An overwhelming majority of the audience at an RSNA special focus session Thursday voted in favor of keeping up the efforts to get FDA approval for the use of contrast ultrasound for general radiology applications.

When moderator Dr. Peter N. Burns asked those in the 200-plus crowd to raise their hands if they thought the plug should not be pulled on ultrasound contrast, not more than a dozen physicians kept theirs down. When Burns asked to see the hands of those who thought contrast should be let go, only one went up.

A panel composed of Drs. Burns and Stephanie R. Wilson from Canada, Luigi Solbiati from Italy, and Myron A. Pozniak from Madison, WI, discussed the regulatory approval status for contrast-enhanced sonography around the world, its clinical applications, and the arguments in favor of and against the technique.

After the panel discussion and the symbolic voting, members of the audience shared commentaries. Most agreed that the technique is useful and valuable in multiple imaging subspecialties: musculoskeletal, ob/gyn, cardiovascular, and interventional radiology, to name only a few. They also agreed, however, that the reimbursement landscape in the U.S. overwhelmingly favors CT and MR imaging over sonography, which is still considered a time-consuming and operator-dependent modality.

Many said the choice is inevitable. But it could also be harmful to radiology.

"The FDA does not get any benefit from saying ‘yes' and having a complication or something negative occur. And there is no cost to them to saying ‘no.' The constituency for this is outside radiology," an audience member said. "But then everybody else will end up doing ultrasound and in the future radiologists will be relegated to the sidelines by other subspecialists, who will be doing diagnostic studies using contrast ultrasound."