International practice patterns in the use of ultrasound as first-line imaging for suspected midgut volvulus in children: a joint society for pediatric radiology-European society of paediatric radiology survey.

BACKGROUND: Midgut volvulus is a surgical emergency that requires rapid diagnosis to prevent bowel ischemia. Although fluoroscopic upper gastrointestinal examinations have traditionally been used in some countries, ultrasound is gaining acceptance as a potential first-line imaging modality. OBJECTIVE: To evaluate international practice patterns of first-line ultrasound use for suspected midgut volvulus in children and identify factors influencing adoption. MATERIALS AND METHODS: A voluntary online survey was distributed to members of the Society for Pediatric Radiology and the European Society of Paediatric Radiology between August and September 2025. Survey items addressed institutional use of first-line ultrasound for suspected midgut volvulus, duration of experience, personnel performing examinations, protocol details, and factors influencing adoption. Responses were analyzed by geographic region. RESULTS: Overall, 227 responses representing 179 hospitals across 38 countries were analyzed. First-line ultrasound was used by 78.2% of European hospitals, 28.9% of North American hospitals, and 61.1% of hospitals in other regions. In Europe, the most frequently reported barrier to adoption was radiologist acceptance, whereas in North America the most common barrier was sonographer training and competence. Across all regions, most institutions reported no formal clinical pathway, no standardized reporting template, and no routine administration of oral or nasogastric fluid during the examination. Publication of formal guidelines was the most commonly reported factor that respondents believed would facilitate adoption. CONCLUSION: Use of ultrasound as first-line imaging for suspected midgut volvulus varies widely across regions. Barriers to adoption reflect local staffing and training models, and formal published guidelines were frequently identified as a potential facilitator of broader implementation.