) in the mid-sagittal plane of ultrasound examinations performed between 18 and 22 weeks' gestation. The secondary aims were to compare this rate to that achieved 5 years earlier at the same center; assess the need for transvaginal ultrasound; identify fetal head positions most favorable for sagittal CC assessment; and evaluate the impact of maternal body mass index (BMI) and gestational age on CC visualization. METHODS:A retrospective analysis of images from second trimester screening examinations of singleton pregnancies performed between January 2019 and June 2019 was undertaken. The mid-sagittal image of the CC was scored on a scale from 0 to 4, with one point assigned for the visualization of each anatomical part. A score of 4 indicated complete visualization, a score of 1 to 3 was considered partial visualization, and a score of 0 represented nonvisualization. The chi-squared test was used to compare the visualization rates to those achieved 5 years earlier and previously reported by our group. RESULTS:A total of 999 second trimester screening examinations were included in the study. Complete CC visualization significantly improved from 71.3% at initial protocol implementation and training to 92.1% in the current study (P < .001). A transvaginal approach was required in 4.4% of cases. The craniocaudal fetal head position had the highest success rate (98.2%) for CC visualization. The odds of nonvisualization of the CC were 2.6 times higher before 20 weeks (7.4%) than at or after 20 weeks (3.0%) (odds ratio = 2.63, 95% confidence interval [1.20-5.76], P = .012). Higher maternal BMI (≥30.0 kg/m2) was associated with increased rates of nonvisualization in obesity classes I-III. CONCLUSION:Complete visualization of the CC in the mid-sagittal plane is achievable in routine second trimester morphology ultrasound examinations. Improvement in the quality of imaging is possible with a standardized protocol and training.

This article introduces a new evidence-based clinical practice guideline (CPG) for sonographers; Ultrasound assessment of the gravid cervix to assess for risk of spontaneous preterm birth (sPTB). The purpose of this new CPG is to provide evidence-based guidance for sonographers in Australia and New Zealand when making decisions on how and when they should sonographically assess the cervix in the gravid patient. Clinical questions relevant to the sonographic assessment of the gravid cervix were developed to inform the CPG. The primary sources to answer the clinical questions were relevant, existing CPGs. Recommendations in these existing CPGs were appraised for the level of evidence on which they were based and adapted for use in the new CPG. New recommendations were adapted from 19 existing CPGs rated as being based on best evidence and were applicable to three specific patient groups, each at different risk for sPTB. 'How to Guidance', statements about safety, acceptability, feasibility of ultrasound techniques, sonographer training and supplementary material were also developed using information from existing CPGs, relevant literature and the clinical experience of clinical guideline group members. The CPG recommendations, 'how to guides' and areas of future research are presented in this article. The full guideline and its supplementary materials are available at .

With, Sonography, celebrating its 10th birthday, it is timely to reflect on the changes in ultrasound and the role of the sonographer, across the same period. This paper will present the significant changes that have occurred across the last 10 years in a large public hospital network in Australia across a diversity of themes. In the areas where challenges have emerged, the way these were navigated will be described. Documenting this change in ultrasound provision may be valuable to future planning for all key stakeholders.

INTRODUCTION:The increasing usage of positron emission tomography/computed tomography (PET/CT) for detection and monitoring of malignancy has led to an increase in incidental detection of thyroid nodules. Nodules that demonstrate increased avidity for 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) have been shown to carry a high incidence of malignancy and warrant further investigation. At present, there has been limited research on the risk stratification of FDG-avid thyroid incidentalomas. Thus, this study aims to evaluate the efficacy of the ACR TIRADS classification in the risk stratification of such nodules. METHODS:Data were collected retrospectively for FDG-avid thyroid incidentalomas over a 10-year period. Nodules were characterised using the TIRADS classification and, subsequently, underwent fine-needle aspirate cytology. Cytological findings were classified using the Bethesda reporting system. Non-diagnostic samples (Bethesda class I) were excluded. The remaining samples were divided into two groups: benign (Bethesda class II) or suspicious for malignancy/malignant (Bethesda class III or above). RESULTS:Thirty-six percent of low-risk nodules and 45% of high-risk nodules were malignant, respectively (P = 0.516). The sensitivity and specificity of TIRADS for detection of malignant nodules were 56% and 54%, respectively. There were no malignant TIRADS 1 or 2 nodules. The absence of any suspicious sonographic features had a 1.0 negative predictive value. CONCLUSIONS:FDG-avid nodules classified as TIRADS 1 or 2 or have no suspicious ultrasound features have a 0% incidence of malignancy and thus may not require further assessment with fine-needle aspirate cytology (FNA) when detected incidentally. FDG-avid nodules that are TIRADS 3 or above should undergo FNA regardless of size due to the high risk of malignancy and poor sensitivity of the TIRADS classification system.

Chronic liver disease (CLD) poses significant challenges in the developing world. The prevalence of this problem and the health burden on local health services are not well understood. The diagnosis and monitoring of CLD are difficult in these settings because of limited access to expensive imaging with limited mobility and/or liver biopsy. The aim of this project was to develop and implement an efficient evidence-based robust ultrasound protocol for the assessment of chronic liver disease using a hand-held ultrasound device that could be effectively used in the developing world. A protocol was established using scoring systems that have established accuracy for the diagnosis of hepatic fibrosis/cirrhosis and hepatic steatosis. Included in the protocol was the identification of hepatic masses, portal venous enlargement, hepatic size and splenic size. Hepatic steatosis was common, identified in 46 of 94 participants (49%). Hepatic fibrosis was observed in only 13 of 94 participants (14%). A significant limitation of the methodology was the inability to validate the results with biopsy or other forms of cross-sectional imaging. The protocol was successfully implemented in a community in a rural setting in South Ethiopia with a mean examination time of around 6 min. It is feasible to use handheld ultrasound for the screening of CLD in remote settings. This project provides an evidence-based framework for further studies in this area.

The Editorial Board would like to thank all who reviewed Sonography manuscripts in 2020. It is a really important behind-the-scenes activity, and we acknowledge the time spent by all the reviewers in performing the reviews, especially given the special challenges that COVID-19 presented in 2020. The peer review process ensures that manuscripts published in Sonography continue to be of a high standard and relevant to the sonography profession. We thank you all for your commitment to the journal and your time and expertise is greatly appreciated.

BackgroundAccurate estimation of fetal weight is essential in guiding management of fetuses with abdominal wall defects (AWDs), as growth restriction is an important predictor of perinatal morbidity and mortality. Several sonographic formulae are available involving multiple biometric parameters, but abdominal circumference measurements may underestimate weight in fetuses with AWDs. No formula has yet shown superior accuracy.AimsThe objectives of this study were to evaluate, in fetuses with gastroschisis and omphalocoele, the accuracy of a sonographic estimated fetal weight (EFW) formula proposed by Siemer and colleagues, specifically for use in fetuses with AWDs compared to the commonly used Hadlock IV formula in estimating fetal weight, and detecting small for gestational age (SGA) fetuses.Materials and MethodsA retrospective cohort of 113 fetuses with AWDs was identified from an Australian teaching hospital over 13 years. Pregnancy data and sonographic fetal biometry parameters were obtained. The accuracy of each formula in predicting birthweight was compared using Bland–Altman limits of agreement, and the intraclass correlation coefficient between EFW and actual birthweight. Performance of each formula in detecting SGA fetuses was determined.ResultsThe Siemer and Hadlock formulae have similar accuracies for predicting birthweight in fetuses with AWDs. The Hadlock formula has a higher detection rate for SGA < 10th centile and < 3rd centile compared to the Seimer formula (84% vs 68% and 83% vs 67% respectively), albeit with a higher false‐positive rate.ConclusionThere is no clear clinical advantage in using the Siemer formula, which is specifically designed for fetuses with AWDs, over the Hadlock formula to estimate weight in fetuses with AWDs.

The Editorial Board would like to thank all who reviewed Sonography manuscripts in 2019. It is a really important behind-the-scenes activity, and we acknowledge the time spent by all the reviewers in performing the reviews. The peer review process ensures that manuscripts published in Sonography continue to be of a high standard and relevant to the sonography profession. We thank you all for your commitment to the journal and your time and expertise is greatly appreciated.

Obtaining growth and physiologic data in the postnatal laboratory animal is common. However, monitoring growth in utero is far more difficult, with little data available except upon termination of pregnancy. High-resolution ultrasound was used to monitor growth, morphology, and fetal well-being in normotensive and hypertensive rabbits (21 fetuses) at day 16, 20, and 26 of the 32 day gestational period. Set protocols, comparable to those routinely assessed in humans, were devised and followed for each examination. Birth weight was greater in offspring of hypertensive as compared to normotensive mothers (p < 0.001); however, litter size was reduced. The greater birth weight was reflected in growth parameters measured throughout gestation indicating the predictive value of ultrasound. High-resolution ultrasound was a reliable and sensitive method for biometric and morphologic assessment of the fetal rabbit, demonstrating that growth trajectory of offspring of hypertensive mothers may be altered early in gestation.

There are no publications reporting on scan duration and Doppler use during neonatal cranial ultrasound scans. We investigated current practice of neonatal cranial ultrasound at four large tertiary neonatal intensive care units in Australia. Cranial scans were prospectively recorded between March 2015 and November 2016. Variables, including total number of scans, scan duration and frequency and duration of colour and spectral Doppler mode, were extracted. A total of 196 scans formed the final cohort. The median (range) number of scans for each neonate was 1 (1–12). The median (range) overall total scan duration was 309 (119–801) s. Colour mode with or without spectral Doppler mode was used in approximately half of the cohort (106/196, 54%). Our findings comport with our hypotheses. Operators performing neonatal cranial scans in Australia have low overall scan durations. Although the use of Doppler mode during neonatal cranial scans is not standard practice in all neonatal intensive care units, it is used widely irrespective of the degree of prematurity or the presence of brain pathology. Further efforts are required to incorporate recommendations on scan duration and the routine use of Doppler mode during neonatal cranial scans. This is especially imperative given that the most vulnerable neonates with the greater neural tissue sensitivity are likely to be scanned more often.

Point of care ultrasound (PoCUS) has evolved rapidly and is used by many medical specialties. We propose five essential pillars of PoCUS that are necessary framework for hospital-based PoCUS training and credentialing programs. The pillars are: governance, infrastructure, administration, education and quality. It is time to establish these pillars to ensure the best practice in PoCUS use.

Background Reference charts depicting normal growth are important for the sonographic assessment of the pediatric kidney. Limited charts are available for clinical use in an Australian population. Objective To retrospectively collate sonographic renal length measurements in a cohort of low-risk Australian children aged newborn to 16 years to produce a reference table and comparison with other published charts. Materials and methods We identified consecutive pediatric patients who were at low risk for renal disease and had renal lengths measured. After exclusions, we included 941 renal lengths (male 490, female 451). We used linear regression to estimate the relationship of renal length with age, gender and side. We calculated percentile values of renal length according to age categories. Results No statistically significant differences in mean renal length were observed between males and females, or for left and right kidneys. We tabulated reference data and provide them in a reference chart (1-, 2.5-, 5-, 10-, 50-, 90-, 97.5- and 99-percentiles). Conclusion We calculated new reference ranges for pediatric renal length using a larger cohort than previously published, from a population with diverse ethnicity.

Introduction: Familial hypercholesterolaemia (FH) is a commonly underdiagnosed hereditary lipid disorder characterised by increased low density lipoprotein cholesterol (LDL-C). FH predisposes patients to premature cardiovascular disease (CVD). Achilles tendon (AT) xanthoma is pathognomonic of FH and can be detected via physical examination or ultrasound. Objectives: Evaluate the accuracy of ultrasound in AT xanthoma detection compared to physical examination in FH patients. Methods: Forty-two consecutive patients from MonashHEART lipid clinic with likely FH according to the Dutch Lipid Clinic Network Score were included in the study. On physical examination, patients were categorised as xanthoma (+) and xanthoma (−) based on tendon thickness and/or nodularity. On ultrasound, patients were categorised based on AT thickness or presence of hypoechogenic lesions within the tendon. Results: Eighty-four AT were investigated in total. Mean age 35.5 ± 14.7 years, mean LDL-C 5.5 ± 1.95 mmol/L and 47.6% were male. Premature CVD was present in 50% of the patients. The frequency of xanthoma was 73.8% by ultrasound and the median antero-posterior diameter was 5.15mm (IQR 4.7–5.7). Physical examination had sensitivity of 38% [95% confidence interval (CI) 24.7–52.8] and specificity of 73.5% [95% CI 55.6–87.1] in AT xanthoma detection. No statistically significant association between age and xanthoma was observed. Conclusion: This study suggests that ultrasound, used in conjunction with physical examination increases the accuracy of AT xanthoma detection in patients with likely FH.