Introduction to special issue ‘Evolution of Sonography: Into the future’

This special issue celebrates the 10th birthday of Sonography by focusing on how sonographic practice is evolving as the technologies we use continue to shape what we do. I hope sonographers reading this issue can use the knowledge offered in the articles to refine their skills to meet and adapt to the changing landscape of medical sonography. It is difficult to accurately predict how our profession will change as we move towards 2030 and beyond, but we can be certain that change is inevitable due to our constantly evolving world. For sonographers, the introduction of new technologies and the refinement of existing technologies open up new ways of doing things and also practicing in new areas. Also, the changing expectations and demographics of our patients will impact on our practices. The ageing population, coupled with an increasing incidence of chronic diseases, has potential to lead to gaps and additional pressures on ultrasound services, workforce and infrastructure. To help alleviate these gaps and pressures, we need to adapt and think of solutions. In the first article in this issue, Coombs et al.,1 in their reflective commentary, look back on the changes that have occurred at their institution: a large public ultrasound service in Melbourne. This retrospective not only creates an interesting story but also provides valuable insights into the patterns and factors that shape the present and influence the future. Artificial intelligence (AI) is bringing revolutionary changes, reaching into many aspects of our lives. It will almost certainly impact on medical sonography. A number of articles in this issue address AI. Watabe et al.2 demonstrate in their study how AI-assisted echo reduction can improve the detection of pancreatic cystic lesions. Boman et al.,3 in their literature review, identified six articles that have investigated AI in specific areas of medical sonography: remote breast ultrasound, remote obstetric assessment, melanoma, ultrafast blood flow, atherosclerosis of the carotid artery and echocardiography. McGuire4 presents a narrative review that specifically reviews the accuracy of AI in the detection of rotator cuff pathology, and Stoodley et al.5 in their commentary highlight the importance of including AI education in the pre-qualification sonography curricula. There is a building body of evidence to support AI in ultrasound, but caution is needed if implementing AI tools as ultrasound images do not possess the same level of predictability, reproducibility and operator independence of other imaging modalities such as magnetic resonance imaging (MRI) and computer tomography (CT). Internal validation of any AI tool should be performed to ensure it is suitable for any particular setting. It also may require that image acquisition needs to be standardised. There is a lack of high-quality evidence-based studies to validate the efficacy of ultrasound AI tools, therefore presenting research opportunities for sonographers interested in this topic.6 Elastography is another technology featured in this issue. Ultrasound elastography was first described in the 1990s, and has been refined and developed to enable quantitative assessments of tissue stiffness (shear wave elastography), and its applications are still emerging.7 O'Hara et al.8 provide an overview of the essential physics principles and the clinical uses of two-dimensional shear wave elastography. Further insight into the clinical value of shear wave elastography is provided by Clements and Doherty9 in their investigation of breast lesions, and by Günay et al.10 in their investigation of shear wave elastography in the renal parenchyma of paediatric patients secondary to hydronephrosis. Two articles in this issue look at the physical and emotional well-being of sonographers, which is important not only for individual sonographers but also for the sustainability of the profession, and ultimately, outcomes for patients. Hall et al.11 identify through a survey of sonographers, what the greatest perceived demands of sonographers are, and the strategies they use to overcome them. White et al.12 advocate for the use of reflective practice to build sonographer emotional resilience to foster well-being. Interacting with our patients and interprofessional teams is central to what we do, but this can at times be challenging with the transition of health service to a more patient-centred approach. Sonographers need to be self-aware and able to understand the socio-cultural diversity of their patients. To assist, White et al.13 provide some useful strategies for interacting appropriately with older (>65 years) patients. The way we perform sonographic examinations is always evolving and Sonography was pleased to receive submissions from authors looking at how and why we do things the way we do. Roche and Fenech14 show us how to assess for ulno-humeral joint instability with one operator in an ergonomically friendly way. Ma et al.15 show us how to use finger compression to better demonstrate rotator cuff tears. Deslandes et al.16 discuss how the role of transvaginal ultrasound has transitioned from a pre-operative assessment to a diagnostic test with high accuracy when performed using a comprehensive and specific protocol, and they pose the question on how that might change practice for sonographers. McLean and Lewis17 outline how research culture can be fostered in ultrasound facilities. I believe a research culture is central to sonographers taking charge of their own profession using an evidence-based approach to inform practices, and ultimately benefit the patients we care for. Finally, I would like to thank all the authors who contributed to this special issue, as well as members of the editorial board who assisted in selection and reviewing of the articles. Enjoy the read!