Selective use of low-osmolality contrast media in computed tomography

Abstract

The aim of this study was to describe our experience and institutional savings with a selective use of low-osmolality contrast media (LOCM) in CT. From 1995 to 1998, a total of 19,834 contrast-enhanced CT examinations were performed at our institution. Contrast was injected with a power injector and large venous catheter, 20-G for 2- to 3-ml rate and 18-G for 3- to 5-ml rate. High-osmolality contrast media was used in 13,670 patients (71%). The LOCM was used in 5884 (29%) patients. Our guidelines for the use of LOCM included cardiac dysfunction, severe pulmonary impairment, history of allergy or prior moderate reaction to HOCM and severe debilitation. Prior to the injection of HOCM, 10 mg of metoclopramide (Primperan, Delagrange Quétigny, France) were administered to reduce nausea and vomiting. In the HOCM group there were 304 minor or mild adverse reactions (2.2%), and 10 severe adverse reactions (0.08%). In the LOCM there were 34 mild or moderate adverse reactions (0.59%) and 3 severe adverse reactions (0.05%). Significant differences in terms of mild adverse reactions were found between HOCM and LOCM (Fischer's test, p<0.001). No significant differences were found in terms of severe adverse reactions ( p=0.27). After subtracting the cost of treating additional adverse reactions, the net differential cost between universal and selective use of LOCM was 565,285 Euro (601,067 US dollars). This means a net increase of 41.4 Euro per patient or 414,000 Euro per 10,000 patients (438,840 US dollars). Selective use of LOCM in CT is safe and effective and results in a substantial reduction in costs.

Immediate adverse reactions to intravenous iodinated contrast media in computed tomography

“…Intensity levels of these events were light and they were solved spontaneously. These results are within the limits quoted in literature (1,4,7) , reflecting fully acceptable and What contrast extravasation is concerned, this occurred in 2.2% of radiopaque substance injections through peripheral venous access, also according to parameters found in literature (2,(8)(9)(10) . In a large majority of cases, extravasated volumes remained under 10 ml, without any complication deriving from contrast administration in the extravascular space.…”

“…The frequency of adverse events associated with iodinated contrast ranges between 2.2 and 12.7% when ionic medium is used and between 0.2 and 3.1% when non-ionic contrast is used (1)(2)7) . Iodinated contrast extravasation is considered a local adverse effect of intravenous radiopaque substance administration.…”

“…That study included feeling hot as an adverse reaction, with a frequency of 2.29% for ionic medium and 0.92% for non-ionic medium, while that symptoms was not considered here. Other authors (7) ignore not only feeling hot, but also the occurrence of vomiting. Therefore, when drawing a parallel with the results of that reference source, manifestations of vomiting were excluded.…”

“…Some conditions that are very common among hospitalized patients have already been associated with a two-to fourfold increase in chances for the occurrence of adverse reactions to radiopaque medium, such as exposure to surgeries, invasive procedures or regular medication intake during the five days before the exam (12) . With respect to immediate adverse reactions, this research considered vomiting, while international studies (1,7) exclude vomiting and include other symptoms, such as feeling hot and pain in the injection site. In other words, study results can only be compared when samples in equivalent health conditions are used and when the same research subject inclusion and exclusion criteria are adopted.…”

Cost-Effectiveness of Angiographic Imaging in Isolated Perimesencephalic Subarachnoid Hemorrhage

“…20 Some decision models, such as the one by Ward et al 19a considered tumor as a possible complication from radiation.…”