How Advances in Technology Help Patients and Providers

Greg Freiherr, Industry Consultant

Power injectors can improve efficiency and patient safety, for example, ensuring that contrast agent is not wasted due to the lack of a saline bolus. Image courtesy of Lior Molvin

 

Patient safety and operational efficiency are behind the development of modern contrast media, selection and utilization strategies — as well as refinements in the injector technologies for these media. Much remains to be done.

New agents for MRI and diagnostic sonography were created to get the most from these imaging modalities, which do not rely on ionizing radiation — gadolinium-based agents for MRI; bubble agents for diagnostic ultrasound. The development some three decades ago of nonionic iodinated contrast agents exemplifies the importance of patient safety as a force underlying the development of modern contrast agents.1,2

Similarly, low-osmolar nonionic contrast agents for CT may have fewer side effects and less nephrotoxicity than traditional ionic, high-osmolar agents. Intravenous MRI contrast agents are not toxic to the kidney, but the development of NSF (nephrogenic systemic fibrosis) is a continuing concern, say opinion leaders. The clinical significance and reason for gadolinium accumulation in tissue among patients without renal impairment, they say, is not known.

It is known, however, that the nonionic molecules of gadolinium chelates have lower osmolality and viscosity, which makes them more digestible at higher concentrations and allows faster bolus injections.3

Sonographic agents use microbubbles to improve the diagnostic yield,4 while maintaining safety.5

 

Technological Evolution Picking Up

From now on, however, much of the innovation involving contrast-enhanced studies will likely involve the power injector. And its evolution could be dramatic.

Just as the cell phone has become much more than a phone, contrast injectors are evolving into new—and different—roles. Injector-oriented technologies, for example, are already available in the management of protocols and the supply chain. These tools could help assess waste, the number of extravasations, technologist performance, site and shift performance, even department budgets.

“Beyond the obvious ability to standardize injections (to achieve) image consistency, there are so many opportunities for injectors to become clinical devices that cannot be lived without,” said Lior Molvin, a CT technologist and protocol manager for the diagnostic CT group at Stanford Health Care in Palo Alto, Calif.

Simple algebraic tools might be built into injectors, Molvin said. Power injectors could help departments with “just-in-time” supply, for example. This would improve efficiency by reducing the need to over stock contrast agents. “The injector would know exactly how much contrast it has injected, so we would know how much we need to order in order to maintain operational efficiency,” he said. The injector might even link to a data base associated with the ordering cycle.

Injectors could also automatically consider the size of the patient — tall or short; skinny, average or obese — saving time that technologists otherwise may spend factoring body habitus into injection strategies and protecting patients from over- and under-dosing. Even more might be accomplished with the integration of smart algorithms that check the circumstances surrounding extravasations, especially as they pertain to CT and MRI.

 

References:
  1. Pradubpongsa P, Dhana N, Jongjarearnprasert K, et al. Adverse reactions to iodinated contrast media: prevalence, risk factors and outcome-the results of a 3-year period. Asian Pac J Allergy Immunol. 2013;31(4):299-306. https://www.ncbi.nlm.nih.gov/pubmed/24383973
  2. McClennan BL. Ionic and nonionic iodinated contrast media: Evolution and strategies for use. AJR Am J Roentgenol. 1990;155(2):225-233.
  3. Hunt CH, Hartman RP, Hesley GK. Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: Retrospective review of 456,930 doses. AJR Am J Roentgenol. 2009;193:1124-1127. https://www.ncbi.nlm.nih.gov/pubmed/19770337
  4. Ignee A, Atkinson, NSS, et.al. Ultrasound contrast agents. Endosc Ultrasound. 2016 Nov-Dec; 5(6): 355–362. http://www.eusjournal.com/article.asp?issn=2303-9027;year=2016;volume=5;issue=6;spage=355;epage=362;aulast=Ignee
  5. Ultrasound Societies Urge FDA to Remove Black Box Warning on Contrast Agents https://www.itnonline.com/content/ultrasound-societies-urge-fda-remove-black-box-warning-contrast-agents
The views, information, or opinions expressed in the video(s) or article(s) above are solely those of the individuals involved and do not necessarily represent those of Bracco Diagnostics Inc. (“BDI”). The primary purpose of this video(s) or article(s) is to educate and inform. This information does not constitute medical or other professional advice or services.

EmpowerCTA®+ Injector System

Caution: Federal law restricts this device to sale by or on the order of a physician.

INDICATIONS:

The EmpowerCTA®+ Injector System is indicated for the vascular administration of contrast and flushing media in conjunction with computed tomography (CT) scanning of the body with an optional interface to a CT scanner and an optional calculator for glomerular filtration rate (GFR).

The Extravasation Detection Accessory (EDA™) is an optional accessory and is indicated for the detection of extravasations of ionic and nonionic contrast during CT procedures using a power injector.

Protocols have been independently developed and are not intended as medical advice. Bracco and Bracco Injeneering S.A. shall not be responsible for any physicians’ reliance on these or any other products.

 

CONTRAINDICATIONS:

The EmpowerCTA®+ Injector System is not intended for use as a long-term infusion pump, nor is it intended to be used to inject any agents other than contrast or flushing media. Do not attempt to use the Injector for any other purpose (such as chemotherapy or drug infusion). The EmpowerCTA+ Injector System should not be used to inject substances into nonvascular body cavities. Any applications of the EmpowerCTA+ Injector System other than those described in its Operator Manual are inappropriate and should not be attempted.

Not all products available in all global markets.

EmpowerCTA+ is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Bldg. H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Professional Services: 1-800-257-5181 (Option 2); EmpowerCTA+ Email: empowerinfo@diag.bracco.com; Website: https://www.braccoimaging.com/us-en/products/injectors-informatics/empowercta

EmpowerCTA+ is manufactured for Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. http://imaging.bracco.com

 

EmpowerMR® Injector System

Caution: Federal law restricts this device to sale by or on the order of a physician.

INDICATIONS:

The EmpowerMR® Injector System is indicated for vascular administration of contrast media and flushing media in conjunction with magnetic resonance imaging (MRI).

Protocols have been independently developed and are not intended as medical advice and Bracco shall not be responsible for any physicians’ reliance on these or any other protocols.

Bracco Injeneering S.A. reserves the right at any time and without notice, to change the specifications and features described herein, or to change the production or adjust the product described.

Not all products available in all global markets.

EmpowerMR is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Bldg. H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; Customer Service: 1-877-BRACCO 9 (1-877-272-2269); Professional Services: 1-800-257-5181 (Option 2); Website: https://www.braccoimaging.com/us-en/products/injectors-informatics/empowermr

EmpowerMR is manufactured by Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. http://imaging.bracco.com

 

NEXO® Contrast Management System

Intended Use:

The NEXO® Contrast Management System is a server-based application intended to be used as a data-management and visualization system. The NEXO Contrast Management System is able to read, store, share, compare/relate, as well as graphically display data and injection programs coming from RIS, PACS and multiple enabled EmpowerCTA® Injector Systems. This device provides users with record-lists, graphics and reports about data and performances.

This device is intended for retrospective and statistical data management and visualization. It is not intended for real-time data visualization, diagnostic applications or for any other use for which the device is not indicated. This device is only to be operated by and under quasi-continuous supervision of qualified and trained staff in an appropriate licensed healthcare facility.

The NEXO Contrast Management System is compatible with the EmpowerCTA Injector System version 8.0, and EmpowerCTA®+ Injector System version 9.0 and higher.

Bracco Injeneering S.A. reserves the right at any time and without notice, to change the specifications and features described herein, or to change the production or adjust the product described.

Not all products available in all global markets.

NEXO is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Building H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; NEXO Customer Service: 1-877-BRACCO 9 (1-877-272-2269); NEXO questions: Nexo.Answers@diag.bracco.com; NEXO U.S. Technical Service and Support: Phone: 888-670-7701; Fax: 609-514-2448; NEXO Email:  customer.support@acistmedical.com; Website: https://imaging.bracco.com/us-en/products/injectors-informatics/nexo

NEXO is manufactured by Bracco Injeneering S.A., Avenue de Sévelin 46, CH-1004 Lausanne, Switzerland. http://imaging.bracco.com

 

NEXO [DOSE]® Multi-Modality Radiation Informatics

Intended Use:

NEXO [DOSE]® Multi-Modality Radiation Informatics is a server-based application that acquires, stores, and reports radiation dose index data from medical imaging procedures.

NEXO [DOSE] Multi-Modality Radiation Informatics is intended to be used by qualified medical personnel only.

NEXO [DOSE] is distributed by Bracco Diagnostics Inc.; 259 Prospect Plains Road, Building H; Monroe Township, NJ 08831 USA; Phone: (800) 631-5245; Fax: (609) 514-2424; NEXO [DOSE] Customer Service: 1-877-BRACCO 9 (1-877-272-2269); NEXO [DOSE] questions: Nexo.Answers@diag.bracco.com; Website: https://imaging.bracco.com/us-en/products/injectors-informatics/nexo-dose NEXO [DOSE] Technical Support provided by PACSHealth, L.L.C: 1-877-299-6587

NEXO [DOSE] is manufactured by and is licensed from PHS Technologies Group, L.L.C, 32531 N. Scottsdale Road, Suite #105-282, Scottsdale, AZ 85266; a wholly-owned subsidiary of PACSHealth, L.L.C.

Not all products available in all global markets.

 

About Bracco Injeneering S.A.

Bracco Injeneering S.A., located in Lausanne, Switzerland, is the most recently added Business Unit of Bracco Imaging. Bracco Injeneering is committed to develop the best-in-class integrated injection solutions with a strong heritage in research and innovation. It provides quality solutions for state-of-the-art radiology centers, offering proven injection technology, built on Bracco Imaging’s expertise.

Thanks to this strengthened product portfolio, including the CT Exprès® 3D Contrast Media Delivery System, EmpowerCTA+ Injector System, EmpowerMR Injector System, NEXO Contrast Management System and NEXO [DOSE] Multi-Modality Radiation Informatics, Bracco Imaging will be able to focus on constant innovation, not only for devices, but also for software development and data management.

CT Exprès, EmpowerCTA, EmpowerMR, IRiSCT, NEXO and NEXO [DOSE] are registered trademarks of Bracco Injeneering S.A.

EDA and FastLoad are trademarks of Bracco Injeneering S.A.

These are representative images from reference studies; individual results may vary.

© 2022 Bracco Diagnostics Inc. All Rights Reserved.