You are spending a month in rural Kenya, doing an ultrasound teaching course. Your enthusiastic participants have been ultrasounding every chance they get. Unfortunately, this has caused your ultrasound gel supplies to dwindle. It will be a month before a new shipment of gel arrives from Nairobi. This gel will cost about $5 per bottle, which is a considerable expense for the local hospital’s budget.
Trick of the Trade: Homemade ultrasound gel
With a few simple and ubiquitous ingredients, you can make your own ultrasound gel to use.
- Corn starch
- Pot or pan
- Heat source
- Empty and clean bottle
- Combine 1 part corn starch to 10 parts water in a pan. Here, we use ¼ cup corn starch to 2 ½ cups water to make about 2 gel bottles full.
- Heat this mixture while stirring constantly at medium heat for 5-10 minutes.
- When the substance begins to boil, turn off the heat and allow the mixture to cool.
- Pour the mixture into a clean, preferably sterilized, container. Here, we use an old commercial ultrasound gel bottle which we placed in boiling water for 10 minutes first.
- Ultrasound away! Note that the gel should be used within 48-72 hours for best results. After that, it may begin to separate a bit.
Word of Caution
This homemade gel does not have the same bacteriostatic ingredients that are in commercial ultrasound gel. Therefore we do no recommend its use for skin and soft tissue infections.
Expert Peer Review
For anyone who has spent time working abroad in a low resource area, you are likely familiar with the utility of ultrasound. It has a wide range of applications, it is easy to use, and there is an increasing number of portable machines available. There are very few ongoing costs associated with the use of ultrasound machines. The exception to this is ultrasound gel.
There is very little published about ultrasound gel alternatives. The 1995 WHO Manual of Diagnostic Ultrasound  contains a recipe for making your own ultrasound gel which requires many chemicals not available in most low resource settings. Olive oil has been studied as a feasible alternative  but is messy and provides less surface contact between the patient and the probe. Water baths have been looked at but are only applicable to extremity ultrasound .
In our recent pilot study , we found that a cornstarch-based alternative is at least comparable to commercial gel. Our study, which is a randomized blinded trial (abstract forthcoming at SAEM 2014) found no statistically significant difference between commercial gel and the cornstarch alternative in terms of image quality. The cornstarch-based alternative is an easily created, easily used, extremely inexpensive option that will hopefully make ultrasound more feasible and accessible in low resource settings.\"
- Manual of diagnostic Ultrasound [PDF 3.6 MB], 2nd Edition. World Health Organization. 2011. Retrieved Aug 13, 2012
- Luewan S, Srisupundit K, Tongsong T. A comparison of sonographic image quality between the examinations using gel and olive oil as sound media. J Med Assoc Thai. 2007 April; 90(4)624-7. Pubmed
- Blaivas M, Lyon M, Brannam L, et al. Water bath evaluation technique for emergency ultrasound of painful superficial structures. Am J Emerg Med. 2004 Nov;22(7):589-93. Pubmed
- Binkowski A, Riguzzi A, Fahimi J, Price D. Evaluation of a Cornstarch-Based Ultrasound Gel Alternative for Low-Resource Settings. J Emerg Med. 2013 Nov 12. pii: S0736-4679(13)01064-0. Pubmed