McDermott Michael C, Wildberger Joachim E, Bae Kyongtae T
Department of Radiology & Nuclear Medicine, Maastricht University Medical Center + , Maastricht, The Netherlands.
CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
Insights Imaging. 2024 Aug 28;15(1):219. doi: 10.1186/s13244-024-01750-4.
Past decades of research into contrast media injections and optimization thereof in radiology clinics have focused on scan acquisition parameters, patient-related factors, and contrast injection protocol variables. In this review, evidence is provided that a fourth bucket of crucial variables has been missed which account for previously unexplained phenomena and higher-than-expected variability in data. We propose how these critical factors should be considered and implemented in the contrast-medium administration protocols to optimize contrast enhancement.
This article leverages a combination of methodologies for uncovering and quantifying confounding variables associated with or affecting the contrast-medium injection. Engineering benchtop equipment such as Coriolis flow meters, pressure transducers, and volumetric measurement devices are combined with small, targeted systematic evaluations querying operators, equipment, and the physics and fluid dynamics that make a seemingly simple task of injecting fluid into a patient a complex and non-linear endeavor.
Evidence is presented around seven key factors affecting the contrast-medium injection including a new way of selecting optimal IV catheters, degraded performance from longer tubing sets, variability associated with the mechanical injection system technology, common operator errors, fluids exchanging places stealthily based on gravity and density, wasted contrast media and inefficient saline flushes, as well as variability in the injected flow rate vs. theoretical expectations.
There remain several critical, but not commonly known, sources of error associated with contrast-medium injections. Elimination of these hidden sources of error where possible can bring immediate benefits and help to drive standardized and optimized contrast-media injections.
This review brings to light the commonly neglected/unknown factors negatively impacting contrast-medium injections and provides recommendations that can result in patient benefits, quality improvements, sustainability increases, and financial benefits by enabling otherwise unachievable optimization.
How IV contrast media is administered is a rarely considered source of CT imaging variability. IV catheter selection, tubing length, injection systems, and insufficient flushing can result in unintended variability. These findings can be immediately addressed to improve standardization in contrast-enhanced CT imaging.
过去几十年来，放射科诊所对造影剂注射及其优化的研究主要集中在扫描采集参数、患者相关因素和造影剂注射方案变量上。在本综述中，有证据表明遗漏了第四类关键变量，这些变量解释了以前无法解释的现象以及数据中高于预期的变异性。我们提出了在造影剂给药方案中应如何考虑和实施这些关键因素，以优化造影增强效果。
本文利用多种方法来发现和量化与造影剂注射相关或影响造影剂注射的混杂变量。将科里奥利流量计、压力传感器和容积测量装置等工程台式设备与小型、有针对性的系统评估相结合，这些评估涉及操作人员、设备以及使将液体注入患者这一看似简单的任务变得复杂且非线性的物理和流体动力学。
围绕影响造影剂注射的七个关键因素提供了证据，包括选择最佳静脉导管的新方法、较长输液管组导致的性能下降、与机械注射系统技术相关的变异性、常见的操作人员错误、基于重力和密度液体悄然换位、造影剂浪费和盐水冲洗效率低下，以及注射流速与理论预期的变异性。
造影剂注射仍存在几个关键但不为人知的误差来源。尽可能消除这些隐藏的误差来源可带来直接益处，并有助于推动标准化和优化的造影剂注射。
本综述揭示了对造影剂注射产生负面影响的常见被忽视/未知因素，并提供了相关建议，通过实现原本无法实现的优化，可使患者受益、提高质量、增强可持续性并带来经济效益。
静脉注射造影剂的方式是CT成像变异性中很少被考虑的来源。静脉导管的选择、输液管长度、注射系统和冲洗不足会导致意外的变异性。这些发现可立即得到解决，以提高增强CT成像的标准化程度。
