Sonography – anyone, anytime, anywhere?

As I reflect on this issue of the journal, I’m struck by the diversity of the papers we are publishing and I realise just how far and wide ultrasound imaging is being used. I am also reflecting on how far this technology has come: from a massive water bath in the 1950s; to A‐mode scans displayed on an oscilloscope; to the first moving images using M‐mode; through to two‐dimensional (2D) and now three‐dimensional (3D) imaging. We have gone from imaging whole organs to targeting cell motion, such as with shear wave technology as in this AJUM issue, where Laroia et al¹ present their experience of using shear wave electrography for the detection of liver fibrosis.

Similarly, the engineering marvel that provides a point‐of‐care ultrasound (POCUS) device with technology previously only available in a 200‐kg cart is staggering. The growth of a point‐of‐care ultrasound (POCUS) continues, and clinicians are using POCUS in a variety of settings. In this AJUM issue, Bhoi et al² present a case series using POCUS to diagnose cervical spine injury.

Yet, none of this technology is useful if it is not reliable in different patients, on different days and between different operators. Before we adopt new techniques in our own practice, ideally we would undertake studies to ensure we can do it with enough reproducibility to enable meaningful clinical changes to be detected. This is often done in research settings but less so in clinical practice in my experience. This is why I am particularly happy to see authors going to the trouble to document the reliability of techniques in their hands and publishing their results so we can all benefit, such as Farragher et al³ have done in this issue.

Another cross‐over technology is ultrasound enhancing agents (UEAs), which are now used in different specialities. UEAs allow us to overcome the physical limitations of ultrasound imaging and yet at the same time exploit other physical characteristics to aid diagnosis. The helpful role of UEAs for diagnosing liver tumours in children is explored in a retrospective study by Torres et al⁴ in this issue of the journal.

Yet, as sonographers and sonologists we are facing changes. On one end of the ultrasound continuum, we have highly specialised technology that allows us to image in ways we have not routinely before. We ‘see’ and, more importantly, understand anatomy and physiology in ways we could not before. At the other end of the continuum, POCUS users are performing relatively simple, some might say ‘pared back’ examinations to aid their clinical management. They are asking straightforward questions that will aid their immediate management. This is not a referral service, this is a doctor using an ultrasound probe as many have used stethoscopes to aid their clinical decision‐making for many years. In between, specialist physcians are taking up probes and offering "advanced POCUS" for their patients.

I suspect we are on the precipice of a major shift in ultrasound practice, and it is both exciting and scary. The potential for new clinical applications is exciting, but I am nervous that the clinical applicability will not be as well documented and researched as ultrasound has in the past. But what an opportunity for future research – in clinical settings; in educations settings; in rural and remote settings; and in non‐traditional research settings. I encourage you to research, document and share your findings as we forge this new path forward.