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Central to the provision of effective patient care is the ability to obtain a timely and accurate assessment of an individual’s clinical condition while maintaining the lowest risks for adverse outcomes. Contrast enhanced ultrasound (CEUS) offers a safe, reliable imaging option to establish a clinical diagnosis across a variety of multidisciplinary settings. CEUS studies use intracavitary or intravenously (IV)-injected ultrasound contrast agents (UCA, a.k.a. ultrasound enhancing agents), along with widely-available ultrasound hardware and software, to produce diagnostic images in real time [1, 2–3]. The focus of this paper will be the CEUS via IV route. CEUS studies do not expose patients or staff to ionizing radiation, and UCAs are among the safest contrast agents used in modern medical imaging with no influence on renal or thyroid function [4]. CEUS studies can reduce the need for additional downstream testing [5, 6, 7–8], improve the time to diagnosis [9], lower overall imaging costs [5, 6–7], and potentially improve workflows. There are also situations where CEUS may be the only suitable modality to evaluate an abnormality [10].
CEUS imaging has multiple applications in cardiology and radiology. UCAs are useful in diagnosing cardiac and vascular disease by improving endocardial border resolution and assessment of blood volume and myocardial perfusion [1, 2,9,11,12]. UCAs also enable identification and characterization of tumors, and monitoring of inflammatory and neoplastic gastro-intestinal and renal diseases. [1, 2, 9, 11, 12] In addition, novel applications of UCAs are being explored in the therapeutic realm, including molecular imaging, sonothrombolysis, and enhanced delivery of chemotherapy drugs and gene therapies [13, 14].
Although CEUS is underutilized relative to potential applications [5, 15], CEUS indications and use are growing in adult and pediatric patient populations worldwide. Reflecting that trend, numerous multi-societal guidance documents now support the administration of UCAs by sonographers and other medical professionals under appropriate supervision [1, 2, 9, 11, 12, 16]. For example, the recently updated “Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer,” promulgated by the Society of Diagnostic Medical Sonography (SDMS), allows a trained sonographer to determine when a CEUS examination is necessary, place an IV, and inject UCAs [17].
This Expert Consensus Statement serves to outline expert opinion on what constitutes appropriate supervision and the essential components of safe CEUS...