Page 78 - JSOM Spring 2026

FIGURE 4 Right kidney scanned using the Butterfly during contrast
administration; no contrast is visualized.

FIGURE 5 Right kidney
scanned using the GE
Vscan Air during contrast
administration; contrast is
visualized, and the kidney
is more echogenic than the
adjacent liver.

FIGURE 6 Right kidney scanned using the GE Vscan Air during
contrast administration; contrast is visualized, and the kidney is more
echogenic than the adjacent liver. Video: https://jsom.us/kidcont2
(Figures 5, 6, 7). This outcome was unexpected because the MI
of 1.4 was anticipated to destroy the perflutren microbubbles.

The GE Venue is a cart-based portable ultrasound system pres-
ent in the emergency department of the MTF where the authors
are stationed. It is not a system typically found in the deployed
environment. However, it has more powerful image process-
ing, and we included it in the methods testing as a baseline
for comparison. Using a 4C curvilinear probe on abdominal
settings, with an MI adjusted to 0.14, contrast enhancement
was visualized in the right kidney following administration of
a 0.11mL bolus of perflutren (Figure 8).
The results of our methods testing are summarized in Table 1.
Realizing the full military potential of cFAST requires stud-
ies to lay the groundwork and build capacity for cFAST far
Discussion
forward. In the process of designing one such study, our team
cFAST is a prospect with tremendous promise for Combat tested methods for performing contrast-enhanced ultrasound
Casualty Care. It can support medical evacuation decisions, and discovered an initial hurdle: four of the five ultrasound
optimize limited resources (such as blood), and direct patients systems likely to be found from point-of-injury to a Role 2
who most need operative intervention to surgical capabilities. did not visualize the contrast enhancement under conditions
In addition, cFAST supports delivery of excellent care during expected to support visualization.
prolonged casualty care, as it is “particularly useful in moni-
toring the evolution in patients with traumatic injuries which Two main possibilities likely contributed to the failure to visu-
are not submitted to immediate surgical treatment.” 10 alize contrast enhancement. First, the cFAST protocols specify
TABLE 1 Results of Methods Testing for Contrast-enhancement Using Handheld and Portable Ultrasound Systems and Perflutren Contrast
Ultrasound system Mechanical index Setting Probe Contrast dose, mL Visualization
Fuji Sonosite M-Turbo 0.2 Ocular Phased array 0.02 No
0.1 No
Fuji Sonosite Edge II 0.2 Ocular Phased array 0.1 No
Philips Lumify 0.1 Abdominal Curvilinear 0.02 No
0.1 No
Butterfly 0.5 Abdominal Butterfly 0.1 No
GE Vscan Air 1.4 Abdominal Curvilinear 0.1 Yes; right kidney, heart
GE Venue 0.1 Abdominal Curvilinear 5-1 0.1 Yes; right kidney

76 | JSOM Volume 26, Edition 1 / Spring 2026