Uncover opportunities to improve echo lab performance
Advancing sonographer engagement to elevate diagnostic quality and workflow1
Learn about the potential benefits of fully engaging your echo lab team with guidance from respected associations in echocardiography2,3
Sonographer-initiated UEA protocols can help improve efficiency4,5
In a retrospective study of 232 echocardiograms, it was found that when sonographers were allowed to administer ultrasound enhancing agents (UEAs), individual echo study times were reduced.5
A study of 672 patients found that
Despite the benefits, UEAs are underutilized due in part to a misconception that they slow down the process1
A sonographer-driven UEA echo-enhancement protocol is not only feasible in busy echo labs, it can be clinically effective and reduce decision and administration time substantially, making echo enhancement with a UEA time-efficient1,*
In an inpatient study of 320 patients, a sonographer-administered echo‑enhancement protocol significantly reduced time spent completing an echo4,†
WITH
a sonographer-administered echo-enhancement protocol4
WITHOUT
these protocols (p < 0.001)4
In the study, sonographer administration of UEAs
SAVED AN AVERAGE OF
12MINUTES PER STUDY4
*
Data derived from retrospective, single-center, observational studies conducted in a high-volume echocardiography laboratory evaluating the implementation of sonographer-driven UEA protocols and associated workflow and time-efficiency outcomes. Limitations include the retrospective design, lack of randomization or comparison to a third imaging technique, performance in high-volume centers with dedicated personnel, and absence of formal assessment of diagnostic accuracy.1
†
Retrospective, single-center, observational study evaluating implementation of a sonographer-initiated, perflutren-based contrast echocardiography protocol for inpatient transthoracic echocardiography, comparing workflow efficiency and exam completion times before and after protocol adoption. Limitations include its nonrandomized design, conduct at a single high-volume academic center, potential confounding from temporal workflow changes and training effects, and limited generalizability to lower volume centers or institutions.4
How could similar time savings impact your echo lab?
To find out, contact Lantheus by calling 1.800.362.2668 or by completing a brief form
Help minimize barriers to using a UEA when a patient has a suboptimal echocardiogram6
A prospective study of over 15,000 patients who went through an echocardiography exam where a pretest score was computed to determine if certain patients could be prequalified for UEA use6,‡
Early identification of candidates may facilitate use of these agents in small- and medium-volume laboratories where resources are limited.6
The IN-USE retrospective study of over 97,000 inpatients and outpatients showed:
Can be used to identify patients who may benefit from IV placement for UEA administration before the start of the echocardiogram to potentially improve workflow efficiency.7,§
IV=intravenous.
‡
Data derived from a prospective observational analysis that developed and validated a simple pretest clinical scoring system to predict the need for microbubble contrast during stress echocardiography, using patient characteristics and image quality parameters to improve efficiency in contrast utilization. Key limitations include single-center design, relatively modest sample size, potential operator and institutional practice bias, and lack of external validation at the time, which may limit generalizability across different echo laboratories and patient populations.6
§
Large single-center, retrospective, observational study analyzing structured report data from consecutive transthoracic echocardiograms to evaluate patterns of UEA use and develop a predictive model for identifying patients likely to benefit from a UEA prior to image acquisition. Limitations include its retrospective, nonrandomized design, reliance on routinely collected variables, potential institutional practice bias, and lack of prospective validation or direct assessment of downstream clinical outcomes, which may limit generalizability.7
ASE guidelines are the industry standard for the use of a UEA2
The 2014 and 2018 ASE guidelines indicate the use of a UEA when2,||:
S
Structural
abnormalities of the LV can’t adequately
be assessed
I
ICU & ED patients
are proving technically difficult
M
Myocardial ischemia is suspected, and ECG is nondiagnostic in ED patient
P
Pseudoaneurysms and LV thrombus need to be diagnosed or ruled out
L
LV segments (2+) can’t be visualized
E
Essential for LVEF quantitative assessment
Guidelines for Sonographers to Overcome Technical and Administrative Barriers to Contrast Utilization8
- Recognize when and how to perform contrast echo
- Obtain IV access privileges
- Understand microbubble physics and ultrasound instrumentation
- Develop written policies and procedures for contrast administration
ASE Recommendations for Quality Echocardiography Laboratory Operations9
- Establish quality assurance policies to minimize uninterpretable or nondiagnostic studies
- Create written policies for the use of UEAs
- Implement quality assessment and improvement programs
- Obtain accreditation
ASE=American Society of Echocardiography; ECG=electrocardiogram; ED=emergency department; ICU=intensive care unit; LV=left ventricular; LVEF=left ventricular ejection fraction; TTEs=transthoracic echocardiograms.
||
Adapted from the ASE guidelines.
IV insertion and UEA administration are considered within the sonographer’s scope of practice by 20 industry organizations10
Rely on established industry organizations to help your echo lab fully engage sonographers for improved efficiency1-3
Some of these organizations include:
Intersocietal Accreditation Commission: Echocardiography3
Highlights of the Standards and Guidelines for Adult Echocardiography Accreditation
International Contrast Ultrasound Society (ICUS)11
Expert Consensus Statement on the Safe Administration of Ultrasound Contrast Agents
American College of Cardiology Foundation12
Appropriate Use Criteria for Echocardiography
Training and resources are available through numerous organizations
Lean on established guidance from respected organizations to implement a sonographer-initiated UEA administration protocol
Scope of Practice and Clinical Standards for the Diagnostic
Medical Sonographer
These guidelines set standards around sonographers’ scope of responsibility.10
American Society
of Echocardiography Guidelines
ASE guidelines provide clear, actionable standards around the use of UEAs.2
ICUS Sample UEA Policy
The ICUS provides an example of a UEA policy and procedure document for echo labs.
Lantheus is here to provide support for your echo lab team
Information is available to help you find guidance for the development of sonographer-initiated UEA protocols
Call Lantheus at 1.800.362.2668 to learn more.
Lantheus EchoInsights Program
Discover your echo lab’s potential for improvement using an interactive data‑analysis tool.
Clinical Specialist Programs
These programs can provide on‑site support, including for implementing sonographer‑initiated UEA protocols.
- Castello R, Bella JN, Rovner A, Swan J, Smith J, Shaw L. Efficacy and time-efficiency of a “sonographer-driven” contrast echocardiography protocol in a high-volume echocardiography laboratory. Am Heart J. 2003;145(3):535-541. doi:10.1067/mhj.2003.164
- Lindner JR, Porter TR, Park MM. American Society of Echocardiography guidelines and recommendations for contrast echocardiography: a summary for applications approved by the U.S. Food and Drug Administration. Accessed March 11, 2026. https://www.asecho.org/wp-content/uploads/2025/05/Contrast-Echo-On-Label-Summary-FINAL-rev.pdf
- Intersocietal Accreditation Commission. IAC Standards and Guidelines for Adult Echocardiography Accreditation. Published May 15, 2021. Accessed May 15, 2024. https://www.intersocietal.org/echo/
- Prentice R, Ahmadian H, Thomas D, Berger J, Gore R. Improved efficiency and diagnostic utility of inpatient transthoracic echocardiography following implementation of a sonographer-initiated perflutren-based contrast administration protocol. Cardiovasc Ultrasound. 2020;18(1):35. doi:10.1186/s12947-020-00215-0
- Usry CR, Shin SR, Aden JK, Gore R. Optimizing contrast-enhanced echocardiography by employing a sonographer driven protocol. J Echocardiogr. 2021;19(3):173-178. doi:10.1007/s12574-021-00523-y
- Bernier M, Abdelmoneim SS, Moir S, McCully RB, Pellikka PA, Mulvagh SL. Pretest score for predicting microbubble contrast agent use in stress echocardiography: a method to increase efficiency in the echo laboratory. Cardiol Res Pract. 2009;2009:308486. doi:10.4061/2009/308486
- Fraiche AM, Manning WJ, Nagueh SF, Main ML, Markson LJ, Strom JB. Identification of need for ultrasound enhancing agent study (the IN-USE study). J Am Soc Echocardiogr. 2020;33(12):1500-1508. doi:10.1016/j.echo.2020.07.015
- Porter TR, Abdelmoneim S, Belcik JT, et al. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27(8):797-810. doi:10.1016/j.echo.2014.05.011
- Picard MH, Adams D, Bierig SM, et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr. 2011;24(1):1-10. doi:10.1016/j.echo.2010.11.006
- Society of Diagnostic Medical Sonography. Scope of Practice and Clinical Standards for the Diagnostic Medical Sonographer. Revised March 6, 2024. Accessed March 30, 2026. https://www.sdms.org/docs/default-source/Resources/scope-of-practice-and-clinical-standards.pdf
- Strom JB, Appis A, Barr RG, et al; International Contrast Ultrasound Society. Multi-societal expert consensus statement on the safe administration of ultrasound contrast agents. Echo Res Pract. 2025;12(1):4. doi:10.1186/s44156-024-00068-7
- Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. J Am Coll Cardiol. 2011;57(9):1126-1166. doi:10.1016/j.jacc.2010.11.002
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