Quantitative and qualitative evaluation of volume of low osmolality contrast medium needed for routine helical abdominal CT

A. J. Megibow, G. Jacob, Jay Heiken, E. K. Paulson, K. D. Hopper, G. Sica, S. Saini, B. A. Birnbaum, R. Redvanley, E. K. Fishman

Research output: Contribution to journalReview article

45 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of our study was to determine the minimum optimal dose of IV contrast medium for helical CT that can preserve image quality while reducing cost. SUBJECTS AND METHODS. Four hundred sixty-three patients from six centers were enrolled in a prospective trial in which patients were randomized into one of four weight-based dose categories of iopromide, 300 mg 1/mL: 1.25, 1.50, 1.75, and 2.0 mL/kg. Six of 463 patients were excluded from analysis. A radiologist at each center who was unaware of the volume of contrast medium administered determined whether the scans were acceptable. The responses were analyzed by dose, in aggregate, and by weight. Enhancement values (in Hounsfield units) in regions of interest in the liver, pancreas, aorta, and kidneys were obtained at a single time during the scan. The participating radiologist was unaware of these values. Finally, three additional nonparticipating site observers assessed the images for acceptability, diagnostic quality, and overall level of confidence. A cost model comparing incurred charges in using 150 or 100 mL, or 1.5 mL/kg, of low osmolality contrast medium was developed from experience in an additional 303 patients. RESULTS. We found no clinically significant difference in acceptability of scans at doses greater than 1.5 mL/kg. However, significant variability occurred among the centers. The use of 1.5 mL/kg led to a savings of $9927.16 for 303 patients when compared with the use of 150 mL at list price. The cost is the same for 1.5 mL/kg or use of 100 mL of contrast medium. CONCLUSION. A weight-based dose at 1.5 mL/kg of low osmolality contrast medium can provide acceptable scans in most patients, with a significant cost savings.

Original languageEnglish (US)
Pages (from-to)583-589
Number of pages7
JournalAmerican Journal of Roentgenology
Volume176
Issue number3
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

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Spiral Computed Tomography
Osmolar Concentration
Contrast Media
iopromide
Weights and Measures
Costs and Cost Analysis
Cost Savings
Aorta
Pancreas
Kidney
Liver

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Quantitative and qualitative evaluation of volume of low osmolality contrast medium needed for routine helical abdominal CT. / Megibow, A. J.; Jacob, G.; Heiken, Jay; Paulson, E. K.; Hopper, K. D.; Sica, G.; Saini, S.; Birnbaum, B. A.; Redvanley, R.; Fishman, E. K.

In: American Journal of Roentgenology, Vol. 176, No. 3, 01.01.2001, p. 583-589.

Research output: Contribution to journalReview article

Megibow, AJ, Jacob, G, Heiken, J, Paulson, EK, Hopper, KD, Sica, G, Saini, S, Birnbaum, BA, Redvanley, R & Fishman, EK 2001, 'Quantitative and qualitative evaluation of volume of low osmolality contrast medium needed for routine helical abdominal CT', American Journal of Roentgenology, vol. 176, no. 3, pp. 583-589. https://doi.org/10.2214/ajr.176.3.1760583
Megibow, A. J. ; Jacob, G. ; Heiken, Jay ; Paulson, E. K. ; Hopper, K. D. ; Sica, G. ; Saini, S. ; Birnbaum, B. A. ; Redvanley, R. ; Fishman, E. K. / Quantitative and qualitative evaluation of volume of low osmolality contrast medium needed for routine helical abdominal CT. In: American Journal of Roentgenology. 2001 ; Vol. 176, No. 3. pp. 583-589.
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AU - Megibow, A. J.

AU - Jacob, G.

AU - Heiken, Jay

AU - Paulson, E. K.

AU - Hopper, K. D.

AU - Sica, G.

AU - Saini, S.

AU - Birnbaum, B. A.

AU - Redvanley, R.

AU - Fishman, E. K.

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N2 - OBJECTIVE. The purpose of our study was to determine the minimum optimal dose of IV contrast medium for helical CT that can preserve image quality while reducing cost. SUBJECTS AND METHODS. Four hundred sixty-three patients from six centers were enrolled in a prospective trial in which patients were randomized into one of four weight-based dose categories of iopromide, 300 mg 1/mL: 1.25, 1.50, 1.75, and 2.0 mL/kg. Six of 463 patients were excluded from analysis. A radiologist at each center who was unaware of the volume of contrast medium administered determined whether the scans were acceptable. The responses were analyzed by dose, in aggregate, and by weight. Enhancement values (in Hounsfield units) in regions of interest in the liver, pancreas, aorta, and kidneys were obtained at a single time during the scan. The participating radiologist was unaware of these values. Finally, three additional nonparticipating site observers assessed the images for acceptability, diagnostic quality, and overall level of confidence. A cost model comparing incurred charges in using 150 or 100 mL, or 1.5 mL/kg, of low osmolality contrast medium was developed from experience in an additional 303 patients. RESULTS. We found no clinically significant difference in acceptability of scans at doses greater than 1.5 mL/kg. However, significant variability occurred among the centers. The use of 1.5 mL/kg led to a savings of $9927.16 for 303 patients when compared with the use of 150 mL at list price. The cost is the same for 1.5 mL/kg or use of 100 mL of contrast medium. CONCLUSION. A weight-based dose at 1.5 mL/kg of low osmolality contrast medium can provide acceptable scans in most patients, with a significant cost savings.

AB - OBJECTIVE. The purpose of our study was to determine the minimum optimal dose of IV contrast medium for helical CT that can preserve image quality while reducing cost. SUBJECTS AND METHODS. Four hundred sixty-three patients from six centers were enrolled in a prospective trial in which patients were randomized into one of four weight-based dose categories of iopromide, 300 mg 1/mL: 1.25, 1.50, 1.75, and 2.0 mL/kg. Six of 463 patients were excluded from analysis. A radiologist at each center who was unaware of the volume of contrast medium administered determined whether the scans were acceptable. The responses were analyzed by dose, in aggregate, and by weight. Enhancement values (in Hounsfield units) in regions of interest in the liver, pancreas, aorta, and kidneys were obtained at a single time during the scan. The participating radiologist was unaware of these values. Finally, three additional nonparticipating site observers assessed the images for acceptability, diagnostic quality, and overall level of confidence. A cost model comparing incurred charges in using 150 or 100 mL, or 1.5 mL/kg, of low osmolality contrast medium was developed from experience in an additional 303 patients. RESULTS. We found no clinically significant difference in acceptability of scans at doses greater than 1.5 mL/kg. However, significant variability occurred among the centers. The use of 1.5 mL/kg led to a savings of $9927.16 for 303 patients when compared with the use of 150 mL at list price. The cost is the same for 1.5 mL/kg or use of 100 mL of contrast medium. CONCLUSION. A weight-based dose at 1.5 mL/kg of low osmolality contrast medium can provide acceptable scans in most patients, with a significant cost savings.

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