New training standards proposed by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) could help aspiring ultrasound practitioners learn best practices for contrast-enhanced ultrasound (CEUS).
The new standards would require CEUS training for students at accredited sonography training programs -- and ultrasound societies are voicing support.
“Sonography students absolutely need this training if they are to enter the profession prepared to offer CEUS services to their patients,” the International Contrast Ultrasound Society (ICUS) told AuntMinnie.com.
The ICUS on May 15 issued a statement applauding the proposed training standards, saying they address the “urgent need” to expand CEUS training so students can gain fundamental CEUS knowledge and skills.
The training standards would require sonography students at accredited institutions to learn basic principles, safety and administration, transmission routes, common clinical applications, and enhancement patterns. The CAAHEP draft standards align with CEUS content recently added to the National Education Curriculum, which ICUS provided CEUS-related content for.
CEUS uses microbubbles to enhance images for better diagnosis of various diseases in adults and children. These include heart and vascular disease, chronic gastrointestinal diseases, and tumors, among others.
In recent years, CEUS has gained traction in regulatory approvals, with the U.S. Food and Drug Administration (FDA) approving ultrasound contrast agents for echocardiography applications, focal liver lesion characterization, and evaluating vesicoureteral reflux in children.
The American College of Radiology (ACR) in 2024 added a CEUS non-radiotherapy treatment response evaluation algorithm into the LI-RADS system. And the American Institute of Ultrasound in Medicine (AIUM) in 2023 updated its practice parameters for CEUS that cover liver, renal, and vascular applications.
However, medical societies have noted a lack of standardization in CEUS training. This training gap may lead to sonographers tasked with administering ultrasound scans to enter the profession without any CEUS exposure.
The ICUS in 2020 published survey results showing that about 86% of respondents expressed interest in adding CEUS curriculum to their programs. However, almost half of respondents said they had inadequate resources to do so, and about 72% said their educators did not have sufficient expertise to provide CEUS education.
“If sonography training programs still don’t provide adequate CEUS training, their students will be disadvantaged in the job market and patients will be deprived access to this safe, affordable and sometimes life-saving imaging modality,” the ICUS told AuntMinnie.com.
The Society of Diagnostic Medical Sonography (SDMS) also stated its support for the proposed CAAHEP standards. The society in 2024 updated its Scope of Practice and Clinical Standards document, expanding the role of sonographers in administering CEUS exams to “enhance image quality or obtain additional diagnostic information.”
“As reflected in the Scope of Practice and Clinical Standards, sonographers are increasingly expected to adapt to evolving technologies and emerging clinical applications that improve patient care,” said SDMS and SDMS Foundation president Aubrey Rybyinski. “CEUS use continues to expand across healthcare settings because it can enhance diagnostic image quality, improve clinical decision-making, and in some cases reduce the need for additional imaging studies.”
Rybyinski also told AuntMinnie.com that as CEUS use grows, it is important that that students entering the workforce are prepared with foundational knowledge and exposure to CEUS, “so they can safely and effectively meet the evolving needs of patients and employers.”
The full proposed standards can be found here.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
