LAUSR

Just Because There is a Button Doesn’t Mean it is Appropriate to Use or That it will Give Accurate Information M odern ultrasound equipment has many options to help improve image quality or provide additional clinically relevant information. The addition of techniques such as harmonic imaging, spatial compounding, ability to change transducer frequency, speed of sound correction, and others have significantly improved image quality and improved diagnostic capabilities of medical ultrasound. The use of these techniques, however, requires additional training to understand and optimize these features. People using ultrasound should be familiar with all these techniques and know how to use them appropriately to provide the best patient care. We also have new techniques such as shear wave elastography (SWE) which use very high output power to obtain new information on the tissues we are evaluating. These techniques are not appropriate for all indications due to the high output power. Vendors have these applications turned on in presets for appropriate organs and not available in presets for other organs. However, by selecting a preset for an appropriate organ it is possible to exam other organs. This off-label use requires the performing physician to be well educated on the technique, including the basic science, and have appropriate literature supporting its use. Contrast-enhanced ultrasound has now been approved for use in adult and pediatric patients for focal liver lesion characterization and voiding cystography. The ultrasound contrast agents are very safe. However, this safety data is for use of these agents with low mechanical index (MI). When high MIs are used the bubbles burst and have the potential for adverse events in certain organs. All ultrasound techniques have artifacts. Some are easy to detect while others may not be recognized. For example, with SWE, just because the system provides an estimate of stiffness does not mean it is accurate. The addition of a quality measure or confidence map has helped in determining if shear wave speed estimates are accurate in SWE. However, there are still artifacts that can occur even if the confidence map suggests an accurate measurement. Anyone using these options must have adequate training regarding the appropriate use of these techniques and when they can cause injury to patients. With the expanding use of point-of-care ultrasound it is imperative that the training include appropriate safety training. Training should also include how to determine if results are free of artifacts and on which organs certain techniques should not be used.