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Open research questions in Ultrasound in Clinical Applications

51 unresolved questions extracted from the limitations and future-work sections of 411 Ultrasound in Clinical Applications papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • EndoFLIP also shows promise in diagnosing hiatus hernia with accuracy compa- rable to HRM [16]; patients with hiatus hernia exhibit an increased DI compared with normal controls [16], while the application of EndoFLIP in diagnosing GERD remains con- troversial and warrants further research [3].

    Development of expert consensus protocols for diagnostic and procedural use of the EndoFLIP system · 2026 · DOI

  • Third, we acknowledge that the relationship between viral etiology and LUS severity was not explored, although multiplex polymerase chain reaction testing was performed.

    Utility of Lung Ultrasound Assessment in Infants with Acute Bronchiolitis: An Observational Study – Author’s Reply · 2026 · DOI

  • Although numerous diagnostic test accuracy systematic reviews (DTA-SR) evaluating various POCUS applications are available, clinicians often face uncertainty due to ungraded accuracy estimates and inconsistent evidence.

    Diagnostic accuracy of point-of-care ultrasound in adult non-traumatic emergency medicine: an umbrella review · 2026 · DOI

  • Abstract Background Point-of-care ultrasonography (POCUS) has emerged as a bedside diagnostic imaging modality capable of providing real-time structural and functional assessment; however, its role within internal medicine wards remains incompletely defined from a diagnostic imaging perspective.

    Diagnostic and clinical impact of point-of-care ultrasonography in internal medicine wards: a systematic review of its role in imaging-guided decision-making · 2026 · DOI

  • Despite the many conclusions drawn from this study, certain methodological and interpretative limitations should be acknowledged: 1. Unequal gender distribution – Although the study aimed to assess gender differences, women comprised the majority of the sample. This im- balance may have reduced the statistical power of comparative analyses. 2. Lack of long-term data – The study was cross- -sectional and did not evaluate the long-term retention of educational outcomes. Consequently, it remains unclear whether reported changes in clinical practice were sustained or translated into actual professional behaviour. 3. Potential cultural and institutional differences – The study was conducted in a single country and within a single training institution (GSU). 4. Variability in interpreting open-ended responses – The responses to the open-ended questions may have been interpreted differently by the analysts, introducing an element of subjectivity into the qualitative assessment. Authors’ contribution Study design – S. Mika, H. Misiołek Data collection – S. Mika, M. Wilk Data interpretation – S. Mika, M. Gil-Mika, W. Gola, H. Misiołek Statistical analysis – S. Mika Manuscript preparation – S. Mika, H. Misiołek Literature research – S. Mika, M. Wilk REFERENCES 1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749–757. doi: 10.1056/NEJMra0909487. 2. Tuvali O, Sadeh R, Kobal S, Yarza S, Golan Y, Fuchs L. The long-term effect of short point of care ultrasound course on physicians’ daily practice. PLoS One. 2020;15(11):e0242084. doi: 10.1371/journal.pone.0242084. 3. Wenger J, Steinbach TC, Carlbom D, Farris RW, Johnson NJ, Town J. Point of care ultrasound for all by all: a multidisciplinary survey across a large quaternary care medical system. J Clin Ultrasound. 2020;48(8):443–451. doi: 10.1002/jcu.22894. 4. Stowell JR, Kessler R, Lewiss RE, Barjaktarevic I, Bhattarai B, Ayutyanont N, et al. Critical care ultrasound: A national survey across specialties. J Clin Ultrasound. 2018;46(3):167–177. doi: 10.1002/jcu.22559. 5. Mongodi S, Bonomi F, Vaschetto R, Robba C, Salve G, Volta CA, et al. Point-of-care ultrasound training for residents in anaesthesia and critical care: results of a national survey comparing residents and training program directors’ perspectives. BMC Med Educ. 2022;22(1):647. doi: 10.1186/s12909-022- 03708-w. 6. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of evidence. Acad Med. 2011;86(6):706–711. doi: 10.1097/ACM.0b013e318217e119. 7. Recker F, Neubauer R, Dong Y, Gschmack AM, Jenssen C, Möller K, et al. Exploring the dynamics of ultrasound training in medical education: the 225 S. Mika et al.: ULTRASOUND TRAINING AND THE GENDER OF DOCTORS medical interns in Denmark: a national cross-sectional study. BMC Med Educ. 2024;24(1):1489. doi: 10.1186/s12909-024-06510-y. 12. Heiligers PJ. Gender differences in medical students’ motives and career choice. BMC Med Educ. 2012;12:82. doi: 10.1186/1472-6920-12-82. 13. Varsou O. The use of ultrasound in educational settings: what should we consider when implementing this technique for visualisation of anatomical structures? Adv Exp Med Biol. 2019;1156:1–11. doi: 10.1007/978-3-030- 19385-0_1. 14. Benacerraf BR, Minton KK, Benson CB, Bromley BS, Coley BD, Doubilet PM, et al. Proceedings: Beyond Ultrasound First Forum on improving the quality of ultrasound imaging in obstetrics and gynecology. Am J Obstet Gynecol. 2018;218(1):19–28. doi: 10.1016/j.ajog.2017.06.033. 15. Neubauer R, Recker F, Bauer CJ, Brossart P, Schäfer VS. The current situation of musculoskeletal ultrasound education: A systematic literature doi: Biol. review. 10.1016/j.ultrasmedbio.2023.02.008. 2023;49(6):1363–1374.

    Gender differences in the perception and impact of ultrasound training among physicians: A survey analysis · 2026 · DOI

  • ABSTRACT Background Emergency medicine (EM) interns have been required to complete a minimum of 25 eFAST (Extended Focused Assessment with Sonography in Trauma) scans during residency training, despite limited evidence supporting this numeric benchmark.

    A Multi‐Center Study on <scp>eFAST</scp> Learning Curves for Emergency Medicine Residents Using <scp>CUSUM</scp> Analysis · 2026 · DOI

  • However, training opportunities in pediatric POCUS remain limited, and few studies have detailed the curriculum development process, making it challenging for other institutions to adopt.

    Iterative development of a pediatric point-of-care ultrasound training program · 2026 · DOI

  • Several directions for future research emerge from these findings. Multi-institutional studies would help 2026 Nguyen et al. Cureus 18(5): e108659. DOI 10.7759/cureus.108659 8 of 12 determine whether the themes identified here are generalizable. Studies incorporating residency program directors’ perspectives on expected POCUS competencies would provide an important complementary viewpoint. Intervention studies comparing focused versus comprehensive curricula on measurable residency performance outcomes would help resolve the content prioritization question. Finally, longitudinal studies tracking whether UME POCUS training translates into improved clinical performance during residency remain an important gap.

    Medical Students’ Perceptions of Point-of-Care Ultrasound Education: A Qualitative Interview Study · 2026 · DOI

  • Several limitations were identified. These limitations include small case numbers of 169 examinations com- pared to the total number of EMS responses. Addition- ally, the evaluated cohort may not fully represent the entire spectrum of diseases and disease severity. Conse- quently, diagnostic accuracy estimates may be overesti- mated and should be interpreted carefully. Additionally, final diagnoses were based on a composite reference standard including imaging and clinical documentation; differential verification bias cannot be fully excluded. Perceived impact on clinical and logistical decision-mak- ing was assessed by paramedic self-report and was not independently adjudicated, introducing potential report- ing and observer bias.

    Feasibility and diagnostic accuracy of paramedic-performed prehospital point-of-care ultrasound: a retrospective observational study · 2026 · DOI

  • The iteration of the inferential loop is proposed to terminate at a satisfactory probability of correct diagnosis guided by 'clinical sense' supported by Bayesian hypothesis, but the paper does not specify quantitative probability thresholds (e.g., >90% posterior probability) at which the diagnostic loop should stop in specific respiratory conditions.

    Paradigm shift in medicine and in clinical reasoning method: time has come for a new chest semiotics · 2026 · DOI

  • While the paper argues that ultrasound should be positioned as an 'epistemic mediator' rather than delegated to specialists, it does not establish specific training requirements, competency assessment benchmarks, or clinical time requirements for generalist physicians to perform reliable bedside chest ultrasound during initial patient contact.

    Paradigm shift in medicine and in clinical reasoning method: time has come for a new chest semiotics · 2026 · DOI

  • The proposed three-pillar model (visual inspection, ultrasound-integrated auscultation, palpatory ultrasound evaluation) replaces traditional percussion entirely, but the paper provides no evidence or trial data comparing diagnostic outcomes when percussion is omitted versus retained in chest physical examination protocols.

    Paradigm shift in medicine and in clinical reasoning method: time has come for a new chest semiotics · 2026 · DOI

  • The paper mentions quantitative lung ultrasound spectroscopy as a novel emerging technique for differentiating cardiogenic versus pneumogenic/fibrotic interstitial syndrome, but does not specify the computational algorithms, frequency ranges, or datasets required to validate this spectroscopic approach across different patient populations and pathologies.

    Paradigm shift in medicine and in clinical reasoning method: time has come for a new chest semiotics · 2026 · DOI

  • The CHEPHEUS project aims to demonstrate that chest physical examination pillars can be replaced by ultrasound-aided assessment, but the paper does not specify quantitative diagnostic accuracy thresholds or performance metrics for when ultrasound-integrated auscultation and palpatory evaluation achieve equivalence or superiority to traditional percussion and tactile fremitus assessment.

    Paradigm shift in medicine and in clinical reasoning method: time has come for a new chest semiotics · 2026 · DOI

  • Further studies are recommended to build on the diagnostic accuracy of POCUS and explore its use in other injuries beyond ankle and wrist tendon and ligament injuries.

    Point-of-care ultrasound for diagnosing tendon and ligament injuries of the wrist and ankle in emergency medicine · 2026 · DOI

  • High operator dependency of POCUS, where accuracy is highly dependent on the skill of the diagnosing clinician who obtains and interprets images in real time.

    Point-of-care ultrasound for diagnosing tendon and ligament injuries of the wrist and ankle in emergency medicine · 2026 · DOI

  • This work is a narrative review and conceptual synthesis rather than a systematic review. As such, it does not employ a predefined search strategy, formal inclusion or exclusion criteria, or risk of bias assessment. Consequently, the selection of literature may not fully capture the breadth of available evidence, particularly in rapidly evolving fields such as AI in healthcare. This limitation should be considered when interpreting the scope and generalizability of the proposed framework. The scope of this manuscript is intentionally focused. It is not intended to provide a technical review of AI, nor to offer detailed discussion of model architectures, prompting strategies, or specialized computational methods. Instead, the objective is to examine the role of AI and POCUS within the clinical method and its parallelism with the scientific method. Finally, the proposed framework has not yet been empirically validated and should be interpreted as a conceptual model intended to guide future research, education, and clinical integration. Given the rapid evolution of AI, some elements of this framework may require refinement as new evidence, technologies, and regulatory standards emerge. Further studies are needed to evaluate its applicability across different healthcare settings and specialties.

    Integrating Artificial Intelligence and Point-of-Care Ultrasound Within the Clinical-Scientific Method: A Framework for Safer, Smarter Medicine · 2026 · DOI

  • Objectives: There is no standardized protocol for performing educational point-of-care ultrasonography (POCUS) that addresses patient-centered ethical issues such as obtaining informed consent.

    Consensus‐based ethical best practices for performing educational point‐of‐care ultrasonography in the emergency department · 2024 · DOI

  • Abstract Background Resuscitative clinician‐performed transesophageal echocardiography (TEE) is a relatively novel ultrasound application; however, optimal teaching methods have not been determined.

    Optimizing simulator‐based training for emergency transesophageal echocardiography: A randomized controlled trial · 2023 · DOI

  • Conclusions: We had mixed results in our attempt to externally validate the UCAT with poor correlation between faculty and moderate to good correlation with faculty to diagnostic sonographer.

    External validation of the ultrasound competency assessment tool · 2023 · DOI

  • Abstract Introduction Point‐of‐care ultrasound (POCUS) has become an important diagnostic tool in acute care medicine; however, little is known about the biomechanical differences between novice and expert practitioners.

    Characterizing the biomechanical differences between novice and expert point‐of‐care ultrasound practitioners using a low‐cost gyroscope and accelerometer integrated sensor: A pilot study · 2022 · DOI

  • MATERIAL AND METHOD: The study covered 553 sonographers who responded to an online survey comprising 27 questions, including branching questions allowing to provide more detailed information depending on the answers given, as well as open questions.

    Evaluation of musculoskeletal symptoms among physicians performing ultrasound · 2017 · DOI

  • RESULTS: All preterm infants had an improvement of L-US findings from one to four grades observed within the first 24 hours after surfactant administration, which has not been previously reported.

    Evaluation of surfactant replacement therapy effects: A new potential role of lung ultrasound · 2015 · DOI

  • The paper proposes incorporating focused ultrasound into advanced life support-compliant resuscitation protocols to detect reversible causes of cardiac arrest in real time, but provides no data on the time-to-diagnosis, specificity for differentiating causes of cardiac arrest, or the clinical impact on resuscitation outcomes compared to standard ACLS protocols without integrated ultrasound assessment.

    Advances in chest imaging in acute medicine · 2013 · DOI

  • The paper identifies operator-dependent image acquisition and interpretation, image quality degradation in obese patients with heavy musculature and tissue edema, and difficulty documenting examination results as key weaknesses of ultrasonography in chest imaging. No specific studies are cited that quantify the impact of these limitations on diagnostic accuracy or propose standardized documentation protocols for point-of-care ultrasound in emergency settings.

    Advances in chest imaging in acute medicine · 2013 · DOI

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51 open questions have been extracted from the limitations and future-work passages of 411 Ultrasound in Clinical Applications papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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