The Adelaide Children's Hospital (now Women's and Children's Hospital) was the first children's hospital in Australia to acquire a diagnostic ultrasound system, in 1976. This year marks the 50-year anniversary of that purchase.
This presentation shows, step by step, the progression of the modality from day one, when images consisted of nine shades of grey saved on polaroid film, to the present-day images with markedly improved resolution and different modes of operation.
The primitive characteristics of early ultrasound images demonstrate how indebted we are to the clinicians who referred patients to the service in the early years, clearly in anticipation of things to come.
The presentation also highlights the technical developments that allowed huge improvements in image quality, resulting in ultrasound replacing many X-ray investigations, avoiding ionising radiation exposure and becoming such a valuable part of current medical imaging for children.

Introduction: Early diagnosis of necrotising enterocolitis (NEC) in preterm neonates remains challenging, with abdominal radiography (AXR) demonstrating limited sensitivity in early or evolving disease. Abdominal ultrasound (AUS) is increasingly recognised as a valuable adjunct for identifying early pathological changes; however, its clinical impact is limited by operator dependence, variability in scanning technique and inconsistent documentation. This presentation aims to review current literature relating to sonographic assessment of NEC and to propose a structured ultrasound technique to support earlier detection and management.
Method: The pathophysiology and clinical significance of NEC in the preterm neonate are reviewed to contextualise key sonographic findings. Current literature describing ultrasound technique and imaging appearances is examined. Key assessment elements include evaluation of bowel wall thickness, echogenicity, pneumatosis intestinalis, peristalsis and perfusion, in addition to assessment for portal venous gas and free fluid.
Results: Literature review identifies key sonographic features associated with early NEC and highlights the importance of a systematic assessment approach. Application of a structured ultrasound technique improves consistency of image acquisition and reporting, enabling earlier recognition of NEC features, particularly when AXR findings are equivocal. This supports increased diagnostic confidence and more timely clinical escalation.
Conclusion: Structured AUS reduces inter-operator variability and enhances the clinical utility of AUS in suspected NEC, supporting earlier detection and improved multidisciplinary communication.
Take home message: Ultrasound plays a key role in the early diagnosis and management of NEC. A systematic sonographic approach and recognition of key imaging features are essential to optimise diagnostic accuracy and patient outcomes.