This presentation explores the benefits of shared learning between tertiary centres and secondary hospitals to enhance paediatric ultrasound capability. Initiated through collaboration at ASA 2025, the project centred on a one‑week placement at Queensland Children’s Hospital (QCH). This offered valuable exposure to complex pathology, paediatric specialised workflows, and multidisciplinary clinical practice. Key learnings included protocol refinements, practical scanning techniques, and strategies for improving the patient experience in paediatric imaging.
Comparing departments highlighted significant differences in resources, caseload volume, and specialist availability. This underscored the importance of shared learning to bridge capability gaps. Several illustrative cases demonstrate the clinical impact of refined scanning approaches. Additionally, a clinical improvement initiative focused on pyelonephritis assessment revealed further opportunities to enhance diagnostic consistency.
Overall, the presentation emphasises collaboration, the translation of tertiary‑level expertise into smaller hospital settings, and future directions for strengthening paediatric ultrasound services.

Cystic fibrosis is a multi-organ affecting, genetic based disease with ever improving patient outcomes. These patients frequently present for liver surveillance scans, and the purpose of today's talk is to discuss common findings.

In pediatric imaging, ultrasound (USG) is the primary first-line tool for evaluating congenital hepatic lesions due to its safety and real-time assessment of blood flow.

The approach focuses on distinguishing benign developmental masses from rare malignancies using morphological features and vascularity.
Some of the common Benign Hepatic lesions are : Hepatic cysts, Congenital haemangioma, Mesenchymal hamartomas, Biliary hamartomas, focal Nodular hyperplasia. This have to be differentiated from the Malignant Hepatoblastoma.

The presentation will highlight the various characteristics of the lesions on Ultrasound, Colour Doppler and other Radiological investigations.

It will also briefly highlight the follow up and management of these lesions.

Introduction: Our literature review suggests wide variation in accepted pyloric measurements for diagnosis and lack of agreement on which dimension of the pylorus is most accurate for diagnosis of HPS. A correct diagnosis is dependent on sonographer technique and measurement accuracy.
Methods: In a retrospective audit we analysed 161 cases of infants who underwent an ultrasound for suspected hypertrophic pyloric stenosis, with outcomes of evaluating accuracy of sonographic criteria for diagnosis of HPS through correlation with findings at time of surgery. A single observer retrospectively measured the length and transverse diameter of the pyloric canal, and thickness of the pyloric muscle. Measurements were double checked by a second observer and correlated with clinical and surgical findings.
Results: In infants with hypertrophic pyloric stenosis, mean pyloric muscle thickness was 4.7 mm +/- 0.8 mm, pyloric canal length was 19.6 +/-2.4 mm, and pyloric transverse diameter was 13.8 mm +/- 2.0 mm. In patients without hypertrophic pyloric stenosis, pyloric muscle thickness was 1.7 +/- 0.8 mm, pyloric canal length was 10.2 +/- 2.5 mm, and pyloric transverse diameter was 9.5 +/- 2.3 mm.
Conclusions: The mean pyloric measurements of this study are within the range of accepted diagnostic criteria of our institution. Ultrasound diagnosis is 100% congruent with post-surgical diagnosis of HPS. Study showed male predilection and increased likelihood of cases in younger age. No significant separation in measurement for positive and negative cases, and no significant difference in pyloric measurements based on patient age was found.

Necrotising enterocolitis (NEC) is a serious gastrointestinal disease that primarily affects premature neonates. Diagnosis can be challenging, as early symptoms such as abdominal distension, feeding intolerance, and lethargy are non-specific. Abdominal radiography is traditionally the first-line imaging modality; however, radiographic findings may lag behind clinical deterioration. Bowel ultrasound is increasingly recognised as a valuable adjunct in the evaluation of suspected NEC.
Ultrasound has demonstrated higher sensitivity than abdominal radiography, particularly in early disease. It enables direct assessment of bowel wall thickness, peristalsis, perfusion, free fluid, and highly specific findings such as pneumatosis intestinalis and portal venous gas. Doppler imaging plays an important role in evaluating bowel perfusion and may help identify more severe disease as well as other clinically relevant abdominal pathology.
NEC can also occur in term or near term infants with congenital heart disease (CHD). Although the clinical presentation may appear similar between these vulnerable populations, the underlying pathogenesis differs. This presentation aims to: increase sonographer confidence in recognising NEC; differentiate pathogenesis, with a particular focus on cardiac patients; discuss relevant anatomy; review sonographic technique; and highlight key ultrasound findings.

Introduction: Neonates with bilious vomiting are typically investigated for midgut malrotation and volvulus. Recent publications have successfully demonstrated the transition to ultrasound from the traditional upper gastrointestinal (GI) study in the initial investigation for midgut malrotation and volvulus.
Method: In collaboration with the paediatric surgical and newborn services teams at our tertiary institution, we transitioned to a management pathway using ultrasound as the initial investigation for a neonate with suspected midgut malrotation and volvulus. The ultrasound assessment included two important components; (i) assessment of the mesenteric vessels orientation and (ii) following the course of the duodenum from the pylorus to the duodenojejunal flexure with the use of sterile water, thus ensuring a normal retroperitoneal course of the third part of the duodenum (D3). Abnormal or inconclusive ultrasound findings were investigated further with an upper GI study.
Results: In the 18 months post transition, ultrasound results and patient outcomes at our institution were consistent with published literature, resulting in a 90% reduction in the use of upper GI studies. Some of the challenges of the transition at our institution included developing sonographer expertise to ensure adequate afterhours coverage, building confidence in the collaborating teams and the utility of assessment in moderate or extreme preterm neonates.
Conclusion: Transition to ultrasound can be achieved with a clearly established management pathway and appropriate development of sonographer expertise to ensure adequate assessment.
Take home message: Transition to ultrasound as the first diagnostic test for midgut malrotation can be done safely and effectively.

Elastography has emerged as a key non‑invasive tool for assessing liver fibrosis and monitoring chronic liver disease in children. While paediatric cirrhosis remains uncommon, early and accurate detection of fibrosis is essential, as timely treatment can stabilise or even reverse disease progression. This presentation reviews the role of ultrasound‑based elastography— including point shear‑wave elastography (pSWE), and two‑dimensional shear‑wave elastography (2D‑SWE). Elastography techniques provide quantitative measures of liver stiffness that correlate with fibrosis stage, with reported sensitivities for detecting significant fibrosis (≥F2) ranging from 81–95%, depending on modality. In addition to fibrosis staging, elastography assists in differentiating biliary atresia from other causes of neonatal cholestasis, monitoring inflammatory activity in autoimmune hepatitis, and assessing hepatic congestion in conditions such as Fontan physiology. Important limitations include age‑dependent normal values, technical variability between vendors, and confounders such as inflammation, steatosis, and congestion. Despite these challenges, elastography is now central to routine follow‑up, risk stratification for portal hypertension, and treatment response assessment in children with chronic liver disease. This session will highlight current evidence, practical considerations, and emerging applications of elastography in paediatric hepatology.