What advice do you have for sonographers who remain wary of contrast?
Bierig: When the FDA announced a boxed warning, a lot of sonographers became concerned about the possibility of side effects. We need to put that boxed warning and those risks in perspective. I don’t want to minimize the fact that there are risks in everything that we do, but the possibility of side effects with contrast is quite small, especially compared with other imaging modalities. Angiography, nuclear imaging, CT and even transesophageal echo each have higher associated risks than those associated with contrast. At the end of the day, it comes down to making sure you’re providing the best care possible without having to subject the patient to redundant and multiple tests. ADVANCE: What are some examples of clinical situations where contrast agents can and should be used in echocardiography? Bierig: The package insert suggests use any time you need to enhance endocardial border definition. But we can extrapolate from that and think about different situations where it would be appr
