A New Ultrasound Procedure Increases Safety and Comfort for Pediatric Patients
Taking a child to the hospital for a suspected urinary problem can be stressful for everyone. At UCSF Benioff Children's Hospitals in Mission Bay and Oakland, radiologists are now offering a new, more comfortable, and radiation-free imaging method called pediatric Contrast-enhanced voiding urosonography (ceVUS).
ceVUS replaces a procedure called a voiding cystourethrogram (VCUG) which uses X-ray imaging (fluoroscopy). For young children, VCUG can be a stressful experience. It requires them to lie on an unfamiliar table and urinate in a way that may go against their potty training. ceVUS offers a significant advantage: it uses ultrasound, eliminating the need for radiation. Children can even be held by their caregiver during the procedure, creating a more comforting environment.
Jesse Courtier, MD, division chief of pediatric radiology at UCSF Benioff Children’s Hospital, San Francisco, recently competed the first two pediatric ceVUS procedures at Mission Bay, following the groundwork laid by Kayla Cort, DO, at Benioff Children's Oakland. Dr. Cort's experience at Children's Hospital of Philadelphia proved invaluable in setting up the program at UCSF. UCSF expects to perform one or two ceVUS procedures per week in the near future.
ceVUS is used to diagnose vesicoureteral reflux (VUR), a condition where urine flows backward from the bladder to the kidneys. VUR can increase the risk of infections and scarring. This new procedure has the potential for other applications as well. It can help identify kidney abnormalities, anatomical variations, and guide treatment decisions. Replacing fluoroscopy and X-rays, ceVUS uses tiny micro bubbles in its contrast agent, which catch the ultrasound waves to make the signal show if any urine backflow occurs.
The new ultrasound-based procedure has many advantages over the methods currently in use at other institutions. Unlike X-ray imaging, ceVUS avoids exposing children to radiation and it allows children to sit in a potty chair or stand, making it less stressful than lying flat on a table in a medical setting that some children experience as claustrophobic. ceVUS can provide continuous real-time visualization of the urinary system during the exam, increasing the diagnostic utility. And studies show that ceVUS is just as effective as traditional X-ray methods in diagnosing VUR.
Courtier described the second procedure at Mission Bay, performed on July 1, 2024, “We got excellent visualization of the kidneys and bladder, all without ionizing radiation. Our sonographer Jennifer Paoletti was key in helping to coordinate all of the supplies and worked in conjunction with our Mission Bay nursing team.”
Cort is excited about the promising implementation of ceVUS at UCSF, “Providing patients and their families with the ultrasound alternative will eliminate exposure to ionizing radiation, increase the sensitivity for detecting vesicoureteral reflux, and provide a more comfortable exam environment. I am very happy that the pediatric radiology department is now able to provide this service at both Mission Bay and Oakland.”