EFSUMB Sets Rules for Live Ultrasound Training

Live ultrasound scanning remains an important part of ultrasound education, including hands-on training in small groups, demonstrations at courses and congresses and online transmission from clinical settings. A 2026 European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) position statement published in the European Journal of Ultrasound sets out recommendations for live scanning involving apparently healthy volunteers and volunteer patients at educational events. The framework places learning objectives alongside personal integrity, safety, confidentiality and informed consent. It applies to organisers, lecturers, tutors and participants involved in live ultrasound scanning events. It also addresses higher-risk settings, including scanning of pregnant women and children, eye scanning, endocavitary and endoscopic ultrasound, ultrasound-guided interventions and use of ultrasound contrast agents.

Consent and Privacy Safeguards

Patients and healthy volunteers must receive oral and written information well in advance before inclusion in a live ultrasound demonstration. The information should explain the planned setting, including supervised hands-on training, live demonstration for a training group or audience, live transmission or video recording. It should also identify the experts who will perform or supervise the examination, including external faculty, and state where the live demonstration will take place when this is planned.

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Information must cover the possibility of incidental findings and misinterpretations. Patients and volunteers should have at least 48 hours to consider participation. Consent should be written, comply with the General Data Protection Regulation and remain withdrawable at any time. Rejection of an invitation or withdrawal of consent must not lead to disadvantages.

Additional information is required for endoscopic or endocavitary ultrasound, ultrasound-guided interventions and contrast-enhanced ultrasound, including procedural risks. A pre-scan before the workshop or demonstration is recommended so that anatomy and potential incidental findings are known to the examiner.

Organisers must protect personal rights, anonymise patient or volunteer data on ultrasound screens and omit facial images during online or live-streamed examinations. Where anonymisation is limited in small-group demonstrations, advance information and consent must state this clearly.

Safety Rules for Higher-Risk Scanning

Live scanning should be performed or directly supervised by ultrasound practitioners involved in the educational event. These practitioners should have expertise and experience at least equivalent to EFSUMB level II or an analogous level certified or endorsed by national ultrasound societies. Corporate employees may assist at events, but their role should remain limited to demonstrating optimal ultrasound equipment setup and supporting the ultrasound practitioner.

When live scanning involves patients, the examination or procedure must meet applicable medical and safety standards, receive adequate documentation and end with an examination report. Endoscopic, intracavitary and intravascular examinations and ultrasound-guided interventions should not be performed on healthy volunteers. These procedures require an appropriate medical environment and a well-established medical indication.

Ultrasound contrast agents are not recommended for healthy volunteers. In patients, contrast-enhanced scanning must take place in a medical environment or in an educational setting that guarantees hygienic standards for peripheral venous access and adequate preparation for a pseudo-allergic reaction, including resuscitation measures when necessary.

Scanning of children and scanning of the eyes should involve practitioners highly experienced in the relevant ultrasound application and aware of thermal index and mechanical index requirements. Such scans should take place in a clinical or educational setting and not within a commercial exhibition. Live scanning of children should be limited to findings that cannot be adequately demonstrated in adolescent or adult patients or volunteers, with documented parental or guardian consent.

Conduct, Incidental Findings and Comfort

Organisers must have a written policy for incidental findings and compliance with the General Data Protection Regulation. Before the course, the course instructor should inform all participants about respectful treatment of the person being examined, expected behaviour if alleged pathological or unexpected findings appear and the duty of confidentiality connected with such findings. These rules should be integrated into consent forms and, where available, non-disclosure agreements.

Clinically relevant incidental or unexpected findings in healthy volunteers should be communicated in a timely manner by an ultrasound practitioner, such as a faculty member or course director. Communication should occur before or after the live demonstration, not during it. Unexpected findings in volunteers should also lead to a written report after the session. Female participants must confirm that they are not pregnant. If a previously unknown pregnancy appears during a non-obstetrical live scanning event, the scanning session must end, and the participant should be told where to seek professional advice.

Every person performing live scanning must understand thermal index and mechanical index values, ultrasound safety, potential ultrasound bioeffects and ways to reduce those values when required. Acoustic output should remain as low as reasonably achievable while still allowing adequate imaging. Individual scanning sessions should be as short as possible, should not exceed 45 minutes and should include sufficient breaks.

The framework defines live ultrasound training as an educational activity that requires structured preparation, clear supervision, written consent, privacy protection and safety controls. It separates routine educational scanning from higher-risk applications that require specific expertise, medical indications or clinical environments. It also places responsibilities on organisers and faculty before, during and after each event, including policies for incidental findings, confidentiality, equipment data handling and participant comfort. The recommendations support live demonstrations while setting boundaries for patients and healthy volunteers.

Source: European Journal of Ultrasound

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