How to set‐up and perform contrast‐enhanced ultrasound

Abstract

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.

Barriers to contrast‐enhanced ultrasound in New Zealand and proposed solutions

“…The lack of knowledge on part of practitioners can be addressed through continuing professional development including self‐directed study, organised CEUS‐specific education and clinical site visits 12 . CEUS sessions and presentations are incorporated into virtually all abdominal US meetings in Australia and overseas, including the recent World Federation for Ultrasound in Medicine and Biology, Australasian Society for Ultrasound in Medicine, Australasian Sonographers Association and European Federation of Societies for Ultrasound in Medicine and Biology.…”

“…It would be unrealistic to expect enthusiastic support for CEUS from radiologists who are poorly informed and not skilled in its performance and interpretation. Sonographers and radiologists should take active leadership in promoting CEUS, educating the imaging team and implementing CEUS service 12 . Step‐by‐step recommendations on how to set up and perform CEUS have been published by numerous authors, 12,16,17 including NZ and Australian experts, making it easier to get up and started.…”

“…Sonographers and radiologists should take active leadership in promoting CEUS, educating the imaging team and implementing CEUS service 12 . Step‐by‐step recommendations on how to set up and perform CEUS have been published by numerous authors, 12,16,17 including NZ and Australian experts, making it easier to get up and started. Expert sonographers should be encouraged and expected to take leadership with regard to CEUS.…”

“…CEUS has been prolifically used in Europe, Asia and Canada for over two decades 11 . A number of comprehensive guidelines have been published, informing sonographers and radiologists about the technique and clinical interpretation of CEUS 2‐4,12‐17 . Despite its proven clinical utility, freely available reference literature and ease of implementation, the uptake of CEUS in Australia and NZ has been very low 12 .…”

The visualisation of focal liver lesions on ultrasound: A review of 300 liver ultrasounds with CT or MRI correlation

“…Sonographers, radiologists, and clinicians should be aware of the limitations of conventional US and exercise a low threshold for the use of additional imaging methods for the detection and characterisation of FLL. For FLLs identified on conventional US and requiring characterisation, CEUS has been proposed as the modality of choice because of its unique combination of favourable characteristics including accuracy, accessibility, ease of implementation, low cost, and proven ability to improve the detection of FLLs . CEUS can also be used to survey the selected patients at risk of malignancy .…”