Proactive Air Management in CT Power Injections: A Comprehensive Approach to Reducing Air Embolization

Abstract

Venous air embolism as a complication of contrast media administration from power injection systems in CT is found to occur in 7%-55% of patients, impacting patient safety, diagnostic image quality, workflow efficiency, and patient and radiographer satisfaction. This study reviews the challenges associated with reactive air management approaches employed on contemporary systems, proposes a novel air management approach using proactive methods, and compares the impact of reactive and proactive approaches on injected air volumes under simulated clinical use. Methods: Injected air volumes from three power injection systems were measured under simulated clinical use via custom air trap fixture. Two of the systems employed reactive air management approaches, while a new system implemented the proposed proactive air management approach. Results: The proactive system injected significantly less air (average of 0.005mL±0.006mL with a maximum of 0.017mL) when compared to two systems with reactive approaches (averages of 0.130mL±0.082mL and 0.106mL±0.094mL with maximums of 0.259mL and 0.311mL, respectively) (p<0.05). CT images were taken of static and dynamic 0.1mL air bubbles inside of a vascular phantom, both of which were clearly visible. Additionally, the dynamic bubble was shown to introduce image artifacts similar to those observed clinically. Conclusion: Comparison of the injected air volumes show that a system with a proactive air management approach injected significantly less air compared to tested systems employing reactive approaches. Significance: The results indicate that the use of a proactive approach could significantly reduce the prevalence of observable, and potentially artifact-inducing, venous air embolism in contrast-enhanced CT procedures.

Iatrogenic venous air embolism using the injector in CT studies

“…All the studies were identified by the literature search (PubMed), and according to selection criteria, 5 classic papers were included: case series from 1987 7 , original with 23 patients from 1988 17 , original with 79 patients from 1997 12 , one review 18 from 1992 that included experimental (animal) data, case reports, case series, and clinical investigations and a review from 1997 8 ; also 17 papers were considered in this systematic review: review article 5 , 9 were case reports 6,9,13,19-24 , technical 14 , technical/procedure 4,15 , technical/comparative analysis 25 , observational study 10 ; originals with 14 patients 11 and other with 100 cases 4 .…”

“…McDermott MC et al 25 reviews the challenges associated with reactive air management approaches employed on contemporary systems, proposes a novel air management approach using proactive methods, and compares the impact of reactive and proactive approaches on injected air volumes under simulated clinical use. The results indicate that the use of a proactive approach could significantly reduce the prevalence of observable, and potentially artifact-inducing, VAE in CECT procedures.…”

“…The results indicate that the use of a proactive approach could significantly reduce the prevalence of observable, and potentially artifact-inducing, VAE in CECT procedures. Proactive air management may not only reduce observable air found in CT images, but also reduce the workflow disruptions of aborted injections that can result in additional radiation exposure for patients 25 .…”

Third-Generation Cardiovascular Phantom

“…Although clinical studies with patients remain the criterion standard, researchers have made use of preclinical evaluation tools to understand underlying physiological principles, as well as advancing clinical understanding and knowledge while avoiding unnecessary radiation exposure to patients. These tools include benchtop engineering test setups, computer modeling software, radiation dose phantoms, animal models, and dynamic flow circulation phantoms 13–18 . Over the past 2 decades, the dynamic flow circulation phantoms have been used in evaluation and optimization of contrast-enhanced CT procedures.…”

“…These tools include benchtop engineering test setups, computer modeling software, radiation dose phantoms, animal models, and dynamic flow circulation phantoms. [13][14][15][16][17][18] Over the past 2 decades, the dynamic flow circulation phantoms have been used in evaluation and optimization of contrast-enhanced CT procedures. These circulation phantoms are intended to represent the dynamic blood flow within a human cardiovascular system and provide a stable testing platform allowing for high levels of standardization and reduced variability.…”