Advancing Abdominal Imaging with Smart CT Solutions
This is the final installment in our three-part series dedicated to sharing best practices for implementing smart solutions in the CT suite.
NYU Langone Health in New York City provides computed tomography (CT) services at many sites throughout Manhattan, Brooklyn, Queens, Staten Island, and Long Island. Because of this wide geographic range, the health system has implemented standardized contrast protocols to deliver uniform, high-quality care to all patients.
Bari Dane, MD, is a clinical assistant professor of radiology and abdominal radiologist at NYU Langone Health. Dr Dane is also director of CT for the department of radiology and director of quality and safety for outpatient imaging at the institution’s main campus.
Dr Dane standardized contrast delivery in abdominal CT imaging with the help of Bracco’s SmartInjectCT solutions. This enables the facility to reduce contrast utilization while improving efficiency, furthering quality, and safety initiatives, and maintaining optimal imaging quality.
“Standardization can help ensure consistent image quality and contrast delivery,” Dr Dane says. “If all sites have the same imaging protocol, that helps improve the radiologist’s efficiency, because they know exactly what series to expect and what to look for when reviewing the images. Standardizing intravenous contrast delivery can lead to contrast reduction, which can save money and help meet safety considerations.”
As interconnected technologies, Bracco’s SmartInjectCT Solutions help radiologists, protocol managers, and technologists manage patient records, support compliance and standardization, and track performance during contrast injection. SmartInjectCT Solutions include the EmpowerCTA®+ Injector system, which optimizes imaging capabilities, streamlines workflow, and enhances patient care.
Complementing the EmpowerCTA®+ is the NEXO® Contrast Management System, a software platform that seamlessly connects patient data to the EMR and PACS. This platform tracks contrast delivery and manages protocols for data-driven clinical support. NEXO® automatically documents contrast injection postprocedural data via DICOM reports, which are sent to the radiologist for review alongside the images.1,2
Optimizing Intravenous Contrast Delivery
To standardize contrast protocols, Dr Dane implemented weight-based dosing, in which smaller patients receive less contrast than larger patients to reduce the overall contrast load delivered to each patient.3
“Weight-based intravenous contrast helps ensure more consistent organ enhancement, despite varying patient body sizes. This can ensure more consistent organ opacification in abdominal CT,” she says. “Smaller patients get less intravenous contrast with the same image quality you’d expect to get with higher doses of contrast.”
Advancing Abdominal Imaging with Smart CT solutions
Although weight-based dosing has been used at the NYU Langone Health main campus for many years, it has not been implemented at all satellite imaging sites. One such site installed NEXO® Contrast Management System, which helped Dr Dane determine how the facility was utilizing contrast.
“The NEXO® system let me easily obtain a report with lots of patient information, including weight, age, how much contrast was loaded, how much contrast was programmed, how much was actually injected, the pressure limit, and how much contrast was residual for each scan, which can all be sorted by a specific protocol,” she says.
NEXO quickly showed Dr Dane that the site wasn’t using weight-based dosing and highlighted inconsistencies in contrast delivery. “It was quick and easy to see how we were using contrast at this site, and it helped us discover that quite a bit of contrast was being wasted,” she said.
Weight-based dosing was subsequently implemented and followed by a before-and-after comparison of imaging results. “It was very easy to track weight-based intravenous contrast dosing with NEXO®. Switching to weight-based intravenous contrast dosing for abdominal imaging helped deliver more consistent solid organ enhancement,” she explains.
Dr Dane also leveraged multi-dose vials to reduce waste. This required use of the EmpowerCTA®+ Injector system. For example, if 75 mL of contrast were administered to a patient from a single 100 mL vial, the 25 mL of leftover contrast would be discarded. With multi-dose vials, the leftover contrast can be saved for the next patient. “Using multi-dose vials helps salvage the extra contrast so you're using every bit of contrast to the best of its ability,” Dr Dane says.
The NEXO® Contrast Management System also helped Dr Dane optimize contrast use. She discovered that “you can use a smaller volume of a more concentrated contrast to achieve similar image quality to that of a larger volume of a less concentrated contrast,” she says.
In CT angiogram protocols, Dr Dane delivers a 20 cc saline bolus to ensure the full amount of contrast is administered. “Using a saline bolus helps clear out the line and makes sure the patient gets all the contrast you think they're getting. It’s a nice way to get an excellent angiogram with less contrast,” she says.
- Caruso D, Rosati E, Panvini N, et al. Optimization of contrast medium volume for abdominal CT in oncologic patients: Prospective comparison between fixed and lean body weight-adapted dosing protocols - insights into imaging. SpringerOpen. March 20, 2021. https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-00980-0. Accessed June 19, 2023.
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