Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol

Mohammad I. Hirzallah, Piergiorgio Lochner, Muhammad Ubaid Hafeez, Andrew G. Lee, Christos Krogias, Deepa Dongarwar, Ramneek Manchanda, Lara Ouellette, Nicholas D. Hartman, Michael Ertl, Felix Schlachetzki, Chiara Robba

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


Background and Purpose: The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC). Methods: A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript. Results: A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement. Conclusions: This review and Delphi protocol aim to establish ONSD US QCC. A broad consensus from this process may reduce the variability of ONSD measurements in future studies, which would ultimately translate into improved ONSD clinical applications. This protocol was reviewed and endorsed by the German Society of Ultrasound in Medicine.

Original languageEnglish (US)
JournalJournal of Neuroimaging
StatePublished - Sep 1 2022


  • Delphi
  • ONSD
  • consensus
  • intracranial pressure
  • optic nerve sheath diameter
  • quality criteria
  • ultrasound
  • Optic Nerve/diagnostic imaging
  • Humans
  • Ultrasonography/methods
  • Intracranial Hypertension
  • Intracranial Pressure/physiology

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging


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