Use of thoracic ultrasound by physiotherapists: a scoping review of the literature

Published:February 04, 2018DOI:



      Use of diagnostic thoracic ultrasound (TUS) in medical professions to examine the pleura, lung parenchyma and diaphragm is gaining in popularity, however the ways in which physiotherapists are using TUS is unclear.


      The aim of this scoping review is to gain an understanding of the emerging evidence base surrounding physiotherapy use of TUS to inform research and clinical practice.

      Data sources

      A systematic search was conducted of the following databases: Cochrane, EPPI centre, PROSPERO, Medline, CINAHL, AMED, EMBASE, HMIC, and BNI.

      Study selection

      Inclusion criteria: primary research reporting the use of diagnostic TUS; a physiotherapist as part of the study design or as the chief investigator; published in English.

      Synthesis methods

      Data regarding demographics, design, type of conditions and anatomical structures investigated and profession leading the TUS of included papers were compiled in a tabular format.


      Of the 26 included papers, nine studied healthy participants, four studied COPD and four studied critical care patients. Most papers (n = 23) involved scanning the diaphragm. In eight studies the physiotherapist operated the TUS.


      The paper selection process was performed by one author; with no cross-checking by another individual.


      Use of TUS by physiotherapists is an emerging area in both diaphragm and lung diagnostics. A wide range of patient populations may benefit from physiotherapists using TUS. Papers in this review are heterogeneous making any generalisability difficult but does show its potential for varied uses. TUS is an innovative skill in the hands of physiotherapists, but more research is needed.


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        • Chavez M.A.
        • Shams N.
        • Ellington L.E.
        • Naithani N.
        • Gilman R.H.
        • Steinhoff M.C.
        • et al.
        Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis.
        Respir Res. 2014; 15: 50
        • Qian-Jing H.
        • Yong-Chun S.
        • Liu-Qun J.
        • Shu-Jin G.
        • Hong-Yu L.
        • Cia-Shuang P.
        • et al.
        Diagnostic performance of lung ultrasound in the diagnosis of pneumonia: bivariate meta-analysis.
        Int J Clin Exp Med. 2014; 7: 115-121
        • Grimberg A.
        • Shigueoka D.C.
        • Atallah A.N.
        • Ajzen S.
        • Iared W.
        Diagnostic accuracy of sonography for pleural effusion: systematic review.
        Sao Paulo Med J. 2010; 128: 90-95
        • Dubé B.-P.
        • Dres M.
        Diaphragm dysfunction: diagnostic approaches and management strategies.
        J Clin Med. 2016; 5
        • Zambon M.
        • Greco M.
        • Bocchino S.
        • Cabrini L.
        • Beccaria P.F.
        • Zangrillo A.
        Assessment of diaphragmatic dysfunction in the critically ill patient with ultrasound: a systematic review.
        Intensive Care Med. 2017; 43: 29-38
        • Gosselink R.
        • Bott J.
        • Johnson M.
        • Dean E.
        • Nava S.
        • Norrenberg M.
        • et al.
        Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients.
        Intensive Care Med. 2008; 34: 1188-1199
        • Lichtenstein D.A.
        Lung ultrasound in the critically ill: the BLUE protocol.
        Springer International Publishing, 2016 (p. 293. ISBN 978-3-319-15370-4.)
        • Leech M.
        • Bissett B.
        • Kot M.
        • Ntoumenopoulos G.
        Lung ultrasound for critical care physiotherapists: a narrative review.
        Physiother Res Int. 2015; 20: 69-76
        • Le Neindre A.
        • Mongodi S.
        • Philippart F.
        • Bouhemad B.
        Thoracic ultrasound: potential new tool for physiotherapists in respiratory management. A narrative review.
        J Crit Care. 2016; 31: 101-109
        • Arksey H.
        • O’Malley L.
        Scoping studies: towards a methodological framework.
        Int J Soc Res Methodol: Theory Pract. 2005; 8: 19-32
        • Levac D.
        • Colquhoun H.
        • O’Brien K.K.
        Scoping studies: advancing the methodology.
        Implement Sci. 2010; 5: 1-9
        • Peters M.D.J.
        • Godfrey C.M.
        • McInerney P.
        Methodology for JBI scoping reviews. The Joanna Briggs Institute reviewers’ manual 2015.
        The Joanna Briggs Institute, Adelaide, South Australia2015
        • Yamaguti W.P.S.
        • Claudino R.C.
        • Neto A.P.
        • Chammas M.C.
        • Gomes A.C.
        • Salge J.M.
        • et al.
        Diaphragmatic breathing training program improves abdominal motion during natural breathing patients with chronic obstructive pulmonary disease: a randomized controlled trial.
        Arch Phys Med Rehabil. 2012; 93: 571-577
        • Rocha T.
        • Souza H.
        • Brandao D.C.
        • Rattes C.
        • Ribeiro L.
        • Campos S.L.
        • et al.
        The manual diaphragm release technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial.
        J Physiother. 2015; 61: 182-189
        • Alaparthi G.K.
        • Augustine A.J.
        • Anand R.
        • Mahale A.
        Comparison of diaphragmatic breathing exercises, volume and flow incentive spirometry, on diaphragm excursion and pulmonary function in patients undergoing laparoscopic surgery: a randomised controlled trial.
        Minim Invasive Surg. 2016; 2016: 1-12
        • Tenório L.H.S.
        • Santos A.C.
        • Neto J.B.C.
        • Amaral F.J.
        • Passos V.M.M.
        • Lima A.M.J.
        • et al.
        The influence of inspiratory muscle training on diaphragmatic mobility, pulmonary function and maximum respiratory pressures in morbidly obese individuals: a pilot study.
        Disabil Rehabil. 2013; 35
        • Souza H.
        • Rocha T.
        • Pessoa M.
        • Rattes C.
        • Brandao D.
        • Fregonezi G.
        • et al.
        Effects of inspiratory muscle training in elderly women on respiratory muscle strength, diaphragm thickness and mobility.
        J Gerentol Ser A Biol Sci Med Sci. 2014; 69: 1545-1553
        • Noh D.K.
        • Koh J.H.
        • You J.S.H.
        Inter- and intratester reliability values of ultrasound imaging measurements of diaphragm movement in the thoracic and thoracolumbar curves in adolescent idiopathic scoliosis.
        Physiother Theory Pract. 2016; 32: 139-143
        • Baldwin C.E.
        • Bersten A.D.
        Alterations in respiratory and limb muscle strength and size in patients with sepsis who mechanically ventilated.
        Phys Ther. 2014; 94: 68-82
        • Grams S.T.
        • von Saltiel R.
        • Mayer A.F.
        • Schivinski C.I.S.
        • Nobre de L.F.S.
        • Nobrega I.S.
        • et al.
        Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility.
        Clin Physiol Funct Imaging. 2014; 34: 18-25
        • Grigorova-Petrova K.
        • Lubenova D.
        • Dimitrova A.
        • Balaranov D.
        • Lozeva J.
        Feasibility of early physical therapy program in-hospital patients with acute ischemic stroke.
        Maced J Med Sci. 2014; 7: 452-455
        • Baldwin C.E.
        • Paratz J.D.
        • Bersten A.D.
        Diaphragm and peripheral muscle thickness on ultrasound: inter-rater reliability and variability of a methodology using non-standard recumbent positions.
        Respirology. 2011; 16: 1136-1143
        • Yamaguti W.P.S.
        • Sakamoto E.T.
        • Panazzolo D.
        • da Cunha Peixoto C.
        • Cerri G.G.
        • Alnuquerque A.L.P.
        Diaphragmatic mobility in healthy subjects during incentive spirometry with a flow-oriented device and with a volume-oriented device.
        J Braz Pneumonol. 2010; 36: 738-745
        • Yamaguti W.P.S.
        • Paulin E.
        • Salge J.M.
        • Chammas M.C.
        • Cukier A.
        • Carvalho C.R.F.
        Diaphragmatic dysfunction and mortality in patients with COPD.
        J Bras Pneumol. 2009; 35: 1174-1181
        • Yamaguti W.P.S.
        • Paulin E.
        • Shibao S.
        • Kodaira S.
        • Chammas M.C.
        • Carvalho C.R.F.
        Ultrasound evaluation of diaphragmatic mobility in different postures in healthy subjects.
        J Bras Pneumol. 2007; 33: 407-413
        • Blaney F.
        • Sawyer T.
        Sonographic measurement of diaphragmatic motion after upper abdominal surgery: a comparison of three breathing manoeuvres.
        Physiother Theory Pract. 1997; 13: 207-215
        • Hardy F.
        • Walker J.
        • Sawyer T.
        Sonographic measurement of diaphragm movement in patients with tetraplegia.
        Spinal Cord. 2009; 47: 832-834
        • Blaney B.
        • English C.
        • Sawyer T.
        Sonographic measurement of diaphragmatic displacement during tidal breathing manoeuvres—a reliability study.
        Aust J Physiother. 1999; 45: 41-43
        • Yamaguti W.P.S.
        • Paulin E.
        • Shiboa S.
        • Chammas M.C.
        • Salge J.M.
        • Ribeiro M.
        • et al.
        Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients.
        Respirology. 2008; 13: 138-144
        • Paulin E.
        • Yamaguti W.P.S.
        • Chammas M.C.
        • Shiboa S.
        • Stelmach R.
        • Cukier A.
        • et al.
        Influence of diaphragmatic mobility on exercise tolerance and dyspnoea in patients with COPD.
        Respir Med. 2007; 101: 2113-2118
        • Kim J.S.
        • Oh D.W.
        Real-time ultrasound imaging biofeedback training in diaphragmatic function in nontraumatic cervical spinal cord injury: a single-subject experimental study.
        Eur J Physiother. 2016; 19: 69-75
        • Leech M.
        • Bissett B.
        • Kot M.
        • Ntoumenopoulos G.
        Physiotherapist-initiated lung ultrasound to improve intensive care management of a deteriorating patient and prevent intubation: a case report.
        Physiother Theory Pract. 2015; 31: 372-376
        • Sota T.
        • Wada T.
        • Miyagi M.
        • Tamaki A.
        • Osaki M.
        • Hagino H.
        The relationship of diaphragm thickening ratio and respiratory muscle strength in young healthy adults. WCPT Congress 2015.
        Physiotherapy. 2015; 101
        • Schewitz J.
        • Roos R.
        • van Aswegen H.
        • Manda S.
        The effect of two passive head down diaphragm length in healthy adult individuals. WCPT Congress 2015.
        Physiotherapy. 2015; 101
        • Silva L.M.
        • Reinaux C.M.A.
        • Souza H.M.
        • Campos S.
        • Souza T.D.
        • Dornelas A.
        Movement of diaphragm before and after use of prolonged slow expiration technique in healthy infants: a pilot study.
        Am J Respir Crit Care Med. 2014; 189: A3238
        • Riley M.L.
        • Cork G.
        • Osman L.
        • Ntoumenopoulos G.
        Does the addition of diagnostic lung ultra-sound impact on chest physiotherapy intervention in critically-ill patients?.
        J Eur Soc Intensive Care Med. 2014; : S203
        • Parry S.
        • Sarwal A.
        • Cartwright M.
        • Morris P.
        • Denehy L.
        Reliability of quantitative muscle ultrasound analysis in the critically ill population.
        Crit Care Med. 2013; 41: 447
        • See K.C.
        • Ong V.
        • Wong S.H.
        • Leanda R.
        • Santos J.
        • Taculod J.
        • et al.
        Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists.
        Intensive Care Med. 2016; 42: 63-71
        • Cholley B.P.
        International expert statement on training standards for critical care ultrasonography.
        Intensive Care Med. 2011; 27: 369-373