The Impact of Ultrasound Probe Tilt on Muscle Thickness and Echo-Intensity: A Cross-Sectional Study.

INTRODUCTION/BACKGROUND: To determine the influence of ultrasound probe tilt on reliability and overall changes in muscle thickness and echo-intensity.

MATERIALS AND METHODS: Thirty-six individuals had a total of 15 images taken on both the biceps brachii and tibialis anterior muscles. These images were taken in 2° increments with the probe tilted either upward (U) or downward (D) from perpendicular (0°) to the muscle (U6°, U4°, U2°, 0°, D2°, D4°, and D6°). All images were then saved, stored, and analyzed using Image-J software for echo-intensity and muscle thickness measures. Mean values (2-3 measurements within each probe angle) were compared across each probe angle, and reliability was assessed as if the first measure was taken perpendicular to the muscle, but the second measure was taken with the probe tilted to a different angle (to assume unintentional adjustments in reliability from probe tilt).

RESULTS: Tilting the probe as little as 2° produced a significant 4.7%, and 10.5% decrease in echo-intensity of the tibialis anterior and biceps brachii muscles, respectively, while changes in muscle thickness were negligible (<1%) at all probe angles. The reliability for muscle thickness was greater than that of echo-intensity when the probe was held perpendicular at both measurements (∼1% vs 3%), and the impact that probe tilt had on reliability was exacerbated for echo-intensity measurements (max coefficient of variation: 24.5%) compared to muscle thickness (max coefficient of variation: 1.5%).

CONCLUSION: While muscle thickness is less sensitive to ultrasound probe tilt, caution should be taken to ensure minimal probe tilt is present when taking echo-intensity measurements as this will alter mean values and reduce reliability. Echo-intensity values should be interpreted cautiously, particularly when comparing values across technicians/studies where greater alterations in probe tilt is likely.