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. 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. 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. 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. 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.