Table 3.

Overview of the main open research questions and areas of development of geriatric thoracic ultrasound identified by the GRETA Group panel

Field	Open research questions on thoracic ultrasound
Technical requirements and settings	What are the best technical requirements of ultrasound machines to optimize visualization of complex pulmonary pathologies typical of older patients? What is the best technique of thoracic ultrasound examination in geriatric patients?
Modality of reporting ultrasound examinations	What is the best way to report thoracic ultrasound examinations with multiple abnormalities, typical of multi-morbid older patients? Can geriatric thoracic ultrasound benefit from the application of a standardized report form?
Diagnosis and monitoring of pulmonary consolidations	Is thoracic ultrasound in older patients able to distinguish aspiration pneumonia from conventional bacterial pneumonia, especially in patients with known dysphagia? Is the diagnostic performance of thoracic ultrasound comparable to that of high-resolution chest computed tomography (HRCT) in identification of pneumonia in geriatric patients?
Diagnosis and monitoring of pleural effusions	What is the best method to estimate severity of pleural effusions and monitor their evolution with ultrasound in older patients? Is ultrasonographic assessment of effusion echogenicity to distinguish exudate from transudate associated with reduced number of invasive pleural procedures in older patients? Is the use of contrast-enhanced ultrasonography associated with reduced complications during pleural drainage positioning in older patients?
Diagnosis and monitoring of other pleural diseases	Is thoracic ultrasound useful as a method for screening pleural lesions in older patients with high risk of asbestos-related diseases? Can Color-flow Doppler ultrasound assist the differential diagnosis between benign and malign pleural lesions in older patients? Are ultrasound-guided procedures of pleural biopsy associated with reduced frequency of complications and better clinical outcomes in older patients?
Diagnosis and monitoring of interstitial syndrome	Can artificial intelligence improve standardization of assessment of interstitial syndrome severity in older patients and assist novice ultrasound operators in the correct interpretation of images? Can artificial intelligence improve the differential diagnosis between acute heart failure and other conditions presenting with interstitial syndrome on thoracic ultrasound?
Diaphragmatic ultrasound	Is ultrasonographic assessment of diaphragmatic excursion and thickening fraction able to predict the outcome of invasive and non-invasive mechanical ventilation in geriatric patients? Is ultrasonographic assessment able to identify diaphragmatic sarcopenia in patients with COPD? Is it able to predict clinical outcomes?
Applications of thoracic ultrasound outside the hospital	Is thoracic ultrasound clinically useful to monitor the presence of post-COVID-19 sequelae in older patients? Is there any correlation with chest HRCT? What is the clinical significance of ultrasound abnormalities detected in lung parenchyma of COVID-19 survivors? Is tele-ultrasound a reliable and cost-effective method to assess respiratory diseases in older people living in the community and in nursing homes? Does chest ultrasound maintain its diagnostic accuracy when performed by non-medical personnel with remote medical consultation in geriatric patients?