Best Practice: Implementation of Liver US Shear-Wave Elastography in Clinical Practice

Chronic liver disease is a substantial cause of mortality and morbidity worldwide, with metabolic dysfunction-associated steatotic liver disease affecting about one-third of the population. Shear-wave elastography (SWE) is a safe and noninvasive US method for quantifying liver fibrosis. It is a widely available, low-cost imaging test that has proven accurate and reliable for diagnosing advanced liver fibrosis, a key determinant of mortality risk among patients with chronic liver disease. Established society guidelines for SWE outline patient selection, preparation, image acquisition, examination reliability characterization, and reporting. However, inconsistencies between guidelines and the complexity of recommendations pose barriers to practical clinical implementation. To address this gap, established best practices for US SWE are reviewed and synthesized, actionable recommendations for streamlining clinical deployment are provided, and common pitfalls are highlighted.