Australasian Journal of Ultrasound in Medicine

Abstract Introduction/Purpose Teleultrasound connects expert point‐of‐care ultrasound (POCUS) users with remote community and rural sites. Evolving technologies including handheld devices, upgraded image quality, and the ability to transmit over low bandwidth connections increase POCUS education, accessibility, and clinical integration. Potential teleultrasound venues include low‐resource settings, prehospital care, and austere environments (high altitudes, microgravity, conflict zones, etc.). This scoping review assesses current teleultrasound uses and identifies implementation enablers and barriers. Methods Using the PRISMA‐ScR checklist, PubMed, Embase, and Cochrane were searched on 16 August 2024 for teleultrasound studies. Two reviewers independently screened results and abstracted data using a data collection table. 165 articles met the following inclusion criteria: research studies describing teleultrasound, involving humans, including healthcare workers, with remote point‐of‐care or medical ultrasound use, in any setting, and in English. Results Teleultrasound studies were reported in most specialties and across all continents. Most were prospective (100 studies), review articles (27), or case studies (14). Study quality was variable, with 28 high quality, 77 moderate, 54 low, and 6 very low (GRADE assessment tool). Common themes that emerged include (1) type of image transmission method utilised, (2) remote provider training and curriculum development, (3) feedback methods between expert and novice users, (4) technologies and devices used, and (5) enablers and barriers to guide future teleultrasound implementation and training strategies. Conclusion Overall, the teleultrasound literature is heterogeneous in setting, design, and quality outcomes. As teleultrasound technology evolves and the use expands, future studies should standardise protocols and ensure image quality fidelity to optimise remote patient care.

Aubree Anderson

Rebecca G Theophanous

Identifying enablers and barriers to teleultrasound use for remote settings: A scoping review

识别远程环境下使用远程超声的促进因素与障碍：一项范围界定综述

Abstract Purpose The purpose of this study was to sonographically evaluate whether intravenous (IV) flucloxacillin administration was associated with an increased risk of peripheral intravenous catheter (PIVC) thrombus formation. Methods This observational study included participants enrolled as a convenience sample from a larger prospective study of patients with cellulitis receiving IV antibiotics in the emergency department. Point‐of‐care ultrasound was used to evaluate the PIVCs for thrombus formation after insertion and at specified timepoints after IV administration of antibiotic or saline solution through to discharge. The primary endpoint included the presence and length of the thrombus in proximity of the catheter tip. Results Between May 2021 and June 2022, 25 participants were enrolled and received either IV flucloxacillin (n = 10), other IV antibiotics (n = 8) or no IV antibiotics (control; n = 7). PIVC thrombus formation was sonographically detected in 100%, 67% and 17% of patients in flucloxacillin, other and control groups at 6–12 h (flucloxacillin vs. control; P = 0.015), with a mean length of 17.4 ± 8.1 (flucloxacillin vs. control; P = 0.46), 15.5 ± 13.4 (other vs. control; P = 0.73) and 7.3 ± 17.9 mm (control), respectively. Thrombus formation increased significantly in the flucloxacillin group over time (0–&gt;12 h; P = 0.03) but did not increase in the other or control groups. Discussion The administration of IV flucloxacillin appears to promote the formation of a PIVC thrombus visible on ultrasound, but the clinical implications are uncertain. Although the vast majority appear to be asymptomatic, they have the potential to become a precursor to thrombophlebitis and lead to early PIVC failure. Conclusions It was feasible to identify and measure PIVC thrombus sonographically. Ultrasound showed that IV flucloxacillin administration appeared to be associated with more frequent formation of PIVC thrombus, with these increasing in length over time. Further research is required to confirm these findings in larger studies and to identify any clinical implications of the findings.

Andrew C. Bulmer

Rachael Nightingale

Wenu Hewage

Gerben Keijzers

Peter J. Snelling

Ultrasound evaluation of peripheral intravenous catheter thrombus formation associated with intravenous flucloxacillin administration: A prospective observational pilot study

超声评估外周静脉导管血栓形成与静脉注射氟氯西林给药的关系：一项前瞻性观察性初步研究

Abstract Introduction In both highly industrialised and developing countries, obesity is reaching epidemic proportions and increasingly becoming a critical indicator of general morbidity, cardiovascular disease (CVD) and renal dysfunction. A promising trend in detection and management of obesity is the measurement of perirenal adipose tissue (PRAT), increasingly recognised as a metabolically active endocrine organ in itself. Its measurement by ultrasound is used increasingly to indicate visceral obesity and its clinical management. This review synthesises current techniques for measuring PRAT and its potential use as an indicator of CVD. Methods We included clinical studies published between 2010 and 2023, investigating the current practice and use of specific ultrasonographic techniques and assessed the reliability and accuracy of included papers. The risk of bias was assessed using the Downs and Black Checklist, and the methodological quality examined using the Grade of Recommendations, Assessments, Development and Evaluation. Results It found, PRAT measures are predictive of CVD risk factors and the accuracy of ultrasound is comparable to CT and MRI, but there is no consistency in ultrasound technique. The lack of any randomised control trials and the use of 20 different non‐standardised ultrasound techniques across the 21 studies resulted in inconsistent and imprecise clinical observations and interpretations, which decreased the overall quality of the studies. Conclusion This review found the inclusion of ultrasound measures in routine abdominal imaging potentially invaluable but demonstrates the need for standardisation of the perirenal fat ultrasound measuring technique to improve reproducibility and reliability.

Victoria J. A. Baumann

Richard Banati

Jillian L. Clarke

Ultrasound measurement of perirenal adipose tissue indicates cardiovascular disease, but standardisation is needed: A systematic review

肾脏周围脂肪组织的超声测量提示心血管疾病，但需要标准化：一项系统评价

Abstract Introduction/Purpose As the frequency and morbidity of musculoskeletal (MSK) disorders increase, the use of MSK ultrasound has become an important diagnostic and procedural tool. This has amplified the importance of quality MSK ultrasound training for medical professionals. This systematic review evaluated and compared peer‐reviewed journal articles on learning methodologies for MSK ultrasound training. Methods Thirty‐three articles met inclusion and exclusion criteria and were evaluated. Results Results showed a lack of randomised studies that compared learning methodologies. Conclusion There was wide variability of methodology used based on educational and institutional needs. Further randomised control trials need to be conducted to ascertain best educational practices.

Amber J. Vogt

Robert Samuel Mayer

Systematic review of musculoskeletal ultrasound learning methodologies

肌肉骨骼超声学习方法的系统综述

To analyse amniotic fluid volume (AFV), specifically oligohydramnios or polyhydramnios, and associated pregnancy and neonatal outcomes in twin gestations through systematic review and meta-analysis.We utilised systematic review methodology to identify items within published and grey literature resources. Prospective and retrospective studies with a control group were included. Inclusion criteria were as follows: studies in English, twin pregnancy in which AFVs and associated pregnancy and/or neonatal outcomes were evaluated. Exclusion criteria included the presence of an anomalous fetus, chromosome abnormality, monochorionic diamniotic twin pregnancy complicated by twin-twin transfusion syndrome or twin-reversed arterial perfusion, twin gestations undergoing therapeutic interventions (i.e. fetoscopic laser photocoagulation and serial amniocentesis) and monochorionic monoamniotic twin pregnancy.The literature search identified 1068 abstracts, only four met criteria for inclusion and analysis. The pooled data (two studies per outcome) revealed no significant difference in rate of pre-term delivery (OR: 2.94; CI: 0.20-43.81), pre-term delivery less than 32 weeks (OR: 1.97; CI: 0.43-9.12), umbilical cord pH < 7 (OR: 2.66; CI: 0.22-32.51), rate of stillbirth (OR: 4.13; CI: 0.40-42.70), neonatal death (OR: 1.48; CI: 0.05-43.94), rate of NICU admission (OR: 1.38; CI: 0.61-3.11) or rate of small-for-gestational-age (SGA) infants (OR: 1.39; CI: 0.33-5.94).Based on the pooled data (two studies per outcome), there was no difference in the fate of pre-term delivery, umbilical cord pH < 7, stillbirth, neonatal death or SGA infants. What is disturbing is the lack of studies (1946-2020) that analysed the association between AFV and pregnancy outcomes in twin pregnancies.

Dayna Whitcombe

Everett Magann

Susan Steelman

Zhuopei Hu

Songthip Ounpraseuth

Amniotic fluid volume and pregnancy outcomes in twin pregnancies: A systematic review and meta‐analysis

羊水容量与双胎妊娠结局：系统综述与Meta分析

Abstract Introduction This case examines the sonographic and clinical challenge of diagnosing a Klebsiella pnumoniae pyogenic liver abscess with systemic metastatic infection. Case Description The patient in this case study is an 81‐year‐old man who presented with intermittent rigors. Following radiological and clinical assessments, a Klebsiella pnumoniae pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion. Discussion The discussion criticises the terminology when describing hepatic lesions, which result from a Klebsiella pnumoniae infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of Klebsiella pnumoniae pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation. Conclusion Ultrasound operators should be aware of the variable sonographic appearances of a Klebsiella pnumoniae liver abscess and how these features, combined with non‐homogenous terminology, can obfuscate the correct diagnosis.

Martin Necas

Jereme Mitchell

Klebsiella liver phlegmon mimicking a solid liver tumour

拟似实体肝肿瘤的克雷伯氏菌性肝蜂窝织炎

ISSN	1836-6864, 2205-0140
h-index	15

Publication Information	Publisher: Australasian Society for Ultrasound in Medicine，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2018，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

Australasian Journal of Ultrasound in Medicine

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Identifying enablers and barriers to teleultrasound use for remote settings: A scoping review

Ultrasound evaluation of peripheral intravenous catheter thrombus formation associated with intravenous flucloxacillin administration: A prospective observational pilot study

Ultrasound measurement of perirenal adipose tissue indicates cardiovascular disease, but standardisation is needed: A systematic review

Systematic review of musculoskeletal ultrasound learning methodologies

Amniotic fluid volume and pregnancy outcomes in twin pregnancies: A systematic review and meta‐analysis

Identifying enablers and barriers to teleultrasound use for remote settings: A scoping review

Ultrasound evaluation of peripheral intravenous catheter thrombus formation associated with intravenous flucloxacillin administration: A prospective observational pilot study

Systematic review of musculoskeletal ultrasound learning methodologies

Ultrasound measurement of perirenal adipose tissue indicates cardiovascular disease, but standardisation is needed: A systematic review

Klebsiella liver phlegmon mimicking a solid liver tumour