This episode explores a study from Radiology Advances challenging FDA's acoustic output limits for liver ultrasound elastography for obese patients. The authors tested the exam at a mechanical index of 2.5, well above the 1.9 regulatory ceiling, and found no liver injury using stringent biochemical criteria. The payoff: a 29.2% reduction in measurement variability and 40% fewer failed attempts in obese participants, potentially transforming metabolic dysfunction associated steatotic liver disease screening in the population that needs it most.

Liver shear wave elastography using a mechanical index exceeding regulatory limits is safe and effective. Pierce et al. Radiology Advances, 2025, 2(6), umaf034.