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Thanks for the question, Brian,
There are numerous carotid stenosis grading criteria published out there that can be used within ultrasound departments, which is likely what you have stumbled across. We recommend referring back to the local guidelines and vascular surgeon for criteria preference (which it seems you are already doing so).
In light of that, what we have noticed is that the main discrepancy tends to occur at the lower end of the scale (50-69% stenosis)
The ASUM guidelines are a great reference. In the presence of disease, you have to have a PSV of >125cm/s AND a ratio of >2 OR just a ratio >2 for a 50-69% stenosis. Again, these are just guidelines and not a criteria.
Hope this covers your question.
Kind Regards,
Heath/Vascular SIG
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Thank you for reaching out and for sharing your experience. Your concerns are valid and important, and we appreciate your commitment to safety, for yourself and your colleagues.
At present, the Australasian Sonographers Association (ASA) does not have a dedicated sharps safety policy specific to sonographers assisting in ultrasound-guided procedures such as biopsies.
We understand that practices can vary significantly between radiologists and departments, and this inconsistency can place sonographers in uncomfortable or unsafe positions. Your example of being asked to hold a Hanksvial during a biopsy, and your decision to decline due to the risk of needlestick injury, underscores the importance of having clear, evidence-based guidelines that prioritise the safety of all team members.
For more information on the handling and disposal of sharps,we recommend referring to the following standards:
- AS 3825:2020 – Procedures and precautions for the disposal of clinical and related waste.
- AS 23907:2023 – Safety-engineered medical devices for the prevention of needlestick injuries.
The ASA is reviewing their Infection Prevention and ControlGuidelines for Sonographers. This document includes some information about theuse and management of sharps. https://www.sonographers.org/publicassets/09d59b70-d0de-ef11-9137-0050568796d8/Infection-Prevention-and-Control-Guidelines-for-Sonographers.pdf
I have attached the Australian Guidelines for the Preventionand Control of Infection in Healthcare which describes guidelines in relationto sharps.
We encourage you to become familiar with:
- Your facility’s protocols on the handling and disposal of sharps.
- Ensure you are vaccinated against blood-borne viruses such as hepatitis B.
- Participate in education and professional development sessions on sharps safety and the use of new safety devices.
- Remember that the person who uses a single-use sharp is responsible for its immediate and safe disposal.
Thank you again for raising this.
australian-guidelines-for-the-prevention-and-control-of-infection-in-healthcare.pdf
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Thank you for the great question.
The deep veins of the lower limb are characterised by their location deep to the fascia. The infrapopliteal deep veins are typically separated into axial veins (posterior tibial vein, anterior tibial vein, peroneal vein, tibioperoneal trunk) and muscular veins (medial and lateral gastrocnemius and soleal veins).
They are still classified as a DVT; however, using the muscular vein thrombosis terminology may help in the reporting process. It's also important to refer back to your local policies and guidelines, as variability will exist between reporting radiologists.
There is, of course, a range of anatomical variations in the gastrocnemius vein drainage. I've copied a paper below for you to read through if you wish.
Anatomical Study of the Gastrocnemius Venous Network and Proposal for a Classification of the VeinsAragão, J.A. et al.European Journal of Vascular and Endovascular Surgery, Volume 31, Issue 4, 439 - 442
I've added some information on the "chronic" DVT reporting issue. The consensus now prefers the use of terms such as post-thrombotic scarring/post-thrombotic change or synechiae over chronic DVT. This helps reduce confusion for clinicians outside of the vascular world to act on the results.
Needleman L, Cronan JJ, Lilly MP, et al. Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018;137(14):1505-1515. doi:10.1161/CIRCULATIONAHA.117.030687
Apologies for the delayed response, as I was on holidays.
Kind Regards
Heath/Vascular SIG
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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
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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)
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 Catherine,
thanks for your comments and questions.
You are correct in your assumption - sampling in the parallel lines trumps the elastogram. As you say this is because the elastogram is reflective of the scale and so can be multicoloured due to vessels, scale, etc etc.
The ROI can be adjusted in size from 10 to a minimum 5 mm if required.
I've attached our TUSL worksheet - we have now moved to Sonoreview so our updated one has drop down options.
I've also attached the short Powerpoint that I put together for my ASA SWE workshop this year.
It has a few dedicated technique slides and in particular, Slides 13 & 14 show the importance of having a straight probe, straight liver capsule, straight elastogram box. This was a slide shared by Dr Richard Barr from the USA at WFUMB 2025 in Kyoto. I loved it so I reproduced it for my talk.
Hope this all helps,
Marilyn
Liver-elastography-workshop-asa.pptx
WS-US-GEN-07-Chronic-Liver.pdf