Molecular imaging with ultrasound relies on microbubble contrast agents (MCAs) selectively adhering to a ligand-specific target. Prior studies have shown that only small quantities of microbubbles are retained at their target sites, therefore, enhancing contrast sensitivity to low concentrations of microbubbles is essential to improve molecular imaging techniques. In order to assess the effect of MCA diameter on imaging sensitivity, perfusion and molecular imaging studies were performed with microbubbles of varying size distributions. To assess signal improvement and MCA circulation time as a function of size and concentration, blood perfusion was imaged in rat kidneys using nontargeted size-sorted MCAs with a Siemens Sequoia ultrasound system (Siemans, Mountain View, CA) in cadence pulse sequencing (CPS) mode. Molecular imaging sensitivity improvements were studied with size-sorted alphavbeta3-targeted bubbles in both fibrosarcoma and R3230 rat tumor models. In perfusion imaging studies, video intensity and contrast persistence was approximately 8 times and approximately 3 times greater respectively, for "sorted 3-micron" MCAs (diameter, 3.3 +/- 1.95 microm) when compared to "unsorted" MCAs (diameter, 0.9 +/- 0.45 microm) at low concentrations. In targeted experiments, application of sorted 3-micron MCAs resulted in a approximately 20 times video intensity increase over unsorted populations. Tailoring size-distributions results in substantial imaging sensitivity improvement over unsorted populations, which is essential in maximizing sensitivity to small numbers of MCAs for molecular imaging.

Background: Cardiac arrests are often preceded by several hours of physiological deterioration that may go undetected.Local Problem: Cardiac arrests frequently occurred on medical-surgical units without prior rapid response team intervention. Methods: A pre/postintervention design was used to evaluate a protocol to guide the use of the Modified Early Warning Score (MEWS) by medical-surgical nurses to escalate the care of deteriorating adult patients. Interventions: Following staff education, the MEWS protocol was implemented across 8 medical-surgical units.Results: There was a significant increase in patients experiencing a rapid response prior to a cardiac arrest after implementing the MEWS protocol (P < .0001). Conclusion: Implementing a consistent review of MEWS values allows medical-surgical nurses to initiate assistance from a rapid response team that may prevent an inpatient cardiac arrest.