Contrast-Enhanced Focused Assessment with Sonography for Trauma (cFAST) Far Forward: Contrast Visualization Methods...

Area of Science:

• Medical Imaging
• Ultrasound Technology
• Trauma Care

Background:

• The Focused Assessment with Sonography in Trauma (FAST) is crucial in operational settings but has limited sensitivity for solid organ injuries.
• Contrast-enhanced FAST (cFAST) improves diagnostic power for parenchymal and vascular injuries, rivaling CT scans.
• Previous cFAST studies have not utilized handheld ultrasound systems common in combat environments.

Purpose of the Study:

• To evaluate the capability of current handheld and portable ultrasound systems to visualize contrast enhancement for cFAST.
• To assess the feasibility of implementing cFAST using field-deployable ultrasound devices.

Main Methods:

• Six handheld/portable ultrasound systems (Philips Lumify, Butterfly IQ3, GE Vscan Air, Fujifilm Sonosite Edge II, Fujifilm Sonosite M-Turbo) and one cart-based system (GE Venue) were tested.
• Devices were configured with minimized gain and a mechanical index below 0.3, as no dedicated contrast settings were available.
• Standardized patients received intravenous perflutren (Definity) boluses followed by saline flush, with the right upper quadrant scanned for contrast visualization in the kidney.

Main Results:

• Contrast enhancement was successfully visualized on only one handheld device, the GE Vscan Air, and the GE Venue cart-based comparator.
• No contrast enhancement was detected on the other tested handheld ultrasound systems.

Conclusions:

• The majority of handheld and portable ultrasound systems currently deployed in medical settings are inadequate for visualizing contrast in cFAST exams.
• The GE Vscan Air demonstrates potential for handheld cFAST, warranting further investigation into system modifications, software upgrades, or dosing adjustments.
• Developing reliable handheld cFAST methods is essential for advancing research and clinical implementation in military trauma care.