Purpose or Case Report: Midgut volvulus (MGV) is a surgical emergency with potentially devastating risks of short gut syndrome, sepsis, and death. Timely diagnosis prevents treatment delay. Although traditionally diagnosed with an upper gastrointestinal (UGI) series, ultrasound (US) offers a rapid, radiation-free alternative when performed by trained operators. As part of our institution’s transition to an “ultrasound-first” protocol for suspected malrotation/MGV, we designed and implemented a structured training program to enhance sonographer proficiency. This study presents the framework and preliminary outcomes of this training initiative.
Methods & Materials: A comprehensive US protocol guided by a structured sonographer reporting template comprising of seven key diagnostic features of MGV was jointly developed by senior sonographers and paediatric radiologists. The training program included a didactic lecture, supervised hands-on scanning, and stepwise competency assessments. Each sonographer was required to complete at least 17 supervised cases (three observed, four assisted, ten unassisted) in which the clinical indication was to exclude malrotation/MGV. Performance was evaluated using a dedicated competency checklist at baseline, mid-training, and final assessment. Assessments were conducted by a senior sonographer (baseline and mid) and a paediatric radiologist (final).
Results: Since the program’s launch in January 2025 up till mid-October 2025, 21 sonographers have participated (6 with >10 years, 5 with 5–10 years, and 10 with <5 years of paediatric scanning experience). Twelve completed baseline and four completed mid-training assessments. At baseline, 11 sonographers could identify ≥5 of 7 key features, and by mid-training, 4 sonographers (>10 years’ experience) demonstrated full competency across all features. The most consistently well identified findings were SMA/SMV orientation, duodenal tracing (D1–D3), and presence of bowel dilatation. Features of whirlpool sign and mesenteric oedema, although limited by the small number of positive cases, were also recognized when present and verified with a senior sonographer.
Conclusions: Our preliminary results demonstrate that a structured, competency-based training program combining didactic education, mentored scanning, and staged assessment can rapidly enhance sonographer proficiency in assessing for MGV. Continued training and evaluation will refine our US-first diagnostic pathway, serving as a model for other paediatric emergency imaging initiatives.