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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: EDU-009 (R)
The sonographers’ perspective: Procedure and imaging in contrast enhanced ultrasonography (CEUS)
Purpose or Case Report: Contrast enhanced ultrasonography (CEUS) is a radiation free, highly sensitive imaging modality for pathology detection in children. CEUS uses ultrasound (US) technology in combination with US contrast agent (UCA). The UCA is administered intravenously via an IV catheter. The UCA is composed of gas-filled microbubbles. This educational exhibit has the aim to describe the procedure and imaging in CEUS from the sonographers’ perspective.
Methods & Materials: The radiologist will protocol the study before exam begin. Initially the patient will be prepped and a 20-22g IV placed prior to start of study, preferably in the left peripheral. 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 5 ml syringe with Optison. If using Lumason, open kit and follow instructions on lid inside kit to reconstitute the UCA. Connect syringe filled contrast to IV catheter. Radiologist will instruct dosage to be administered per injection. Immediately following each injection a 3 to 10 mL saline flush is required to propel the UCA. Every time the connection is broken between the IV, UCA syringe, and/or saline flush you must perform hub scrub. May need additional contrast injections for study based on area(s) of concern. UCA will require agitation in between injections.
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. Prior to contrast administration, perform a grayscale series of images to include all areas of concern. Utilize dual screen imaging while in the contrast application and switch to single mode when the anatomical structures are clearly identified. Agitate syringe prior to contrast administration. Upon radiologist’s instruction, administer the UCA dosage requested. Begin scanning area(s) of interest while acquiring representative cine clips and still images during all phases of the study.
Conclusions: CEUS 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 a 20-22g IV placed prior to start of study, preferably in the left peripheral. 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 5 ml syringe with Optison. If using Lumason, open kit and follow instructions on lid inside kit to reconstitute the UCA. Connect syringe filled contrast to IV catheter. Radiologist will instruct dosage to be administered per injection. Immediately following each injection a 3 to 10 mL saline flush is required to propel the UCA. Every time the connection is broken between the IV, UCA syringe, and/or saline flush you must perform hub scrub. May need additional contrast injections for study based on area(s) of concern. UCA will require agitation in between injections.
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. Prior to contrast administration, perform a grayscale series of images to include all areas of concern. Utilize dual screen imaging while in the contrast application and switch to single mode when the anatomical structures are clearly identified. Agitate syringe prior to contrast administration. Upon radiologist’s instruction, administer the UCA dosage requested. Begin scanning area(s) of interest while acquiring representative cine clips and still images during all phases of the study.
Conclusions: CEUS 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.
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