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Hi,
The concensus from the Paed SIG is 3cm as the cutoff for normal transverse diameter of the rectum.
The only preparation is some filling of the bladder so the rectum can be well visualised.
Attached is a recent article that may be of interest.
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Hi,
Thanks for your questions regarding sonographer performed injections.
Sorry for the delay in replying, we were trying to ensure we provided you the most informed answer.
We are assuming as you have submitted this to the ASA MSK SIG, this question is regarding MSK injections.
We totally understand the difficulty encountered in regional/rural areas, where patients do not have the same access to healthcare (such as easily administered ultrasound guided pain relief/interventions) as their metropolitan counterparts and are in support of sonographers addressing such a need to allow health equity. Unfortunately, the policy/guideline work in this area is slow to develop, not through lack of trying, but addressing the differences that occur in different states around Australia.
Sonographer performed injections are not currently in the Sonographer role/scope of practice.
One of the issues regarding sonographer performed interventional procedures, including the injections of medications/substances/materials into patients is that there are different rulings for different states/territories of Australia.
In some Australian states (such as Victoria), sonographer performed injections is not allowed. In other states, depending on the workplace agreements, sonographers can perform injections following completion of training regarding pharmaceuticals/pharmacology administration.
Sonographers performing MSK guided injections may need to be required to be familiar with poisons/medications acts/legislations (which can vary from state to state).
So, when finding/using a sonographer mentor that also performs injections, you may need to consider using one from the same states as you could encounter differences in rulings/legal requirements in different states.
There is a document the ASA has developed which has FAQ regarding sonographer performed MSK injections:
It appears New South Wales legislation permits medical practitioners to direct other employees (such as sonographers) to administer restricted drugs on their behalf.
We are currently not sure who is performing MSK injections in NSW. You could reach out to the ASA policy and advocacy team (policy@sonographers.org) if you have questions regarding jurisdiction legislations.
The ASA is trying to address this exact issue and is currently planning research into extended scope of practice for sonographers, which includes scoping what is happening in the sonographer performed MSK injection space.
At present, extended scope of practice of sonographers (extension of their role beyond the normal role), needs to be agreed on by the department/workplace of sonographers.
You will also just need to ensure your insurance will cover you undertaking this practice as well.
Sorry that we cannot provide exact advice regarding this form of practice at present. We are hoping in the future, that we can offer more tangible resources and advice. We also hope that you can come to some arrangement to alleviate your patient wait times for access to these procedures that can improve their quality of life.
Thanks
Michelle Fenech (chair of the ASA MSK SIG)
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Hello, thank you for your question.
As per feedback from the various SIG members, the ACA is not routinely investigated at the various children's hospitals and departments around Australia that are represented on the SIG (Royal Children's, Monash Children's, WCH Adelaide, Perth Children's) Queensland Children's have begun to assess the Circle of Willis to determine if complete or incomplete on infants requiring cardiac surgery, however they do not routinely image the ACA.
The below article may be useful:
Jarmund AH, Pedersen SA, Torp H, Dudink J, Nyrnes SA. A Scoping Review of Cerebral Doppler Arterial Waveforms in Infants. Ultrasound Med Biol. 2023 Apr;49(4):919-936. doi: 10.1016/j.ultrasmedbio.2022.12.007. Epub 2023 Jan 31. PMID: 36732150.
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Hi Erica,
Thank you for reaching out. We appreciate your thoughtful reflection on the challenges you have encountered since transitioning to private practice. You have raised an important issue that many sonographers face: variable referral quality and the pressure to proceed with ultrasounds that may lack sufficient clinical justification.
You are correct that Medicare requires imaging requests to include enough clinical information to justify the examination. While ultrasound is considered low-risk, this does not mean that referrals can be vague or unsupported. The request should contain sufficient information for the sonographer to determine that the examination is appropriate. However, there is no strict standard orguidelines from Medicare or RANZCR stating what clinical notes should include.
In cases where the referral lacks clarity and you cannot reach the referrer you could use your clinical judgment to assess whether the ultrasound is likely to give any meaningful information, document your concerns, engage with othersonographers and radiologists to build an understanding of when it is appropriate to delay or question a referral.
You could ask the practice manager to provide feedback to referrers and also ask the practice manager for education and written guidance.
Thank you for raising this important issue. Please reach out if you would like further information.
Thanks,
Emma
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Hi Michelle,
Thank you for reaching out with your question.
The two articles below will give you a good basis around giant cell arteritis and the role ultrasound plays when it comes to assessing patients for query GCA.
2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis
Microsoft Word - BMUS Giant Cell Arteritis ultrasound guidelines v3
If you require any further information feel free to submit another Ask and Expert question.
Kind regards
Vascular SIG
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Hi,
Thank you for reaching out with your question.
The two articles below will give you a good basis around giant cell arteritis and the role ultrasound plays when it comes to assessing patients for query GCA.
2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis
Microsoft Word - BMUS Giant Cell Arteritis ultrasound guidelines v3
If you require any further information feel free to submit another Ask and Expert question.
Kind regards
Vascular SIG
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Hello,
We were unsure if this was a question, or a request, as it is hard to tell from the post.
There is currently no worksheet for ultrasound imaging of RA that is published by the ASA.
At the recent ASA 2025 conference (Saturday afternoon), there was a very good MSK session on ultrasound imaging of arthritis, and the discussions from this session indicated that the development of a worksheet to guide sonographers regarding the sonographic assessment of RA would be ideal and is required. So, your comment/question is timely.
Such a worksheet, however, is best developed by working with a sub-group of the national rheumatology professional body.
The ASA MSK SIG will investigate developing this, however, it may take a while as the evidence-base for its development will need to be researched first.
Thanks
Michelle (Chair ASA MSK SIG)
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hi
Thank you for your question!
In pre and perimenopausal women with AUB
Endometrial biopsy is advocated in ovulatory AUB aged = 45 years and in anovulatory AUB < 45 years to rule out endometrial hyperplasia.
It is preferable to advise ultrasonogram in early proliferative phase to detect endometrial abnormalities and avoid false positive result.
Diffuse homogenous thickening of endometrium > 16 mm in secretory phase has been recommended as cut-off.
When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the risk of premalignant/malignant endometrial pathology increases by 25%.
Endometrial biopsy is indicated when ET is > 12 mm in premenopausal women and = 5 mm in perimenopausal women with persistent erratic menstrual bleeding.
Asymptomatic postmenopausal women
Endometrial biopsy should be considered, if the endometrium measures > 11 mm, or with other risk features.
Symptomatic Postmenopausal women
ET > 4 mm endometrial biopsy is required
Persistent or recurrent bleeding, even with endometrial echo complex less than = 4 mm warrants endometrial biopsy to rule out Type II EC.
Women on Tamoxifen
Pretreatment screening with TVS and or endometrial biopsy before Tamoxifen therapy to rule out pre-existing endometrial pathology which may aggravate during treatment with Tamoxifen.
There is no known added risk of endometrial cancer in premenopausal women on Tamoxifen; hence these women need no stringent follow-up.
Though ET of > 8 mm is taken as cut-off in Tamoxifen users, the evidence suggests not to go for endometrial evaluation in asymptomatic women both pre and post-menopausal.
In patients on Tamoxifen presenting with irregular vaginal bleeding endometrial biopsy is recommended.
Woman with PMB should have TVS done and if ET is > 4 mm, endometrial biopsy should be done regardless of any drug use.
Women on HRT
The acceptable range of endometrial thickness is less well established in this group; cut-off values of 8 mm have been suggested in asymptomatic women.
The risk of carcinoma is ~ 7%, if the endometrium is > 11 mm, and 0.002%, if the endometrium is < 11 mm
Women on HRT the ET of > 8 mm should be treated as thickened and endometrial evaluation be done in asymptomatic women.
Women on HRT with PMB endometrial evaluation should be done if ET is > 4 mm
Leone, F.P. et al. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Page 9 of 10 Australasian Society for Ultrasound in Medicine P (61 2) 9438 2078 F (61 2) 9438 3686 E asum@asum.com.au W www.asum.com.au ACN 001 679 161 ABN 64 001 679 161 Endometrial Tumor Analysis (IETA) group. Consensus Statement. Ultrasound Obstet Gynecol 2010; 35:103-112. DOI: 10.1002/uog.7487
Womens Health SIG
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Hi,
We can use 3d sweep or volume to scan and check length from end of endo.
Two arms should be fully unfolded extending laterally to uterine cornua.
The stem should be seen extending inferiorly or proximally towards cx. Should be less than 2cm from fundal end of uterine cavity.
Kind Regards,
Women's Health SIG
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Hi Tim.
Thanks for your question
Nulliparous women: Average uterine volume is typically around 30–80 mL
Multiparous women: Uterine volume can increase up to 150–200 mL
Please note: these values are influenced by factors such as age, hormonal status, and menstrual phase
Below are some references for you
http://www.ijmse.com/uploads/1/4/0/3/14032141/ijmse_2016_volume_3_issue_3_page_305-309.pdf
https://www.isuog.org/resource/lecture-11.htmlhttp://www.ijmse.com/uploads/1/4/0/3/14032141/ijmse_2016_volume_3_issue_3_page_305-309.pdf
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Hey Sharron,
While cine loops are really great to show and demonstrate pathology, there are no guidelines or literature that states a cine loop has to be recorded.
There is nothing that legally compels you to use a cine loop in diagnosis.
I would recommend you escalate this with your workplace if you have concerns.
Kind Regards,
WH SIG
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Thank you for the great question!
Although we occasionally see duplicated IVC's, from our experience they tend to be slightly bigger than the vein in the picture and are quite apparent when scanning in a supine midline lower abdominal plane...although they can divide at the level discussed.
The consensus from the SIG members was that the vein in question is most likely the Ascending Lumbar Communicant Vein. This vein also can join the renal vein similar to what you are describing and has an almost vertical orientation.
Clinicians are happy when these are found, because if the patient requires spine surgery that has an anterior surgical approach where the major vessels are lifted, this is a vein that is easily ruptured.
As there was a mention of a partial Nutcracker compression, we wanted to address this for you as well. A true Nutcracker will cause renal hypertension with symptoms of haematuria and left flank pain needed for diagnosis. Without these symptoms it is likely that the LRV is simply being underfilled, this can occur when the main draining pathway is via an Ascending Lumbar Communicate Vein, an incompetent left ovarian vein, or a circum-aortic left renal vein. This underfilling is the most common cause for a false positive Nutcracker compression. I've attached recently published papers on this for you to look through.
One technique we are employing is assessing the patient in an LPO position and reassessing the anatomy.
Thanks again for such a great question on a complex topic.
Kind regards,
Vascular SIG
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Hi,
Thanks for your question.
The ISUOG guidelines are found at
https://www.isuog.org/clinical-resources/patient-information-series/patient-information-pregnancy-conditions/heart/fetal-heart-bradycardia.html#:~:text=Fetal%20bradycardia%20means%20an%20abnormally,it%20happens%20in%20fetal%20life.
These state fetal bradycardia is 120-160bpm. However, literature states that fetal bradycardia in the first trimester is under 100bpm at around 6weeks gestation
Thanks
ASA WH Committee
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Hi!
Never a silly question.
Ovarian volume varies greatly amongst women due to many factors such as age, menopause, premenarche, contraception.
In women who are premenopausal an ovarian volume of less than 1mL would be considered atrophic.
However, the OCP does decrease ovarian volume and antral follicle count and while these figures are on the lower end of normal, they are still considered normal and the effects of the OCP reversible and studies show ovarian volume and antral follicles return to normal after 3-6 months of cessation of the OCP
Some articles for you are below
Giorgione, V., et al. (2020). Oral contraceptive use and ovarian reserve markers: a systematic review and meta-analysis.
Petersen, S. E., et al. (2015). Oral contraceptive pills reduce antral follicle count and AMH in healthy women: a cross-sectional study.
Bentzen, J. G., et al. (2012). Ovarian reserve parameters: a comparison between users and non-users of hormonal contraception.
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Dear ASA member,
I apologise greatly for not responding to your enquiry sooner.
Please see below the advice and the relevant documents.
kind regards,
Alison White
As the Chair of the Cardiac SIG, I agree with the comment posted below by Kim Prince.
In Australia, we follow the guidelines from the American Society of Echocardiography (ASE), the American College of Cardiology (ACC) and the American Heart Association (AHA). The ACC/AHA clinical competence statement on echocardiography states that a transoesphageal echocardiogram (TOE) is performed by a physician, where physician is defined as a licensed practising medical doctor.
As outlined by Kim Prince in her comment below, in Australia, sonographers are to work within their scope of practice which covers transthoracic echocardiograms, not transoesphageal echocardiograms (see the attached PICSA document in Kim's comment).
In addition, The Cardiac Society of Australia and New Zealand (CSANZ) provides position statements on training and performance in echocardiography, including TOE. See the attached document. (CSANZ Position Statement for Training and Performance in Adult Echocardiography). This document outlines that TOE is part of Level 2 training for cardiologists (not sonographers).
kind regards,
Alison White
Kim Prince:
Thank you for this enquiry.
In Australia Transoesophageal echo's (TOE's) are performed by qualified imaging cardiologists (or anesthetists in surgery).
Cardiac sonographers are not qualified to perform a TOE in Australia. Qualified cardiac sonographers can assist the cardiologist with machine functions and if necessary hold the TOE probe while the doctor gets into position, however, inserting the TOE probe or operating the TOE probe to perform the test is outside of the cardiac sonographers scope of practice in Australia. I have attached a document in regard to scope of practice for cardiac testing for your information, however it does not cover TOE as it is not a procedure sonographers perform.
I have also attached the Qld Health TOE consent form which at the end just explains that the doctor will be performing the test.
I hope this assists you. Medicare may also be able to provide additional information that I could not find on their item list.
Please contact us if you have any further questions.
Disclaimer: by using this service you recognise that the information provided is general in nature; it does not constitute professional advice. Any views expressed are those of individual(s) and may not reflect ASA’s views. The ASA does not endorse any product or service identified. You use any information provided at your sole risk and the ASA is not responsible for any errors or for any consequences arising from that use.
Hi Michelle,
We do not currently have a generic worksheet available for IVF follicle tracking ultrasound.
Every IVF Clinic or referrer have different criteria or requirements that are usually set on the request with some clinics even providing their own worksheet for sonographers fill out and send back.
Kind Regards,
Women's Health SIG