Are Two Planes Better Than One?: A Comparative Analysis of Transverse versus Sagittal Pelvic Views in the FAST Examinations

Objective: This study aimed to assess the diagnostic value of the sagittal and transverse views of the suprapubic window during a FAST/eFAST examination. Methods: This retrospective chart review analyzed suprapubic windows of FAST/eFAST images performed 08/15/2017-08/01/2024. Each ultrasound video was reviewed for the presence or absence of free fluid, image quality, and diagnostic confidence. Reviewers were blinded to clinical information and did not assess more than one imaging plane in the same patient. Results: Of the 958 FAST/eFAST studies identified, 497 met inclusion criteria. 433 (87.1%) were diagnostic, while 64 (12.9%) were non-diagnostic in at least one imaging plane. Among diagnostic images, 93 (21.5%) sagittal views and 74 (17.1%) transverse views were positive for free fluid. 32 exams (34.3%) showed free fluid in the sagittal views but were negative on the transverse view, whereas 13 cases (17.6%) were positive on the transverse view but negative on the sagittal view. Using both views reduced overall non-diagnostic rate from 12.9% to 1.2%. Conclusion: Using both sagittal and transverse views in the suprapubic window during a FAST/eFAST examination can reduce the non-diagnostic rates and improve identification of free fluid. The observed discrepancies between views and variability in the image quality and confidence support a multi-view approach.