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JPEN J Parenter Enteral Nutr. 2014 Sep;38(7):886-90. doi: 10.1177/0148607113501327. Epub 2013 Aug 26.

Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness.

Author information

  • 1Brigham and Women's Hospital, Boston, MA, USA.
  • 2University of Alberta, Edmonton, AB, Canada.
  • 3University of Colorado School of Medicine, Aurora, CO, USA.
  • 4University Hospital, University of Strasbourg, Strasbourg, France.
  • 5Kingston General Hospital, Kingston, ON, Canada.
  • 6Erasme University Hospital, Brussels, Belgium.
  • 7UT Health Science Center of Houston, Houston, TX, USA.
  • 8Kingston General Hospital, Kingston, ON, Canada dkh2@queensu.ca.



Critically ill patients commonly experience skeletal muscle wasting that may predict clinical outcome. Ultrasound is a noninvasive method that can measure muscle quadriceps muscle layer thickness (QMLT) and subsequently lean body mass (LBM) at the bedside. However, currently the reliability of these measurements are unknown. The objectives of this study were to evaluate the intra- and interreliability of measuring QMLT using bedside ultrasound.


Ultrasound measurements of QMLT were conducted at 7 centers on healthy volunteers. Trainers were instructed to perform measurements twice on each patient, and then a second trainee repeated the measurement. Intrarater reliability measured how consistently the same person measured the subject according to intraclass correlation (ICC). Interrater reliability measured how consistently trainer and trainee agreed when measuring the same subject according to the ICC.


We collected 42 pairs of within operator measurements with an ICC of .98 and 78 pairs of trainer-to-trainee measurements with an ICC of .95. There were no statistically significant differences between the trainer and trainee results (trainer and trainee mean = -0.028 cm, 95% CI = -0.067 to -0.011, P = .1607).


Excellent intra- and interrater reliability for ultrasound measurements of QMLT in healthy volunteers was observed when performed by a range of providers with no prior ultrasound experience, including dietitians, nurses, physicians, and research assistants. This technique shows promise as a method to evaluate LBM status in ICU or hospital settings and as a method to assess the effects of nutrition and exercise-based interventions on muscle wasting.

© 2013 American Society for Parenteral and Enteral Nutrition.


critical care; muscle layer thickness; muscle wasting; ultrasound

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