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-2100062 06/24