1. Explain what ultrasound contrast agents (USCA) are.
2- use Chicago curtin style 16th edition as references style, I uploads on PDF file to help you in references style.
3- You are required to answer the questions and you are also expected to include illustrations (diagrams, pictures, etc) with references for picture and diagram
4- at least 5 journals articles of 10 references published in the last 5 years.
5- avoid plagiarism.
6- write text citation with page number for each paragraph or new information.
7- add table of contents
Ultrasound Contrast Agents (USCA)
Table of contents
2. The behaviour of ultrasound contrast agents in an ultrasonic field……………………………………3
The safety aspects of USCA (Ultrasound Contrast Agents)
USCA invention has contributed immensely in the field of medicine. USCAs are particularly beneficial in that images enable cardiologists to detect and, thereby, treat coronary heart diseases that are potentially fatal. According to Marelli (2012: 345), no key risks are involved in this process. USCAs are considered to be generally safe for use and failing to them results to patient deterioration and misdiagnosis. However, it is worth considering pregnant women and people with conditions such as asthma, renal challenges, diabetes mellitus before using USCAs (Marelli, 2012: 348). This paper aims at discussing the risks associated with USCAs and their general safety. Although USCAs are associated with a few risks, they are generally safe in human beings.
Exposure of USCAs to an ultrasound pressure field makes them behavein an acoustic cavitation form(Joseph et al. 2009, 1830). At low pressures, the bubbles do not have significantly adverse impacts on the adjacent cellular structures. At high pressure, there is collapse or inertial cavitation, and this is the concern for safety issues (Marelli, 2012: 345).
An image showing how renal blood flow is assessed (Krix et al. 2011, 1359).
An image showing where the USCA should be injected depending on the targeted area of drug delivery (Correas et al., 2008: 1322).
An image showing how USCAs enhance the quality of images (Correas et al. 2012, 106).
A diagram showing where USCA should be injected to achieve proper impact (Marelli, 2012: 345).
An enhanced imaged after use of USCA (Krix et al. 2011, 1359).
A physician viewing images following use of USCAs (Correas et al., 2008: 568).
According to Joseph et al (2009, 1830), there is a wide array of adverse reactions that vary from exceptionally rare life-threatening anaphylactoid or anaphylactic reactions to mild physiological disturbances. It is imperative that contrast agents’ users are informed about their risk factors. Consequently, they should be ready to manage adverse impacts promptly (Correas et al. 2012, 109).
Mostly, side effects are experienced if the contrast agents are administered intravascularly although they many occur if administration is by other paths. If a patient has a previous reaction history to any contrast medium, there is a high likelihood there will be increased vulnerability to adverse reactions (Correas et al. 2012, 109). Moreover, patients with acknowledged clinical hypersensitivity such as food allergies, hay fever, or bronchial asthma and those who are sensitive to iodine may suffer from severe adverse reactions (Joseph et al. 2009, 1830).
Use of ultrasound contrast agents, newly developed microbubble based products whose administration is intravenous to enhance the ultrasound image quality, present risks in regard to clinical safety (Marelli, 2012: 345). This is because of the locally destructive forces of inertial caviation caused by the interaction of the ultrasound with the micro bubbles (Correas et al. 2009, 72). Research has shown that these destructive forces can damage the endothelium and smooth muscle of the vascular wall. This poses a greater danger to the great number of patients exposed to microbubbles/ ultrasound.
According to the results of several investigations, if organs that have air such as the intestine or lungs and cultured cells are exposed to USCAs, there is a high likelihood of endothelial cell damage and tissue hemorrhage (Joseph et al. 2009, 1832). If USCAs are used on the heart, vital capillary damage is often experienced and contractile performance altered. An alteration of the heart’s contractile performance is linked to increased coronary perfusion as well as an escalation in lactate production (Correas et al. 2009, 72). These are the key factors that are attributed to transient myocardial ischemia.
If ultrasound contrast agents are used on pregnant women for a period of more than twenty hours every week, there is a high likelihood of miscarriage. Ultrasounds involving the use of contrast agents are also associated with infant mortality and pre-term labor (Krix et al. 2011, 1359). USCAs are associated with ultrasonic waves that are exceptionally harmful. These put physical and thermal pressure on the unborn fetus and this is uncalled for. Prolonged use of USCAs among pregnant women renders them vulnerable to having children with defects such as learning challenges, dyslexia, and speech delays (Correas et al. 2009, 72).
People who suffer from diseases such as asthma, renal challenges, diabetes mellitus, previous contrast reaction, and those undergoing metformin therapy are likely to be affected by USCAs (Correas et al. 2009, 70). Patients who are asthmatic are highly vulnerable to severe contrast reactions, particularly when high osmolar agents are used (Correas et al. 2011, 60).
According to recent research, the general safety of USCAs overshadow the patient’s heart potential risks; an indication that USCAs are generally safe for use (Correas et al., 2009: 72). According to Melda Dolan’s research, a cardiologist at Saint Louis University School of Medicine, USCAs are particularly safe. Moreover, since their use was withheld by FDA, diagnosing heart disease and other life-threatening diseases was rendered hard, which led to deterioration of patients’ conditions and deaths (Correas et al. 2008, 569).
In 1997, FDA approved the use of USCs after a vital scrutiny. Following these discussions, a study was conducted with the aim of evaluating the overall general safety and risks associated with USCAs (Correas et al., 2011: 65). The researchers used results obtained from 2 university hospitals. Consequently, the clinical outcomes of close to 24,000 patients were examined. These patients had USCAs used during their echocardiogram. These results were compared to a group of about six thousand patients whose condition did not require the use of USCAs (Correas et al., 2008: 568).
To assess whether USCAs were safe, the researchers assessed both the long-term and short-term outcomes (Correas et al., 2012: 110). In their study, short- term denoted infusions within 30 minutes and long-term, twenty four hours (Correas et al., 2008: 1320). Any grave adverse occurrences or deaths were noted. Out of the 24,000 patients who received USCAs, not even a single one experienced a critical event within thirty minutes. However, there were 3 non-fatal heart attacks as well as one death in 24 hours (Correas et al., 2008: 568). These were, however, not attributable to USCAs. According to Labovitz, the research indicated that USCAs are safe for use in patients to offer optimal imaging.
Dolan argues that the most vital benefit of USCAs is that optimal echocardiography images enable cardiologists to detect and, thereby, treat coronary heart diseases that are potentially fatal and no key risks are involved in this process (Krix et al. 2011, 1359). This benefit was tested through assessing the long-term patient’s survival rate after USCAs were administered at pharmacological stress echocardiogram exams and if the USCAs were not administered. There were nearly similar death rates in both groups (Correas et al. 2010, 2041).
Grayburn testified that USCAs do not have dye in them. Furthermore, patients are not exposed to nephrotoxicity risk or ionizing radiation (Correas et al., 2008: 1321). According to him and as stated earlier, USCAs are much safer as opposed to alternative imaging. On the same note, failure to use USCAs results to greater risks such as downstreaming other procedures or tests and misdiagnosis, which can easily cause death (Krix et al. 2011, 1359).
From the foregoing discussion, it can be emphasized that every treatment goes with a number of risks that may arise from surgery or medications. According to Jakobsen (2010, 1330), in the health care field and more particularly as far as USCAs are concerned, no guarantees can be offered. However, since the general safety of USCAs’ test or treatment is more compared to the risks, which has been evidenced through research, it would be worthwhile to use them so as to promote the wellbeing of patients (Correas et al., 2010; 2041).
Correas, J. M., M. Claudon, F. Tranquart, and O. Helenon. 2010. “Contrast-enhanced ultrasonography: renal applications].” Journal de radiologie 84(12): 2041.
Correas, Jean-Michel, Lori Bridal, Amélie Lesavre, Arnaud Méjean, Michel Claudon, and Olivier Hélénon. 2008. “Ultrasound contrast agents: properties, principles of action, tolerance, and artifacts.” European radiology 11(8): 1316-1328.
Correas, Jean-Michel, Adrienne R. Meuter, Eric Singlas, Dean R. Kessler, Dilip Worah, and Steven C. Quay. 2008. “Human pharmacokinetics of a perfluorocarbon ultrasound contrast agent evaluated with gas chromatography.” Ultrasound in medicine & biology 27(4): 565-570.
Correas, Jean-Michel, Michel Claudon, François Tranquart, and Olivier Hélénon. 2011. “The kidney: imaging with microbubble contrast agents.” Ultrasound quarterly 22(1): 53-66.
Correas, J. M., O. Hélénon, L. Pourcelot, and J. F. Moreau. 2012. “Ultrasound contrast agents. Examples of blood pool agents.” Acta radiologica. Supplementum 412: 101-112.
Correas, Jean-Michel, Peter N. Burns, Xiaoming Lai, And Xiuling Qi. 2009. “Infusion versus bolus of an ultrasound contrast agent: in vivo dose-response measurements of BR1.” Investigative radiology 35(1): 72.
Jakobsen, Jarl. 2010. “Ultrasound contrast agents: clinical applications.” European Radiology 11(8): 1329-1337.
Joseph, Shiba, Thomas Marten Arnold Gronewold, Marc Dominic Schlensog, Carsten Olbrich, Eckhard Quandt, Michael Famulok, and Michael Schirner. 2009. “Specific targeting of ultrasound contrast agent (USCA) for diagnostic application: an in vitro feasibility study based on SAW biosensor.” Biosensors and Bioelectronics 20(9): 1829-1835.
Krix, Martin, Christian Plathow, Fabian Kiessling, Felix Herth, Andreas Karcher, Marco Essig, Harry Schmitteckert, Hans-Ulrich Kauczor, and Stefan Delorme. 2011. “Quantification of perfusion of liver tissue and metastases using a multivessel model for replenishment kinetics of ultrasound contrast agents.” Ultrasound in medicine & biology 30(10): 1355- 1363.
Marelli, Collins. 2012. “Preliminary experience with NC100100, a new ultrasound contrast sagent for intravenous injection.” European Radiology 9: 343-346.