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The pediatric benefits of contrast enhanced ultrasound

by Lauren Dubinsky, Senior Reporter | April 20, 2020
Pediatrics Ultrasound
From the April 2020 issue of HealthCare Business News magazine

He added that the ultrasound software for contrast microbubble visualization improved after the FDA approved the contrast agents. The systems are now very sensitive in picking up the contrast agents, which has helped further shorten the learning curve.

Doing things differently
Aside from a lack of training, another barrier to adoption of CEUS is the workflow changes associated with it. Compared to traditional ultrasound exams, CEUS requires greater involvement from the radiologist.

“Using contrast agents with ultrasound is a little bit of a cultural change,” said Darge. “Before ultrasound, you didn’t have an IV line or a bladder catheter or have to inject anything — you just scanned.”

The Department of Radiology at CHOP has about 50 pediatric radiologists that perform contrast ultrasound in the Division of Body Imaging and the Division of Interventional Radiology, along with the sonographers. Since it’s departmental and not limited to one person doing the studies, the workflow is more streamlined.

As with any imaging exam, reimbursement is a key consideration for facilities looking to implement new ways of caring for their patients. Fortunately, reimbursement for CEUS is generally favorable.

In January 2019, major changes in the payment of CEUS imaging of the abdomen were put into place. That includes a new Category I CPT code that supports that use of CEUS for non-cardiac abdominal imaging.

There is also a CPT code that allows for the billing of intravesical and intravenous exams. The code is contrast-agent-neutral and even covers clinical exams in which the agent is used off label.

“The insurance companies have increasingly accepted that, and we have not seen any significant push from them,” said Darge. “It is very important to realize that this was an important factor to have in order to make the exam widespread.”

The black box
Prior to 2007, the FDA received reports of adverse reactions that occurred around the time that an ultrasound contrast agent was administered. In response, the FDA mandated a “black box” on ultrasound contrast agent labels, which is the highest level of labeling for potential adverse events.

However, these reactions were never proved to be caused by the contrast agent. Proponents of CEUS point out that the patients were critically ill and there were many factors that could have contributed to the adverse reactions they experienced.

There is also concern that these contrast agents are associated with embolisms or strokes in the right to left cardiac or peripheral shunts, but a 2013 review of peer-reviewed research published in the American Journal of Cardiology determined this is not a reasonable concern.

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