Hunter T B, Dye J, Duval J F
Department of Radiology, University Medical Center, Tucson, AZ 85724.
AJR Am J Roentgenol. 1994 Oct;163(4):965-8. doi: 10.2214/ajr.163.4.8092044.
The purpose of this study was to determine if the selective use of low-osmolality contrast material for excretory urography and CT is safe and if it saves money.
At the University Medical Center in Tucson, a questionnaire was developed to identify high-risk patients who would benefit from the use of a low-osmolality contrast agent. High-risk patients were defined as those with a history of a reaction to contrast material, severe allergies, asthma, severe cardiac disease, multiple myeloma, sickle cell disease, polycythemia, pheochromocytoma, or renal impairment. Beginning in March 1993, the questionnaire was given to all adult outpatients scheduled for daytime excretory urography and routine CT studies of the head and body. Only patients identified as high risk were given a low-osmolality (non-ionic) contrast agent. All other patients received high-osmolality (ionic) contrast material. The contrast agent chosen for a patient was determined by the person administering the questionnaire, usually a radiologic technologist.
From March 1993 through December 1993, 1114 adult daytime outpatient excretory urographic and contrast-enhanced CT studies were examined at our institution. In 235 (21%) of the studies, a low-osmolality agent was used and in 879 (79%) studies, a high-osmolality agent was used. This represented a reduction in the use of low-osmolality agents from more than 90% of patients to 21%, an annual cost reduction from $288,000 to $60,480. We observed no untoward reactions to contrast material that could be specifically attributed to the increased use of high-osmolality agents.
Selective use of low-osmolality contrast agents during excretory urography and CT can provide substantial cost savings and is not associated with a significant risk of major complications.
本研究的目的是确定在排泄性尿路造影和CT检查中选择性使用低渗造影剂是否安全以及是否能节省费用。
在图森市的大学医学中心，设计了一份问卷以识别那些能从使用低渗造影剂中获益的高危患者。高危患者定义为有造影剂反应史、严重过敏、哮喘、严重心脏病、多发性骨髓瘤、镰状细胞病、红细胞增多症、嗜铬细胞瘤或肾功能损害的患者。从1993年3月开始，该问卷被分发给所有安排在白天进行排泄性尿路造影以及头部和身体常规CT检查的成年门诊患者。只有被确定为高危的患者才使用低渗（非离子型）造影剂。所有其他患者接受高渗（离子型）造影剂。为患者选择造影剂由发放问卷的人员决定，通常是放射技师。
从1993年3月至1993年12月，我们机构对1114例成年白天门诊排泄性尿路造影和增强CT检查进行了研究。在235例（21%）研究中使用了低渗造影剂，在879例（79%）研究中使用了高渗造影剂。这使得低渗造影剂的使用从超过90%的患者减少到21%，每年费用从288,000美元降至60,480美元。我们未观察到可明确归因于高渗造影剂使用增加的造影剂不良反应。
在排泄性尿路造影和CT检查中选择性使用低渗造影剂可大幅节省费用，且与重大并发症的显著风险无关。
