Contrast-enhanced ultrasound (CEUS) is an important part of current ultrasound imaging practice. Sonographers, radiologists and other sonologists should consider CEUS as a standard tool in the diagnostic toolbox of ultrasound and utilise it liberally to solve a wide range of imaging problems whilst reducing the need to resort to CT or MRI. Setting up a CEUS service is within easy reach of all motivated practitioners. The initial process requires assessment of the demand for CEUS, ensuring staff readiness, preparing administrative processes and obtaining CEUS supplies. The CEUS examination includes gaining informed consent, ensuring authorisation to administer contrast agent (preferably by means of a standing order), conventional pre-scan of the area of interest, insertion of a peripheral IV cannula, preparation of the contrast agent, initiation of the contrast imaging mode, administration of the contrast agent, performance of the examination and aftercare. A number of other important considerations are discussed including cannulation and IV certification, scopes of practice for sonographers performing CEUS, contrast dosing, scheduling, training, interpretation, reporting and quality control.

Different strategies, based on CVD risk, resulted in AAA prevalence rates that were significantly greater than that in CVD-free individuals. This may provide opportunities for a targeted approach to community AAA screening in parts of the world where more sophisticated national screening programmes do not exist.

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Epidemiologic studies demonstrate the prevalence of AAA is 3 to 6 times higher in men than women (Pleumeekers HJ et al, Am J Epidemiol 1995;142:1291-9). However, almost one-third of patients with ruptured AAA who present to a hospital are women. Unfortunately, their mortality is also very high so that women are contributing to an increasing proportion of AAA deaths (Anjum A et al, Br J Surg 2012;99:637-45). There is little data available for efficacy of AAA screening studies in women. The current study is a systematic review of contemporary (2000 or later) AAA screening studies in women with a goal to assess the population prevalence and determine how this may vary with age and smoking status. Screening studies since 2000 for AAA that included over 1000 women, aged at least 60 years were included in the review. Studies were identified by searching MEDLINE, Embase and CENTRAL databases until 13th January 2016. Eight studies were identified and included only three based on population registries. The largest studies were based on self-purchase of screening. All together 1,537,633 women were screened. Overall AAA prevalence rates were very heterogeneous, ranging from 0.37 to 1.53%, pooled prevalence 0.74 (95% confidence interval, 0.53%-1.03%). Pooled prevalence increased with both age (>1% in women aged over 70 years) and smoking (>1% for ever smokers and >2% in current smokers).Comment: Data for contemporary prevalence of AAA in women should be considered in the context of ongoing debate about whether it is potentially cost effective to offer AAA screening in women. AAA screening in 65 year old men has been shown to be cost effective down to a prevalence rate as low as 0.35%. Perhaps then AAA screening may also be cost effective in 70 year old women especially as the AAA rupture rate in women is about 4 times that of men for a given AAA diameter (Sweeting MJ et al, Br J Surg 2012;99:655-65). The authors review showing a pooled AAA prevalence of 0.74% in women aged at least 60 years, and rising to over 1% in ever smokers and those aged $70 years strongly suggests that targeted AAA screening in older women may be both clinically useful and cost effective. The study certainly should, at the least, further stimulate debate about offering targeted screening to older women who currently or have ever smoked.

IntroductionA patient's eligibility for carotid endarterectomy (CEA) is determined primarily by the degree of carotid stenosis detected on duplex ultrasound. The Australasian Society for Ultrasound in Medicine (ASUM) criteria are widely used to grade carotid stenoses in many practices throughout Australasia.MethodsWe sought to investigate the potential impact on the grading of carotid artery stenosis if practitioners switched from the ASUM criteria to the United Kingdom's joint recommendation (UKJR) criteria by reviewing 100 patients with a haemodynamically significant carotid artery stenosis.ResultsWe found agreement between the criteria in 100% of cases for stenoses <50%, in 80% of cases for stenoses 50–69%, in 89% of cases for stenoses ≥70% and in 100% of cases for stenoses ≥80%. While there was variation in grading of stenoses in 16% of cases, reclassification resulted in no change in the number of patients eligible for CEA. The UKJR guideline enabled more precise categorisation of haemodynamically significant stenosis into deciles.DiscussionBecause the UKJR guideline is more comprehensive, we believe that adopting this guideline would enable the ultrasound practitioner to grade carotid stenoses more precisely, better understand the nuances of carotid duplex imaging and more successfully navigate and interpret complex carotid examinations, without impacting the number of patients eligible for CEA.