https://www.mdu.se/

Ultrasound coupling technology is pivotal to ensuring high-quality diagnostic imaging, yet conventional water-based gels face persistent challenges, including acoustic impedance mismatch, air-bubble formation, dehydration, messiness, and cross-contamination risks. This review presents a comprehensive analysis of the evolution, materials science, and clinical performance of ultrasound gel pads, an advanced alternative engineered for superior acoustic transmission, hygiene, and patient comfort. Historical progression from early coupling agents to modern polymeric and hydrogel-based pads is traced, highlighting breakthroughs such as bilayer hydrogels, nanocomposite reinforcements, metamaterial-inspired designs, and patient-specific 3D-printed pads. Comparative evaluations demonstrate that gel pads, particularly those integrating nanotechnology, rival but often outperform traditional gels in transmission efficiency, near-field resolution, and adaptability to complex anatomical surfaces, while offering reusability and reduced environmental impact. For instance, solid gel pads achieved 92.3% stone disintegration, compared with 45.5% for semi-liquid gel, in ESWL phantom studies (p < 0.001). Materials, including polyacrylamide, silicone, and advanced hydrogels, are analyzed for mechanical properties, biocompatibility, and sustainability, with emphasis on biodegradable and locally sourced alternatives. Manufacturing innovations ranging from continuous casting to additive manufacturing enable customization, functional integration, and scalable production, although cost, supply chain stability, and regulatory compliance remain critical barriers. By uniting advances in materials engineering, nanotechnology, and precision manufacturing, ultrasound gel pads have demonstrated strong potential to advance coupling media for diagnostic, therapeutic, and wearable ultrasound applications, enabling higher diagnostic accuracy, streamlined workflows, and patient-centered care across diverse clinical and resource-limited settings.