FibroScan^® procedure for users

Find the key recommendations to run a liver examination with FibroScan^®

Pre examination requirements

Patient shall be fasting for at least 3 hours and can take clear fluids only.^1,2,3

Patient shall be lying on the examination bed for 5 minutes before the examination for the body to rest.

Operator shall be duly trained and certified by Echosens or its local representative.

Device probes shall be calibrated.

Examination room set-up

OPERATOR

Facing screen
On a height adjustable stool

PATIENT

Lying flat on the examination bed
Right arm under the head
Banana shaped position

Probe selection criteria with or without SmartExam

Ensure that the probe used corresponds to the patient’s body type:

To choose between the M or XL probe on adults, follow the automatic probe selection tool displayed in real time, based on the Probe to Liver Capsule Distance (PCD), and not on the patient’s BMI.
For children, probe selection criteria are based on thoracic perimeter (TP).

Warning: selecting XL probe only when M probe examination fails is not correct. Follow the automated probe advice.

Examination reliability criteria

LIVER

At least 10 measurements at the same spot shall be performed with one single probe.
Liver stiffness IQR/Median ratio (%) shall remain ≤30% when final median stiffness result exceeds 7.1 kPa.⁴

SPLEEN

At least 10 measurements at the same spot shall be performed with one single probe.
No recommendations on IQR.

Watch the liver examination with FibroScan^® tutorial

Find out more exclusive tips & tutorials on echosensacademy.com to improve your FibroScan^®daily practice.

Watch tutorial

Your questions about examination and training

Frequently asked questions

How do I ensure a reliable examination with FibroScan^®?

To improve your FibroScan^® skills, review the reminder sheets and tips available on echosensacademy.com.

Are there any FibroScan^® contraindications for patients?

No, FibroScan^®can be performed on every single patient. Examinations on pregnant women and patients with active implantable medical devices (pacemaker, defibrillator…) are not contraindicated.

Contraindications have been lifted since April 2016 in Europe, and subsequently in all other countries (including the United States since March 2023), except in Japan.

References on Pacemakers and Defibrillators

1/ Chan Y, et al. Safety Profile of Liver FibroScan in Patients with Cardiac Pacemakers or Implantable Cardioverter-Defibrillators. Can J Gastroenterol Hepatol. 2017;2017:7298032. doi: 10.1155/2017/7298032. Epub 2017 Feb 27. PMID: 28349045; PMCID: PMC5350419.

2 / Friedrich-Rust M, et al. Safety of transient elastography in patients with implanted cardiac rhythm devices. Dig Liver Dis. 2017 Mar;49(3):314-316. doi: 10.1016/j.dld.2016.11.005. Epub 2016 Nov 17. PMID: 27908579.

References on Pregnant Patients

1/ Duvekot J, et al. [5-OR]: Transient elastography (TE) of the liver as a new diagnostic tool to discriminate between HELLP syndrome and acute fatty liver of pregnancy (AFLP)?, Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health, Volume 5, Issue 1,
2015, Pages 2-3, ISSN 2210-7789, https://doi.org/10.1016/j.preghy.2014.10.009.

2/ Liver stiffness reversibly increases during pregnancy and independently predicts preeclampsia
Ammon FJ, et al. Liver stiffness reversibly increases during pregnancy and independently predicts preeclampsia. World J Gastroenterol. 2018 Oct 14;24(38):4393-4402. doi: 10.3748/wjg.v24.i38.4393. PMID: 30344423; PMCID: PMC6189842.

How do I get my probes calibrated?

Probes are calibrated by Echosens support. All you need to know about probe calibration is available in the calibration FAQ.

How can I interpret FibroScan^® results?

The Interpretation Guide and cut-offs are on myFibroScan (app and website).

Peer-reviewed articles used for the cut-off are available in our Clinical Library.

What if I am not a FibroScan^® certified operator?

Training and certification by Echosens or its local representatives is prerequisite for every FibroScan^®user.

How can I request a new training?

Connect with your local representative or contact us directly through the contact page available on this website.

Where can I find clinical studies on liver stiffness and methotexate, PBC/PSC and haemochromatosis?

There are many clinical studies available for reference in our clinical library.

For methotrexate, filter your search by selecting Etiology = “Drug induced liver injury (DILI)”.
For primary biliary cirrhosis and primary sclerosing cholangitis, filter your search by selecting Etiology = “Cholestatic disease”.
For haemochromatosis, filter your search by selecting aetiology = “Other”.

Browse over the Clinical Library

The present page is not intended to provide training or certification to users.

1. Mederacke I, Wursthorn K, Kirschner J, Rifai K, Manns MP, Wedemeyer H, Bahr MJ. Food intake increases liver stiffness in patients with chronic or resolved hepatitis C virus infection. Liver International 2009;29:1500-1506.
2. Arena U, Lupsor Platon M, Stasi C, Moscarella S, Assarat A, Bedogni G, Piazzolla V, et al. Liver stiffness is influenced by a standardized meal in patients with chronic hepatitis C virus at different stages of fibrotic evolution. Hepatology 2013;58:65-72.
3. Berzigotti A, De Gottardi A, Vukotic R, Siramolpiwat S, Abraldes JG, Garcia-Pagan JC, Bosch J. Effect of meal ingestion on liver stiffness in patients with cirrhosis and portal hypertension. PLoS One 2013;8:e58742.
4. Boursier J, Zarski JP, de Ledinghen V, Rousselet MC, Sturm N, Lebail B, Fouchard-Hubert I, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology 2013;57:1182-1191.

Products in the FibroScan^® range are Class IIa medical devices as defined by Directive 93/42/EEC (EC 0459). These devices are designed for use in a medical practice in order to measure liver stiffness and ultrasound attenuation in patients with liver disease. Examinations with FibroScan^® device shall be performed by an operator who has been certified by the manufacturer or its approved local representative. Operators are expressly recommended to carefully read the instructions given in the user manual and on the labelling of these products. Check cost defrayal conditions with paying bodies.