Table 2.

Precautions While Performing Transthoracic Echocardiography

Precautions to Consider	Rationale
Dedicated rooms (e.g., in COVID-19–free zones) for immunosuppressed patients	To avoid using potentially contaminated equipment in immunocompromised patients
Use of “off-site” scanning locations	For cancer centers that do not have their own echocardiography laboratories, consider using an off-site location where the concentration of COVID-19 exposure may be less or moving a dedicated ultrasound machine to the cancer center
“Low exposure risk” sonographers to scan patients	Having sonographers un-exposed to COVID-19–positive patients and low risk of being asymptomatic carriers (e.g., no travel in past 14 days) may reduce potential risk of transmission
Using point-of-care ultrasound whenever possible with capacity to store images	Equipment easier to clean and assessment of LVEF assessment, masses, and pericardial effusions are the priority and can be assessed with these devices
Avoid ECG leads	ECG cables are challenging to clean between patients and may become a source of transmission
Use ultrasound transducer sleeves and single-use ultrasound gel packets	Use of disposable protective probe sleeves and gel can minimize transmission
Perform focused studies	Because the primary question in these patients is left ventricular function, short protocols to assess left ventricular function with focus on two-dimensional imaging may be sufficient
Use PPE as per hospital guidelines and specific barriers developed at the institution to protect sonographers and patients	Consider all patients to be asymptomatic carriers and take appropriate precautions. Consider requesting patients to wear masks/gloves if PPE available
Perform analysis after patient encounter	All post-processing should be done outside the clinical room setting to minimize exposure to patient
Reconsider low-yield tests	Sonographers and imaging laboratories should actively assess requests for screening tests in cancer survivors and consider in consultation with oncologist/cardio-oncologist if these tests could be safely postponed
Use of imaging-enhancing agents in nondiagnostic echo studies only	Limit use of an imaging enhancement agent to nondiagnostic echocardiogram studies to minimize examination length
Consider alternative imaging modalities (e.g., MUGA)	Alternate imaging modalities (e.g., MUGA scans) which can be performed rapidly while minimizing patient/ technologist exposure (https://zenodo.org/record/3738020#.XoXsHIhKiUk)

ECG = electrocardiography; MUGAs = multigated acquisition scans; PPE = personal protective equipment; other abbreviations as in Table 1.