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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: EDU-007 (R)
The sonographers’ perspective: Procedure and imaging in contrast enhanced voiding urosonography (ceVUS)
Purpose or Case Report: Contrast enhanced voiding urosonography (ceVUS) is a radiation free, highly sensitive imaging modality for vesicoureteral reflux (VUR) detection and urethral imaging in children. CeVUS uses ultrasound (US) technology in combination with US contrast agent (UCA). The UCA is administered intravesically via a bladder catheter. These are composed of gas-filled microbubbles. This educational exhibit has the aim to describe the procedure and imaging in ceVUS from the sonographers’ perspective.
Methods & Materials: The radiologist will protocol the study before exam begin. Initially the patient will be prepped and catheterized prior to start of study. Connect large spike to 250ml 0.9% sodium chloride injection USP (SCI USP) bag and fill each 60 ml syringes with SCI USP. If using Optison, remove one vial from refrigerator and agitate by rolling in your hands to mix and warm contrast. Connect small spike to vial. Fill 1 ml syringe with 0.5 ml of Optison. If using Lumason, open kit and follow instructions on lid inside kit to reconstitute the UCA. Attach 18G safety glide needle to contrast filled syringe and inject 0.5 mL into 250 mL SCI USP bag utilizing the white port on the bag. Connect 84” tubing to blue capped port of contrast filled SCI USP bag. Make sure tubing is closed or saline will leak out. Hang on IV pole. 3-way stopcock will be connected to 60ml syringe (blue cap side), 250 ml SCI USP bag (bottom side), and catheter (top side). May need additional contrast filled SCI USP bags for study based on child’s age and/or bladder capacity.
Results: Select appropriate transducer and application for imaging, as well as contrast-specific modality. Optimize image (gain, dynamic range, output power) and select low MI for contrast imaging. Utilize dual screen imaging while in the contrast application and switch to single mode when the anatomical structures are clearly identified. Prior to contrast administration, perform a grayscale series of images to include the urinary bladder and right/left kidneys in dual mode. Agitate bag prior to contrast administration. Upon radiologist’s instruction, open tubing to allow contrast to flow into bladder. Begin scanning in the same sequence as pre-contrast imaging. Acquire representative cine clips and still images during all phases of the study.
Conclusions: ceVUS is a low cost, easy to perform, non-radiating, real time imaging that can be easily performed by sonographers by following the above described procedural steps.
Methods & Materials: The radiologist will protocol the study before exam begin. Initially the patient will be prepped and catheterized prior to start of study. Connect large spike to 250ml 0.9% sodium chloride injection USP (SCI USP) bag and fill each 60 ml syringes with SCI USP. If using Optison, remove one vial from refrigerator and agitate by rolling in your hands to mix and warm contrast. Connect small spike to vial. Fill 1 ml syringe with 0.5 ml of Optison. If using Lumason, open kit and follow instructions on lid inside kit to reconstitute the UCA. Attach 18G safety glide needle to contrast filled syringe and inject 0.5 mL into 250 mL SCI USP bag utilizing the white port on the bag. Connect 84” tubing to blue capped port of contrast filled SCI USP bag. Make sure tubing is closed or saline will leak out. Hang on IV pole. 3-way stopcock will be connected to 60ml syringe (blue cap side), 250 ml SCI USP bag (bottom side), and catheter (top side). May need additional contrast filled SCI USP bags for study based on child’s age and/or bladder capacity.
Results: Select appropriate transducer and application for imaging, as well as contrast-specific modality. Optimize image (gain, dynamic range, output power) and select low MI for contrast imaging. Utilize dual screen imaging while in the contrast application and switch to single mode when the anatomical structures are clearly identified. Prior to contrast administration, perform a grayscale series of images to include the urinary bladder and right/left kidneys in dual mode. Agitate bag prior to contrast administration. Upon radiologist’s instruction, open tubing to allow contrast to flow into bladder. Begin scanning in the same sequence as pre-contrast imaging. Acquire representative cine clips and still images during all phases of the study.
Conclusions: ceVUS is a low cost, easy to perform, non-radiating, real time imaging that can be easily performed by sonographers by following the above described procedural steps.
More abstracts on this topic:
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