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A randomised experiment comparing low-cost ultrasound gel alternative with commercial gel
  1. Christine Riguzzi1,
  2. Allison Binkowski1,
  3. Mike Butterfield2,
  4. Farhad Sani3,
  5. Nathan Teismann4,
  6. Jahan Fahimi4
  1. 1Department of Emergency Medicine, Alameda Health System—Highland Hospital, Oakland, California, USA
  2. 2Department of Emergency Medicine, Tampa General Hospital, Tampa, Florida, USA
  3. 3Department of Radiology, Alameda Health System—Highland Hospital, Oakland, California, USA
  4. 4Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Mike Butterfield, Department of Emergency Medicine, Tampa General Hospital, 1 South Davis Boulevard, Suite 504, Tampa, FL 33606, USA; mcbutterfield{at}


Objective Point-of-care ultrasound is a portable, relatively low-cost imaging modality with great potential utility in low-resource settings. However, commercially produced ultrasound gel is often cost-prohibitive and unavailable. We investigated whether images obtained using an alternative cornstarch-based gel would be of comparable quality with those using commercial gel.

Methods This was a blinded, randomised, cross-over study comparing commercially produced ultrasound gel with home-made cornstarch-based gel. Ultrasound-trained faculty obtained three video clips with each gel type from patients at one urban ED. The clips were evaluated by a radiologist and an ultrasound-trained emergency physician. Images were assessed in terms of overall adequacy (dichotomous) and quality, resolution and detail using a rating scale (0–10). All sonographers and physicians reviewing the images were blinded to the type of gel used.

Results Thirty-four patients were enrolled in the study, producing 204 separate images (102 with each gel). The cornstarch gel clips were deemed accurate in 70.6% (95% CI 63.9% to 76.5%) of the scans, as compared with 65.2% (95% CI 58.4% to 71.4%) of those using commercial gel. There was no difference between the two groups with respect to image detail, resolution or quality.

Conclusions Images produced using the cornstarch-based alternative ultrasound gel were of similar quality to those using commercial gel. The low cost and easy preparation of the cornstarch-based gel make it an attractive coupling medium for use in low-resource settings.

  • ultrasound
  • global health

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  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval IRB Alameda Health System.

  • Provenance and peer review Not commissioned; externally peer reviewed.