Eliminate Excess Contrast With Saline

Decrease contrast volume by 20–40% with integration of a saline bolus chaser

 

Powered injection systems for computed tomography (CT) were first introduced in the mid-1980s. Since these systems control the timing of contrast delivery via adjustments to flow rate, volume and injection duration, the goal was, and is, to optimize target organ opacification to enhance contrast resolution.1

“The initial protocols were sufficient for early generation CT scanners,” noted Mark A. Auler, MD, and colleagues, “however, as the CT scanner technology advanced, the injection protocols were no longer able to reliably optimize peak enhancement.”1

 

Using Saline Flush

 

Fortunately, a number of developments in the past few years have positively impacted CT imaging, including the use of multi-detector row computed tomography (MDCT) technology, usage of nonionic contrast material, and the use of saline flush.

Use of a saline chase technique can reduce the total amount of contrast media needed. A bolus chaser of a saline solution pushed through the injection line right after the injection of the main bolus can yield a significant reduction in required contrast material (CM) volume with vascular attenuation similar to that observed with larger volume.2

In fact, use of a saline chaser can reduce required contrast material (CM) volume by 20–40 percent and lower the incidence of artifacts, all with the same—or superior—arterial enhancement.3

 

Reducing Nonionic Contrast Dose

 

Nonionic contrast materials play an increasingly important role in medical imaging. However, potential nephrotoxicity and cost have been important concerns, which “has compelled radiologists to investigate the possibility of reducing the dosage of contrast material without compromising the quality of the examination.”1

In this regard, several studies have shown that, if saline flush is used, between 15 and 50 mL of contrast material can be saved.1

A study by Schoellnast and coworkers4 evaluated the reduction of cost and contrast material using saline flush in abdominal MDCT. Their results demonstrated iodine dose reduction of approximately 6 g or 17% and a cost reduction of $7.30 per patient (120 mL nonionic contrast versus 100 mL nonionic contrast followed by 40 mL saline).

In addition, it is very important—from a cost perspective—that as the amount of contrast media which is injected into the patient is decreased that these savings are reflected by a reduction in the amount of contrast media that the department purchases.1

Although the price of non-ionic contrast material has decreased over time, non-ionic contrast material still represents a significant expense to radiology departments because of the increasing number of CT examinations.

Hospitals that have an injection system—including injector, disposables and bulk contrast media—designed to “bank” the contrast reductions to patients can potentially save $60,000 per year if 5,000 injections are performed. This amounts to a savings of $12 per patient.5

In fact, CM-reduction benefits have also been shown in multislice CT (MSCT) coronary angiography, where required CM has been reduced by as much as 35 percent, along with resulting cost savings and decreased risk of contrast-induced nephropathy (CIN).2

 

Using Saline Jump Technology

 

In addition to the reduced risk of CIN and increased cost savings, there’s less waste due to the lower contrast volume associated with the use of saline chasers1 and, more recently, with the use of automated “saline jump” features, as found in Bracco SmartInject injector systems.6

According to Keith Dary, RT(R)(CT), Senior Imaging Clinical Applications Specialist for Bracco Diagnostics, “The Saline Jump feature on our EmpowerCTA system is my favorite feature exclusive to our equipment. This gives the user the opportunity to transition to saline during any point of the contrast injection phase. I find it so important to give the technologist this ability, because it can ultimately benefit not only the patient, but the image quality as well. Naturally, it saves the patient from receiving the pre-selected contrast volume, which of course can further reduce any chance of nephrotoxicity.”

“Aside from patient safety, Saline Jump can also improve image quality,” Dary told Applied Radiology. “Often, CTA acquisitions are performed well before contrast delivery transitions to a saline phase. With this feature, we can keep our contrast bolus bright, while also eliminating a common CT image artifact known as “streak.” This is what makes Saline Jump a win-win, in my opinion. Technologists should be very proud of their work, and this feature can improve not only the quality of their imaging, but safety and care for their patients as well.”

 

References:
1. Auler MA, Heagy T, Aganovic L, et al. Saline chasing technique with dual-syringe injector systems for multi-detector row computed tomographic angiography: rationale, indications, and protocols. Curr Probl Diagn Radiol. 2006;35(1):1-11.
2. Cademartiri F, Mollet N, van der Lugt A, et al. Non-invasive 16-row multislice CT coronary angiography: usefulness of saline chaser. Eur Radiol. 2004;14(2):178-183.
3. Cademartiri F, van der Lugt A, Luccichenti G, et al. Parameters affecting bolus geometry in CTA: a review. J Comput Assist Tomogr. 2002;26(4):598-607. doi:10.1097/00004728-200207000-00022
4. Schoellnast H, Tillich M, Deutschmann HA, et al. Abdominal multidetector row computed tomography: reduction of cost and contrast material dose using saline flush. J Comput Assist Tomogr. 2003 Nov-Dec;27(6):847-853. doi:10.1097/00004728-200311000-00002
5. Dorio P, Lee F Jr, Henseler K, et al. Using a saline chaser to decrease contrast media in abdominal CT. AJR Am J Roentgenol. 2003;180(4):929-934. doi:10.2214/ajr.180.4.18009295
6. Bryant M. Device applications specialists deliver technology and expertise. Appl Radiol. September 2021. https://www.appliedradiology.com/articles/device-applications-specialists-deliver-technology-and-expertise
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.
 
US-N/A-2400062 06/24

IMPORTANT SAFETY INFORMATION  |  INDICATIONS AND USAGE

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).

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).

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 are 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); Scientific Information: 1-800-257-5181 (Option 2); EmpowerCTA+ Email: empowerinfo@diag.bracco.com; Website: https://smartinject.wpenginepowered.com/ct-solutions/

EmpowerCTA+ is manufactured by Bracco Injeneering S.A., Avenue de Sevelin 46, CH – 1004 Lausanne, Switzerland. https://www.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 are 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); Scientific Information: 1-800-257-5181 (Option 2); Website: https://smartinject.wpenginepowered.com/mr-solutions/

EmpowerMR is manufactured for Bracco Injeneering S.A., Avenue de Sevelin 46 CH – 1004 Lausanne, Switzerland. https://www.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 can 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 appropriately licensed healthcare facility.

The NEXO Contrast Management System is compatible with the EmpowerCTA Injector System version 8.0, and EmpowerCTA®+ Injector System version 10.0 and higher.

Not all products are 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://smartinject.wpenginepowered.com/digital-solutions

NEXO is manufactured by ACIST Medical Systems, 7905 Full Road, Eden Prairie, MN 55344 USA.

 

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 developing 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 EmpowerCTA®+ Injector System and EmpowerMR Injector System Bracco Imaging will be able to focus on constant innovation, not only for devices but also for software development and data management.

EmpowerCTA, EmpowerMR, NEXO, and IRiSMR are registered trademarks of Bracco Injeneering S.A., registered in the U.S.

FastLoad is a trademark of Bracco Injeneering S.A.

All other trademarks and registered trademarks are the property of their respective owners.