Multiparametric ultrasound (MPUS) combines B-mode, Doppler techniques, microvascular imaging, contrast-enhanced ultrasound (CEUS), and elastography, thereby enhancing diagnostic precision across a wide spectrum of scrotal diseases. Developed under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), these guidelines provide evidence-based recommendations for the clinical use of MPUS in scrotal imaging. Based on the framework of the Oxford Centre for Evidence-Based Medicine, this document outlines the diagnostic value of MPUS in acute scrotal pain, trauma, infertility, focal and extratesticular lesions, cryptorchidism, and testicular incidentalomas. The recommendations highlight CEUS as the reference method for vascular assessment and elastography as a complementary tool for tissue characterization. These guidelines aim to standardize MPUS practice and promote its integration in routine scrotal imaging.

Multiparametric ultrasound (MPUS) integrates B-mode, Doppler techniques and microvascular imaging, contrast-enhanced ultrasound (CEUS) and elastography, enhancing diagnostic precision across a wide spectrum of scrotal diseases. Developed under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), these guidelines provide evidence-based recommendations for the clinical use of MPUS in scrotal imaging. Based on the Oxford Centre for Evidence-Based Medicine framework, this document outlines the diagnostic value of MPUS in acute scrotal pain, trauma, infertility, focal and extratesticular lesions, cryptorchidism, and testicular incidentalomas. The recommendations highlight CEUS as the reference method for vascular assessment and elastography as a complementary tool for tissue characterization. These guidelines aim to standardize MPUS practice and promote its integration into routine scrotal imaging.

The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to produce recommendations on the role of the radiologist in the evaluation of male infertility focused on scrotal imaging. The authors independently performed an extensive literature Medline search and a review of the clinical practice and consensus opinion of experts in the field. Scrotal ultrasound (US) is useful in investigating male infertility. US abnormalities related to abnormal sperm parameters (sperm concentration, total count, motility, and morphology) are low testicular volume (TV), testicular inhomogeneity (TI), cryptorchidism, testicular microlithiasis (TML), high-grade varicocele, bilateral absence of vas deferens, bilateral dilation and echotexture abnormalities of the epididymis. The proposed ESUR-SPIWG recommendations for imaging in the evaluation of male infertility are therefore: to measure TV; investigate TI; perform annual (US) follow-ups up to age 55 in men with a history of cryptorchidism/orchidopexy and/or in men with TML plus “additional risk factors” or with “starry sky” TML; perform scrotal/inguinal US in men with nonpalpable testis; perform scrotal US in men with abnormal sperm parameters to investigate lesions suggestive of tumors; evaluate varicocele in a standardized way; evaluate the presence or absence of vas deferens; investigate the epididymis to detect indirect signs suggesting obstruction and/or inflammation. The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on TV, inhomogeneity, localization, varicocele, vas deferens, and epididymal abnormalities. Cryptorchidism, TML, and lesions should be detected in relation to the risk of testicular tumors. The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal semen parameters in an evidence-based manner, and provide a standardized report to patients.

To determine whether small, incidentally detected testicular lesions can be safely followed up, by assessing growth rate and volume threshold for benign vs. malignant lesions. This retrospective observational study includes a consecutive series of 130 testicular incidentalomas < 1 cm and with negative tumour markers identified from October 2001 to November 2022, which were initially followed up with ultrasound. A total of 39 cases proceeded to surgery during the study period, either due to lesion growth (n = 28) or patient preference/recommendation by the referring urologist (n = 11). For the lesions that were growing, specific growth rate (SGR) and doubling time (DT) were calculated assuming an exponential growth pattern. In addition, the velocity of increase of the average diameter (∆Dav) and of the maximum diameter (∆Dmax) were calculated. Of the 130 nodules that were initially followed up, six disappeared, eight were reduced in size, eighty-eight were stable, and twenty-eight increased in size. For operated nodules all 18 malignant tumours, 8/9 benign tumours, and 2/12 surgically proved non-neoplastic lesions were growing. The best cut-off values of the growth indicators to differentiate between malignant and non-malignant histology were 3.47 × 10−3

BJU InternationalAccepted Articles Research Letter Scrotal Point-of-Care Ultrasound: a UK cross-speciality pilot training course evaluation Akash Sharma, Corresponding Author Akash Sharma [email protected] orcid.org/0000-0001-5229-0431 Department of Radiology, Imperial College Healthcare NHS Trust, London, UK British Urology Researchers in Surgical Training (BURST), London, UK Joint First Authors – both authors contributed equally to the studyCorrespondence: Akash Sharma e-mail: [email protected]Search for more papers by this authorArjun Nathan, Arjun Nathan British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UK Joint First Authors – both authors contributed equally to the studySearch for more papers by this authorMarimo Rossiter, Marimo Rossiter British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorAlexander Ng, Alexander Ng British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorAqua Asif, Aqua Asif orcid.org/0000-0003-3233-7428 British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorMarie Edison, Marie Edison British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorNikita Bhatt, Nikita Bhatt British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorSinan Khadhouri, Sinan Khadhouri orcid.org/0000-0002-1836-8992 British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorNick Mani, Nick Mani orcid.org/0000-0002-5212-1563 Emergency Department, Chesterfield Royal HospitalSearch for more papers by this authorPaul S. Sidhu, Paul S. Sidhu Department of Radiology, Kings College Hospital NHS Foundation TrustSearch for more papers by this authorSimon Freeman, Simon Freeman Department of Radiology, University Hospitals Plymouth NHS TrustSearch for more papers by this authorJulia Burkert, Julia Burkert Emergency Department, Chelsea & Westminster Hospital NHS Foundation TrustSearch for more papers by this authorDean Huang, Dean Huang Department of Radiology, Kings College Hospital NHS Foundation TrustSearch for more papers by this authorAiley McLeod, Ailey McLeod Department of Targeted Intervention, University College LondonSearch for more papers by this authorDaniel Kelly, Daniel Kelly School of Health Care Sciences, University of CardiffSearch for more papers by this authorAishah Azam, Aishah Azam Department of Radiology, Guy's & St Thomas' NHS Foundation Trust British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorVeeru Kasivisvanathan, Veeru Kasivisvanathan British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorHannah Warren, Hannah Warren British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorEleanor Zimmermann, Eleanor Zimmermann British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this author Akash Sharma, Corresponding Author Akash Sharma [email protected] orcid.org/0000-0001-5229-0431 Department of Radiology, Imperial College Healthcare NHS Trust, London, UK British Urology Researchers in Surgical Training (BURST), London, UK Joint First Authors – both authors contributed equally to the studyCorrespondence: Akash Sharma e-mail: [email protected]Search for more papers by this authorArjun Nathan, Arjun Nathan British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UK Joint First Authors – both authors contributed equally to the studySearch for more papers by this authorMarimo Rossiter, Marimo Rossiter British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorAlexander Ng, Alexander Ng British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorAqua Asif, Aqua Asif orcid.org/0000-0003-3233-7428 British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorMarie Edison, Marie Edison British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorNikita Bhatt, Nikita Bhatt British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorSinan Khadhouri, Sinan Khadhouri orcid.org/0000-0002-1836-8992 British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorNick Mani, Nick Mani orcid.org/0000-0002-5212-1563 Emergency Department, Chesterfield Royal HospitalSearch for more papers by this authorPaul S. Sidhu, Paul S. Sidhu Department of Radiology, Kings College Hospital NHS Foundation TrustSearch for more papers by this authorSimon Freeman, Simon Freeman Department of Radiology, University Hospitals Plymouth NHS TrustSearch for more papers by this authorJulia Burkert, Julia Burkert Emergency Department, Chelsea & Westminster Hospital NHS Foundation TrustSearch for more papers by this authorDean Huang, Dean Huang Department of Radiology, Kings College Hospital NHS Foundation TrustSearch for more papers by this authorAiley McLeod, Ailey McLeod Department of Targeted Intervention, University College LondonSearch for more papers by this authorDaniel Kelly, Daniel Kelly School of Health Care Sciences, University of CardiffSearch for more papers by this authorAishah Azam, Aishah Azam Department of Radiology, Guy's & St Thomas' NHS Foundation Trust British Urology Researchers in Surgical Training (BURST), London, UKSearch for more papers by this authorVeeru Kasivisvanathan, Veeru Kasivisvanathan British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorHannah Warren, Hannah Warren British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this authorEleanor Zimmermann, Eleanor Zimmermann British Urology Researchers in Surgical Training (BURST), London, UK Division of Surgery and Interventional Science, University College London, UKSearch for more papers by this author First published: 04 August 2023 https://doi.org/10.1111/bju.16146 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/bju.16146. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Introduction: It is a rare, but recognised phenomenon that malignant testicular germ cell tumours can ‘burn-out’, where the primary lesion spontaneously regresses and presents with no viable remaining malignant cells leaving only a residual ‘tumour scar’, frequently in the context of distant metastatic disease Case Report: We present a case report of a patient who underwent serial ultrasound scans documenting regression of a testicular lesion from a malignant appearance to a burned-out lesion, where subsequent resection and histology demonstrated features of a completely regressed seminomatous germ cell tumour with no residual viable tumour cells. Discussion: To the best of our knowledge, there are no previously documented cases where a tumour has been longitudinally followed from sonographic features of concern for malignancy to ‘burned-out’ appearances. Spontaneous testicular tumour regression has instead been inferred based on the presence of a ‘burned-out’ testicular lesion in patients presenting with distant metastatic disease. Conclusion: This case provides further evidence supporting the concept of spontaneous testicular germ cell tumour regression. Ultrasound practitioners should be aware of this rare phenomenon in men presenting with metastatic germ cell tumour and, additionally, that this condition may present with acute scrotal pain.

INTRODUCTION:This paper reports the results of a rolling audit of sonographer-performed non-obstetric ultrasound examinations undertaken between 2010 and 2020 in a large University Teaching Hospital Ultrasound Department in the United Kingdom. We believe that this represents the largest published audit of sonographer non-obstetric ultrasound examination quality.METHODS:Random samples of sonographer ultrasound examinations were regularly and systematically audited by consultant-level ultrasound practitioners through review of soft copy images and reports. Examination and report quality were assessed against an internal audit standard in 3731 patients over an 11-year period and also against externally set audit standards in 3186 patients over a nine-year period.RESULTS:Both image and report quality exceeded externally set audit standards in all nine years of audit. In the internal audit, the quality standard just failed to be met for the first five years of audit but was achieved in all the subsequent six years.CONCLUSION:This audit provides further information on the quality and safety of sonographer-led ultrasound service delivery within a service that has quality safeguards, readily available support and an active education programme. It is used not only to provide assurance to patients, clinicians, managers and commissioners of this service but also to direct individual professional development and drive an iterative process of quality improvement.

The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required. In patients with splenomegaly (>13 x 6 cm), an imaging, clinical and laboratory evaluation is usually required to determine the underlying cause. Most congenital variants of the spleen, and accessory spleens, have characteristic ultrasound appearances and do not require further evaluation or follow-up. The use of ultrasound contrast microbubbles (contrast-enhanced ultrasound) is of particular value in ultrasound imaging of the spleen when an indeterminate incidental finding is encountered. Splenosis can be confidently diagnosed with contrast-enhanced ultrasound and usually requires no additional imaging or follow-up. The cause of an inhomogeneous splenic parenchyma must be clarified, especially to exclude sarcoidosis or lymphomatous infiltration. Incidental indeterminate focal splenic lesions (with the exception of simple cysts) are often best managed by an interval follow-up examination (initially after 3 months) unless there clearly malignant clinical or sonographic features. For splenic calcifications, including the "starry sky" spleen, no follow-up is necessary. (C) 2021 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

Testicular incidentalomas are non-palpable, asymptomatic lesions, most frequently detected on ultrasound examinations. Each incidentaloma should undergo a standardized diagnostic workup to exclude malignancy and recognize other potentially significant non-malignant conditions that may first present with an incidental finding on scrotal ultrasound. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on management of testicular incidentalomas and describes efficient management strategies with particular reference to the role of ultrasound techniques.

Imaging plays a crucial role in the evaluation of scrotal trauma. Among the imaging modalities, greyscale ultrasound and Colour Doppler ultrasound (CDUS) are the primary techniques with the selective utilisation of advanced techniques such as contrast-enhanced ultrasound (CEUS) and elastography. Despite ultrasound being the mainstay of imaging scrotal trauma, its diagnostic performance is not fully established. Considering these difficulties and their impact on clinical practice, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) established an expert task force to review the current literature and consolidate their expertise on examination standards and imaging appearances of various entities in scrotal trauma. This paper provides the position statements agreed on by the task force with the aim of providing guidance for the use of imaging especially multiparametric US in scrotal trauma. Key Points • Greyscale and Colour Doppler ultrasound are the mainstay of imaging in patients with scrotal trauma. • Contrast-enhanced ultrasound and elastography are the advanced techniques useful as a problem-solving modality in equivocal cases. • This paper summarises the position statements of the ESUR-SPIWG on the appropriate utilisation of multiparametric ultrasound and other imaging modalities in the evaluation of scrotal trauma.

Purpose This study was devised to evaluate the imaging appearances of the interureteric crest (IUC) of the bladder on magnetic resonance imaging (MRI). The primary objective was to determine how commonly the IUC was observed on pelvic MRI examinations. The secondary objectives were to determine the average size of the IUC, its MRI signal characteristics and whether there is variation between men and women. By defining the imaging findings we hope to prevent misinterpretation of normal anatomy on MRI and, therefore, prevent unnecessary further investigations and procedures. Methods We retrospectively reviewed 114 adult patient's magnetic resonance imaging examinations of the pelvis. Two readers independently recorded information about the presence and characteristics of the IUC with a third reader used to arbitrate in cases of disagreement. Results The IUC was demonstrated on MRI in 75% of patients. It was best observed on T2w sequences as a continual ridge of low signal intensity between the ureters. The mean AP diameter of the IUC at its mid-point on the sagittal images was 2.4 mm. Conclusions The IUC is often seen on MRI on T2w images of a non-collapsed bladder. Its characteristic appearance can be used to help the reporting radiologist confidently differentiate identify this normal structure from an area of focal bladder wall thickening that might be misinterpreted as a bladder tumor.

Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.

We present the case of a 14 year old who underwent laparoscopic marsupialisation of a splenic cyst. Postoperative ultrasound demonstrated an echogenic collection in the surgical bed that was initially misdiagnosed as an infected collection/abscess due to its sonographic appearances but was finally correctly identified as haemostatic material that had been packed into the surgical cavity. We subsequently constructed a tissue phantom containing a compressed ball of SURGICEL (r) Absorbable Hemostat and demonstrated that it showed identical sonographic appearances. Haemostatic agents such as oxidised cellulose are often packed within the operative bed to control microvascular haemorrhage. These agents can be observed on a variety of postoperative imaging modalities, in particular ultrasound and computed tomography, and may cause diagnostic error. The critical importance of understanding the details of the surgical procedure and effective communication between the surgical team and ultrasound practitioner is emphasised to minimise the risk of misdiagnosis and unnecessary further imaging and radiological/surgical intervention.

Varicoceles are relatively common particularly in asymptomatic men and are even more prevalent in subfertile men, representing the most common potentially correctable cause of male infertility. Ultrasound (US) is the imaging modality of choice for varicocele evaluation, but there is no widely accepted consensus on examination technique, diagnostic criteria, or classification. In view of this uncertainty, the guideline writing group (WG) of the European Society of Urogenital Radiology (ESUR) Scrotal and Penile Imaging Working Group (ESUR-SPIWG) undertook a literature review and assessment of the quality of relevant evidence. The group then produced evidence-based recommendations for varicocele US examination, interpretation, and classification by consensus agreement. The results are presented in the form of 15 clinical questions with a brief summary of the relevant evidence and the authorised recommendations from the SPIWG. This paper provides a short summary of the evidence evaluation and the complete recommendations.Key Points• Varicocele is a common clinical problem; it is highly prevalent amongst subfertile men and the most common potentially correctable cause of male infertility. • Ultrasound is the imaging modality of choice for varicocele assessment, but there is no generally agreed consensus on the US examination technique or the criteria that should be used for diagnosis, grading, and classification. • This paper summarises the recommendations of the ESUR-SPIWG for standardising the US assessment of varicoceles. This includes examination technique, image interpretation, classification, and reporting.

AIM: To assess prostate magnetic resonance imaging (MRI) image quality and compliance with technical standards between centres in the South West region of the UK. MATERIALS AND METHODS: Fifteen imaging sites in the region submitted seven consecutive anonymised MRI studies. These were assessed by two experienced radiologists in consensus. Overall, subjective image quality for T2-weighted imaging (T2W), diffusion weighted imaging (DWI), and dynamic contrast enhancement (DCE) was scored on a five-point Likert scale. Five additional quality parameters were also assessed visually, including image noise, motion, artefact, and distortion. The degree of compliance by each site with 21 published technical standards was also assessed. RESULTS: Ninety-four MRI examinations were reviewed from across all sites (mean 6.3 scans per site, range 5-7). Mean compliance with technical standards was 63% (range 38-86%). Forty-seven percent of sites did not perform DCE. One site used a 3 T scanner. The percentage of patients with overall quality scores of >= 3 (diagnostically acceptable) were 68% for T2W, 81% for DWI, and 60% for both T2W and DWI. Ninety-three percent of the 45 patients who underwent DCE had diagnostically acceptable studies. By scanner age, the percentage of patients with diagnostically acceptable T2W scores was 53% for scanners >= 7 years and 80% when <7 years (p=0.006). Comparing individual sites, the mean overall quality scores were 2.9 (range 2.2-4.2) for T2W, 3.2 (1.8-4.7) for DWI, and 3.4 (2.5-4.7) for DCE. CONCLUSION: There is wide variation in compliance with recognised technical standards and image quality across sites. If MRI is to replace biopsy in selected low-risk patients, improvements in image quality may be required. (C) 2019 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Splenosis is an unusual condition representing auto-transplantation of splenic tissue following splenic trauma or surgery. When detected on imaging studies, the splenosis deposits are usually misinterpreted as pathological masses. We present a case where a pelvic mass incidentally visualized on an MRI examination, was proven to represent a deposit of splenosis by contrast enhanced ultrasound (CEUS). CEUS demonstrated persistent late-phase enhancement characteristic of splenic tissue. Ultrasound practitioners should be aware of this condition when an unusual abdominal or pelvic mass is encountered in a patient with a history of splenic trauma or surgery. CEUS is ideally suited to confirming the diagnosis.

The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in the many established and emerging applications.

Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.

Introduction Simulation is increasingly used throughout medicine. Within ultrasound, simulators are more established for learning transvaginal and interventional procedures. The use of modern high-fidelity transabdominal simulators is increasing, particularly in centres with large trainee numbers. There is no current literature on the value of these simulators in gaining competence in abdominal ultrasound. The aim was to investigate the impact of a new ultrasound curriculum, incorporating transabdominal simulators into the first year of training in a UK radiology academy. Methods The simulator group included 13 trainees. The preceding cohort of 15 trainees was the control group. After 10 months, a clinical assessment was performed to assess whether the new curriculum resulted in improved ultrasound skills. Questionnaires were designed to explore the acceptability of simulation training and whether it had any impact on confidence levels. Results Trainees who had received simulator-enriched training scored higher in an objective clinical ultrasound assessment, which was statistically significant (p = 0.0463). End confidence scores for obtaining diagnostic images and demonstrating pathology were also higher in the simulation group. All trainees stated that transabdominal simulator training was useful in early training. Conclusions This initial study shows that embedded into a curriculum, transabdominal ultrasound simulators are an acceptable training method that can result in improved ultrasound skills and higher confidence levels. Using simulators early in training could allow trainees to master the basics, improve their confidence, enabling them to get more educational value from clinical ultrasound experience while reducing the impact of training on service provision.