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 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 Dina Pfenning, RT(R)(MR), DAS, Device Applications Territory Manager for Bracco Diagnostics based in Colorado, EmpowerCTA® “Injectors also feature a Saline Jump, which enables the technologist to reduce amount of contrast delivered to the patient while simultaneously optimizing enhancement.”6,7 This also eliminates the need to manually flush the patient IV to clear out the contrast.7

“That’s a win-win situation for everybody,” Pfenning told Applied Radiology.6 “When techs become comfortable with the saline jump feature, you can see their faces light up because they recognize that they are improving patient care by delivering a reduced amount of contrast, yet images are still optimal. And they’re giving a nice saline flush after the contrast injection which hydrates the patient.”

This feature allows for the immediate advancement to saline (once opacification has been reached), minimizing the contrast a patient receives.

 

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
7. Simeonova N. Smart injector technology delivers effective and efficient patient care. Imaging Technology News. April 29, 2021. https://www.itnonline.com/content/blogs/neda-simeonova-contributing-editor/blog-smart-injector-technology-delivers-effective
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.