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May 12, 2021 — Pediatric Radiology


The addition of contrast US to an existing pediatric US service requires several preparatory steps. This overview provides a guideto simplify the process. Initially, it is important to communicate to all stakeholders the justifications for pediatric contrast US,including (1) its comparable or better diagnostic results relative to other modalities; (2) its reduction in procedural sedation oranesthesia by avoiding MRI or CT; (3) its reduction or elimination of radiation exposure by not having to perform fluoroscopy orCT; (4) the higher safety profile of US contrast agents (UCA) compared to other contrast agents; (5) the improved exam comfortand ease inherent to US, leading to better patient and family experience, including bedside US exams for children who cannot betransported; (6) the need for another diagnostic option in light of increasing demand by parents and providers; and (7) its status asan approved and reimbursable exam. It is necessary to have an UCA incorporated into the pharmacy formulary noting that onlySonoVue/Lumason is currently approved for pediatric use. In the United States this UCA is approved for intravenous adminis-tration for cardiac and liver imaging and for vesicoureteric reflux detection with intravesical application. In Europe and China it isonly approved for the intravesical use in children. All other applications are off-label. The US scanner needs to be equipped withcontrast-specific software. The UCA has to be prepared just before the exam and it is important to strictly follow the steps asoutlined in the packaging inserts in order to prevent premature destruction of the microbubbles. The initial training in contrast USis best focused on the frontline staff actually performing the US studies; these might be sonographers, pediatric or interventionalradiologists, or trainees. It is important from the outset to educate the referring physicians about contrast US. It is helpful toparticipate in existing contrast US courses, particularly those with hands-on components

Authors: Kassa Darge1; Susan J. Back1; Richard A. Barth2; Ann M. Johnson1; Jeannie K. Kwon3; M. Beth McCarville4; Trudy A. Morgan1; Aikaterini Ntoulia1; Laura Poznick1; Sphoorti Shellikeri1; Abhay S. Srinivasan1; Anne Marie Cahill1

1 Department of Radiology, Children’s Hospital of Philadelphia, USA
2 Department of Radiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA
3 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
4 Department of Diagnostic Imaging, St Jude Children’s Research Hospital, Memphis, TN, USA

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