Rute Santos

To provide a clinically oriented overview of ultrasound elastography in chronic liver disease, focusing on currently available techniques, their clinical applications, quality assurance, technical pitfalls, and emerging developments that may shape future liver imaging practice. A narrative review of the current literature was conducted using international guidelines, systematic reviews, and original studies retrieved from major scientific databases. Particular emphasis was placed on the clinical applications of ultrasound elastography, quality assurance procedures, interpretation of liver stiffness measurements, and future technological developments. Vibration-controlled transient elastography (VCTE) and shear wave elastography (SWE) have become established non-invasive techniques for liver fibrosis assessment, demonstrating excellent diagnostic performance, particularly for advanced fibrosis and cirrhosis. Beyond fibrosis staging, ultrasound elastography contributes to prognostic stratification, treatment planning, and longitudinal disease monitoring across a broad spectrum of chronic liver diseases. However, liver stiffness measurements may be influenced by technical and biological confounding factors, including inflammation, cholestasis, hepatic congestion, obesity, and postprandial status, highlighting the importance of standardised acquisition protocols and careful clinical interpretation. Emerging developments, including spleen stiffness assessment, multiparametric ultrasound, and artificial intelligence-assisted image analysis, are expected to further improve diagnostic accuracy and support precision hepatology. Ultrasound elastography has become an essential component of the non-invasive evaluation of chronic liver disease, substantially reducing the need for liver biopsy while improving fibrosis staging, prognostic stratification, and longitudinal patient monitoring. Its optimal clinical implementation requires appropriate patient selection, adherence to quality assurance procedures, and careful interpretation within the broader clinical context. Future advances in multiparametric ultrasound, artificial intelligence, and international standardisation are expected to further strengthen the role of ultrasound elastography within precision hepatology and personalised liver disease management. Ultrasound elastography should be integrated into routine liver imaging as part of a multimodal diagnostic approach. Standardised acquisition protocols, continuous quality assurance, and appropriate operator training are essential to ensure reliable and reproducible liver stiffness measurements. Radiographers play a key role in examination quality, protocol adherence, and multidisciplinary patient care, contributing to accurate diagnosis and improved clinical decision-making.

Background/Objectives: Radiofrequency echographic multispectrometry (REMS) technology has emerged as a promising alternative for osteoporosis diagnosis. This non-ionising, portable and accessible method enables early detection of osteoporosis in primary healthcare settings. The aim of this study was to assess the effectiveness of REMS in evaluating osteoporosis within primary healthcare. Methods: Bone mineral density was assessed in 86 participants trough 172 scans of the lumbar spine and femur, using REMS technology in two Portuguese primary healthcare units in Guarda. Results: In the lumbar spine evaluation, 51.2% of the participants had osteopenia and 31.4% osteoporosis; in the femur evaluation, 43.0% had osteopenia and 34.9% osteoporosis. The data indicated a significant prevalence of bone fragility. The bone mineral density estimated by radiofrequency echographic multispectrometry showed good agreement with the clinical diagnosis, suggesting that this technology is effective in the early detection of osteoporosis. Conclusions: Bone densitometry using REMS method, performed by a radiographer in primary healthcare settings, offers a viable and innovative alternative for the effective detection of osteoporosis and osteopenia.

Supersonic shear image (SSI) ultrasound elastography provides a quantitative assessment of tissue stiffness using the velocity of shear waves. SSI’s great potential has allowed researchers in fields like biomechanics and muscle physiology to study the function of complex muscle groups in different conditions. The aim of this study is to use SSI to investigate changes in the stiffness of the vastus lateralis (VL) muscle as a consequence of passive elongation, isometric contraction, and repeated muscle activity. In a single session, 15 volunteers performed a series of isometric, concentric, and eccentric contractions. SSI images were collected from the VL to assess its stiffness before and after the contractions and at various knee angles. Two-way within-subjects ANOVA was used to test the effects of muscle contraction type and knee angle on VL stiffness. Linear regression analysis was employed to assess the relationship between muscle stiffness and the intensity of isometric contractions. After maximal contractions, VL stiffness increased by approximately 10% compared to baseline values, and following maximal isometric (p < 0.01) and eccentric contractions (p < 0.05). Yet, there was no change in VL shear modulus at the end of concentric contractions. The relaxed VL shear modulus increased with knee flexion both before and after the knee extensor contractions (p < 0.001). A linear relationship between the shear modulus and the degree of isometric contraction was observed, although with notable individual variation (R² = 0.125). Maximal contractile activity produces modest increases in relaxed muscle stiffness. The SSI-measured shear modulus increases linearly with the degree of isometric contraction.

Ultrasound elastography is widely used to assess tissue stiffness for lesion characterization, including differentiation between benign and malignant lesions. This study focuses on the use of elastography in the male pelvis, including the prostate, testicles, and rectum, by comparing elastography types (shear wave and strain). This article provides a summary of the existing literature on the use of elastography in the male pelvic region and outlines the clinical perspective. Ultrasound elastography is a good technique for evaluating and monitoring lesions in the male pelvic region.

Introduction: Ultrasound is a non-invasive, low-cost technique that does not use ionising radiation and provides a “real-time” image, and for these reasons, this method is ideal in several situations. Purpose: To demonstrate breast ultrasound evaluation as a first-line diagnostic method and to evaluate the variation of breast characteristics with age. Material and Methods: A total of 105 women with a mean age of 30 years participated and were divided into three age groups: 18–39, 40–59, and 60–79 years, excluding participants subject to mastectomy. After completing the informed consent, all participants answered personal and sociodemographic questions, such as personal and family history, menstrual cycle, pregnancy, ultrasound, and mammography, among others. They were then submitted to a bilateral breast ultrasound examination. Subsequently, all the images and their data were analysed, and a technical report of the examination was given to all the participants. Results: A total of 105 women with a mean age of 30 years participated, 58 of whom underwent the examination for the first time. In 31, changes (of which only 7 were known) were diagnosed. It was verified that, according to age group, the density of the breast stroma varied; older women have less breast density. Conclusions: Ultrasound is a good method for breast evaluation and can be considered important for the early evaluation of breast pathology and follow-up of the pathology.

Introduction: Sonography is an imaging method with several advantages; it is a noninvasive and painless technique, with an enormous daily applicability, and its technology is widespread. However, ultrasound quality control is lacking. Since ultrasounds are operator dependent, different measurements of the same area or anatomical region can occur, as well as errors caused by the lack of technology management. The aim of this literature review is to evaluate the existing recommendations regarding the quality control of the diagnostic ultrasound imaging, describing the main quality control tests and comparing the quality control indicators, which already exist for ultrasound. Methods: A systematic search was performed on Pubmed, with only studies in English, Spanish and Portuguese being considered, over a 10-year period. Eligible studies were complete articles, publications directly related to the object of study, review studies and guidelines. Results: A total of 45 studies were retrieved and 3 articles met the inclusion criteria. Additionally, 55 protocols and guidelines were retrieved. The need to create quality indicators for ultrasound equipment to obtain an optimized image is of great importance. There are a few studies about quality control in ultrasound. The quality control of ultrasound equipment promotes relevant indicators to medical diagnosis. Conclusions: The range of recommendations from various representative entities, medical societies and regulatory entities, establishes the minimum conditions for the proper functioning of ultrasound equipment, verifying the importance of the constant maintenance of the quality control of diagnostic ultrasound imaging. Introdução: A ultrassonografia é um método de obtenção de imagem diagnóstica, trata-se de uma técnica não invasiva, indolor, de enorme aplicabilidade diária, sua tecnologia está bastante difundida. Entretanto, um grande obstáculo é a falta de controle de qualidade do Ultrassom. Por ser operador-dependente, diferentes resultados em mensurações de uma mesma área ou região anatômica pode ocorrer, assim como erros ocasionados pela inexistência de gerenciamento da tecnologia. Objetivo: Levantar os principais controles de qualidade da imagem do ultrassom diagnóstico, através da revisão de recomendações, descrevendo os principais testes de controle de qualidade e comparando os indicadores de controle de qualidade, já existentes para ultrassom. Matérias e Métodos: Através de uma revisão da literatura de forma integrativa sobre Controle de Qualidade da Imagem em Exames de Ultrassonografia. Estratégia utilizada para pesquisa, fontes de dados no PUBMED, no período de 10 anos nos idiomas português, inglês e espanhol. Literatura cinza, publicações de agências de saúde, sociedades, associações. Resultados e Discussão: Destacamos 10 testes de controle de qualidade da imagem em ultrassom no Protocolo Espanhol; 06 testes da BMUS; 05 do ACR; 05 da AAPM; 07 da EFSUMB; 05 da AAPM; 07 da AIUM e 10 da ANVISA. Foi levantada a necessidade da criação de indicadores de qualidade do equipamento utilizado na obtenção da imagem. Poucos são os trabalhos existentes acerca do controle de qualidade da imagem produzida pelo ultrassom. Conclusão: O controle de qualidade dos equipamentos de ultrassonografia promove indicadores de relevância para o diagnóstico médico. A gama de recomendações através das entidades representativas, colegiados, sociedades médicas e órgãos reguladores, estabelecem sobre as condições mínimas para bom funcionamento de um equipamento de ultrassonografia, corroboram com a necessidade básica e constante da manutenção da qualidade.

Aging is associated with functional changes in the human neuromuscular system, and sarcopenia is one of the most diagnosed changes. Not only does muscle mass loss contribute to impaired functionality, but changes in fiber type and others contribute to weaker and slower muscle contractile activity. According to the World Health Organization, it is necessary to implement intervention strategies and programs for active and healthy aging. The [email protected] project, being an intervention model aiming to evaluate and modify habits and improve the quality of life of an older adult group, has previously shown promising results in reducing the effects of aging on the skeletal muscle of the older person, relating any changes at this level with the degree of functionality and autonomy.