Use Of Oral Contrast Material Research Articles

Using Body Mass Index and Bioelectric Impedance Analysis to Assess the Need for Positive Oral Contrast Agents Before Abdominopelvic CT.

The objective of this study was to determine whether body fat percentage, measured using a portable handheld bioelectric impedance analysis (BIA) device, and body mass index (BMI, weight in kilograms divided by the square of height in meters) can estimate the amount of intraabdominal and intrapelvic fat and thereby predict the need for oral contrast material before abdominopelvic CT. A prospective, institutional review board-approved study consisting of 101 patients who presented to the emergency department of a level I trauma center was conducted between June 1, 2016, and July 19, 2016. A medical student calculated patients' BMI and obtained body fat measurements from a handheld BIA device. Three fellowship-trained and board-certified radiologists who were blinded to the collected data then assigned a score of 1-5 on the basis of the amount of intraabdominal and intrapelvic fat seen on CT images. A McNemar test was used to compare overall sensitivity and specificity of this method, and a weighted Fleiss kappa score was used to determine interobserver variability between the three radiologists. Nearly all (97%) of the patients with high BMI (BMI ≥ 25) had sufficient amounts of intraabdominal and intrapelvic fat to allow delineation of anatomic structures without the use of oral contrast material. Of the patients with low BMI (BMI ≤ 21), 83% had inadequate amounts of fat to separate intraabdominal and intrapelvic structures. For patients with intermediate BMIs (21 < BMI < 25), BIA-determined body fat percentage of 30% or more can be used to predict whether a patient will have sufficient intraabdominal and intra-pelvic fat to obviate oral contrast material for CT. Using BIA in addition to BMI accurately predicts amount of intraabdominal and intrapelvic fat. This information may help guide the decision to use oral contrast material in patients presenting for abdominopelvic CT.

Mandated Radiologist-Performed Electronic Order Entry: Effect on CT Oral Contrast Administration

The purpose of this study was to determine whether radiologist-performed electronic order entry affects use of oral contrast material for CT. Contrast media have been classified as medications by The Joint Commission, which necessitates a physician order for their administration. In a retrospective study, rates of use of oral and IV contrast material for inpatient abdominopelvic CT examinations performed 6 months before and 6 months after the date of implementation of computerized physician order entry were calculated. Radiologist perception of order entry time was assessed by survey; order entry time was measured for 10 blinded radiologists. Descriptive, chi-square, and Student t test statistics were used. A protocol that normally includes oral or IV contrast administration was used for 1693 CT examinations (784 before and 909 after May 25, 2010). No significant change (p > 0.05) was found in ratios of indications for CT, rates of use of IV contrast material, or rates of use of oral contrast material after computerized physician order entry was implemented. The mean perceived order entry time was 3 minutes 3 seconds (weighted average); the actual time was 1 minute 47 seconds (range, 1:19-2:25 minutes). The extrapolated cumulative order entry time was 26 hours 38 minutes of physician time in the 6-month period after computerized physician order entry was started. Most of the survey respondents (98%, 41/42) did not think radiologist order entry improved patient safety, and 43% (18/42) believed it to be very or extremely disruptive. Mandatory radiologist-performed electronic order entry does not negatively affect the rate of use of oral contrast for inpatient abdominopelvic CT, but it is potentially time-consuming and disliked by participating radiologists.

Abdominal 64-MDCT for Suspected Appendicitis: The Use of Oral and IV Contrast Material Versus IV Contrast Material Only

The objective of our study was to compare the diagnostic accuracy of IV contrast-enhanced 64-MDCT with and without the use of oral contrast material in diagnosing appendicitis in patients with abdominal pain. We conducted a randomized trial of a convenience sample of adult patients presenting to an urban academic emergency department with acute nontraumatic abdominal pain and clinical suspicion of appendicitis, diverticulitis, or small-bowel obstruction. Patients were enrolled between 8 am and 11 pm when research assistants were present. Consenting subjects were randomized into one of two groups: Group 1 subjects underwent 64-MDCT performed with oral and IV contrast media and group 2 subjects underwent 64-MDCT performed solely with IV contrast material. Three expert radiologists independently reviewed the CT examinations, evaluating for the presence of appendicitis. Each radiologist interpreted 202 examinations, ensuring that each examination was interpreted by two radiologists. Individual reader performance and a combined interpretation performance of the two readers assigned to each case were calculated. In cases of disagreement, the third reader was asked to deliver a tiebreaker interpretation to be used to calculate the combined reader performance. Final outcome was based on operative, clinical, and follow-up data. We compared radiologic diagnoses with clinical outcomes to calculate the diagnostic accuracy of CT in both groups. Of the 303 patients enrolled, 151 patients (50%) were randomized to group 1 and the remaining 152 (50%) were randomized to group 2. The combined reader performance for the diagnosis of appendicitis in group 1 was a sensitivity of 100% (95% CI, 76.8-100%) and specificity of 97.1% (95% CI, 92.7-99.2%). The performance in group 2 was a sensitivity of 100% (73.5-100%) and specificity of 97.1% (92.9-99.2%). Patients presenting with nontraumatic abdominal pain imaged using 64-MDCT with isotropic reformations had similar characteristics for the diagnosis of appendicitis when IV contrast material alone was used and when oral and IV contrast media were used.

Abdominal trauma: use of oral contrast material for CT is safe.

To determine the potential risk of aspiration pneumonitis associated with use of oral contrast material in computed tomography (CT) performed for evaluation of abdominal trauma. In 510 consecutive adult patients, a dilute 2.5% solution of diatrizoate meglumine and sodium was administered orally or by means of a nasogastric tube as part of a routine protocol for CT evaluation of acute abdominal trauma. A retrospective review of medical records was performed to determine evidence of aspiration pneumonitis occurring before or after CT. None of the patients had aspiration of contrast material or gastric contents attributable to the CT examination. Use of contrast material for stomach and bowel opacification during CT for evaluation of abdominal trauma appears to be safe. Proper preparation and administration of contrast material and control of the patient's airway are essential to ensure the safety of this procedure.

Use of oral contrast material in abdominal trauma ct scans: is it dangerous?

Use of oral contrast material in abdominal trauma ct scans: is it dangerous?

Use of oral contrast material in abdominal trauma CT scans: Is it dangerous? : Federle MP, Peitzman A, Krugh J. J Trauma: Injury, Infection and Critical Care. 1995;38(1):51-3

Use of oral contrast material in abdominal trauma CT scans: Is it dangerous? : Federle MP, Peitzman A, Krugh J. J Trauma: Injury, Infection and Critical Care. 1995;38(1):51-3