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Dr. Bernaski, I agree with most of what you say regarding the use of
contrast with renals.  To be honest.  I haven't used contrast with renals in
about a year.  However, I still contend that in the very difficult patient
that contrast improves color flow demonstration of renal perfusion as well
as identification of the renal arteries in their entirety.  For the highly
skilled and experienced renal artery sonographer Contrast is probably
"almost" never necessary.  However, I'm not convinced that it wouldn't
improve the reliability/accuracy of Doppler data in extremely difficult
patients.  I use both the ATL 5000 SonoCT and the Philips/Agilent 5500.  The
Agilent 5500 is by far my system of choice for doing difficult renal
arteries (S3 Sector Probe).  As far as Optison is concerned; Why would you
use a product that requires you to repeatedly "jostle" the infusion when you
have a product that cost essentially the same that will remain suspended
and, by most reports, more stable in blood.

Dwight Michael, RDCS, RVT
Director, Operations & Development
Non-Invasive Cardiovascular Services
Montclair Baptist Medical Center
800 Montclair Road
Birmingham, Al 35213
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-----Original Message-----
From: Ed Bernaski [mailto:[log in to unmask]]
Sent: Monday, November 18, 2002 8:06 PM
To: [log in to unmask]
Subject: Re: Renal Artery Duplex with Ultrasound Contrast


We do a pretty fair number of RA duplexes (3-5 per day) and are an
accredited visceral lab. We used Optison initially during our learning curve
but have not used contrast for a renal duplex in over three years. It does
not help in pt's that are poorly prepped (gassy!) and does not substitute
for a concisely performed, complete study. We have not found that the
addition of contrast has improved significantly in our ability to see the
renals in their entirety in properly prepped pt's. I would suggest that if
you think you need contrast in a fair number of studies that you might need
to spend more time either making sure the patients are prepped and properly
positioned during the exam. Sometimes moving the patient just a little to
either side will make a big difference. Of course patient's breath holding
is crucial also. We do all our studies with an ATL 5000 with SonoCT. I have
found SonoCT to be more helpful than contrast.
    With respect to Optison "layering out" we do use a fair amount of it for
Perfusion Echo studies. If you jostle the IV back every few minutes I think
you will find that it can be given by infusion as easily as Definity.
Ed Bernaski, M.D., F.A.C.C.
Gramercy Park Cardiology
----- Original Message -----
From: "Elaine Erickson" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, November 17, 2002 9:57 PM
Subject: Renal Artery Duplex with Ultrasound Contrast


> Hi,
> Has anyone out there had experience with bubble contrast to enhance renal
> artery studies.  If so, I would be interested in your opinion as to
whether
> or not sufficient optimization resulted from the use of contrast, and what
> protocol was followed to achieve the maximum benefits.  I currently work
> for cardiologists, but my previous experience has been limited to
abdominal
> and peripheral exams.  The cardiologists do rely on Optison for cardiac
> imaging on some technically difficult patients, and was curious if anyone
> has had experience in other applications of bubble contrast.
> Thank you,
> Elaine Erickson
>
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