Feature | February 10, 2015 | Raissa Rocha and Dave Fornell

Latest Trends in Contrast Media Injectors

New injector technology for CT, MRI and angiography systems helps reduce dose and automatically records contrast used for the patient record

There have been several recent advances with contrast media injector technology, including cutting costs by reducing contrast waste and automated data collection for the dose a patient receives. Automated injector systems not only precisely control the amount of contrast used; vendors have moved into the software/IT arena by offering personalized doses for patients using information pulled from an electronic medical record (EMR) or picture archiving and communication system (PACS). Contrast dose recording software also offers new possibilities for radiology departments looking to streamline and document their contrast media usage. Some vendors have now integrated X-ray radiation dose recording capabilities as well. 
 
Syringeless Injectors
Syringeless power injectors have emerged recently as a solution to reduce contrast media waste. The Joint Commission does not allow the reuse of unused doses from single-use syringe injectors, so this option gives facilities the opportunity to use contrast media as efficiently as possible.
 
A study published online in the Journal of Medical Devices: Evidence and Research in November 2013 sought to evaluate the use of syringeless injectors versus dual-syringe injectors for contrast-enhanced computed tomography (CT) in a hospital setting.1  Studying patients enrolled at Legnano Hospital in Italy, the authors recorded data on the quantity of media used, as well as time spent and overall satisfaction on the radiologic technologists’ part. They found syringeless power injectors were more user-friendly and efficient than the dual-syringe power injector, with more waste per contrast-enhanced CT observed for the latter. The syringeless injector also allowed a cost savings of about $8 per patient when considering the lower cost and improved performance of the devices.
 
In March 2014, Guerbet launched FlowSens, its syringe-free injection system composed of a softbag injector and associated disposables, using a hydraulic, syringe-free injector to deliver contrast media. It is compatible with the company’s ScanBag solution and any type of contrast agent available on the market.
Bracco’s new “smart” Empower syringless injectors are able to use every drop of contrast loaded into the system for maximum economy.  These syringeless systems use a bulk 500 mL bolus. The injectors meter out each dose needed. Empower also records the amount injected and imaging protocol used, and sends the information to the PACS. 
 
Bracco’s EmpowerMR injector is designed for magnetic resonance imaging (MRI), conditional for use in 1.5T, 3.0T and even up to 7.0T scanners. It uses hydraulics rather than an electric motor to power rams, which helps eliminate some MRI artifacts. 
 
Both the EmpowerMR and EmpowerCTA (for CT angiography) systems include preprogrammed protocols to work with any make and model of MR and CT angiography scanners. With EmpowerCTA, automatic initialization options prepare syringes for filling, and an auto-purge function automatically removes air from the syringe.  The IRiSCT information reporting system module captures injection-related information, including patient identification. This information can be sent to a PACS, recording the amount of contrast used and any reactions observed by the patient, including any extravasation that may have occurred.
 
Other Recent Technology Upgrades
Covidien’s Optivantage dual-head contrast injector for CT, launched in 2012, uses a radio-frequency identification (RFID)-enabled system. It features simultaneous injection and prefilled Ultraject syringes, offering flexibility for radiology technicians and helping reduce the risk of infection. It automatically captures drug information and checks for expired materials, ensuring patients receive the correct prescribed dose of contrast for the CT examination.
 
Mallinckrodt began its U.S. launch of the OptiSync data management system last fall, which is designed to help efficiently collect and analyze radiology data from when a patient undergoes a contrast media-enhanced CT imaging procedure. OptiSync is used with the OptiVantage dual-head CT contrast delivery system, and allows users to verify and log patient and pharmaceutical information with the scan of a barcode. As injection data is collected, the OptiSync system transmits patient, drug, dose and administration information to HL7-based healthcare systems and automates patient record updates. By assembling a database that includes contrast media usage, workflow and benchmarking across all users, scanners and facilities, OptiSync can help users identify areas where they can reduce errors, increase productivity or improve efficiency.
 
Nemoto Kyorindo offers contrast media injectors for CT, MR and angiography. Customizable protocols give radiologists the opportunity to tailor programs for any diagnostic objective. The company’s MR injectors use non-ferrous construction to allow for safe integration in the MRI room. The latest angiography injector, Press Duo, features air-purge functions and is billed as the first dual injector for angiography.
 
Most injector systems offer extravasation detection. Nemoto offers a contrast media leak detection system to improve patient safety while finding extravasations earlier on in the injection process. Bayer’s XDS extravasation detector stops injections when pooling fluid is detected under the patient’s skin.
 
Iodine contrast agents become more viscous the higher the concentration of iodine, so some manufacturers offer warming systems to help lower their viscosity prior to injection. 
 
Manufacturers of CT/angiography systems and automated contrast injectors are starting to partner to better integrate their systems. This includes contrast dose tracking. An example of this was shown at the Radiological Society of North America (RSNA) 2014 meeting in December. Toshiba demonstrated an FDA-pending feature that integrates  Toshiba CT systems with injectors made by Bayer and Nemoto. It can adjust contrast protocols to synchronize the injector with the scanner to reduce the need for repeat scans. It also records the contrast dose. 
 
Reducing Contrast With Manual Injectors
At Transcatheter Cardiovascular Therapeutics (TCT) 2014 last fall, Osprey Medical displayed its Avert system, which helps reduce reflux (the leakage of extra/wasted contrast into the aorta). The vendor estimates about 70 percent of cath labs still use manual contrast injection. This system is said to reduce up to 40 percent of the contrast used in most procedures, helping reduce the risk of contrast induced nephropathy (CIN). It has European CE mark and is currently in a U.S. clinical trial.
 
Avert uses a contrast modulation system that diverts some of the contrast from a manual manifold into the Avert device. When an injection is made, the diverted contrast is returned to the bolus for reuse. The user injects the same manually as they always have and will not notice any difference in function. However, the system records the exact dose used and the amount of contrast diverted. A patient’s kidney function also can be entered and the system will give an estimated threshold of allowed contrast use.  
 
Comparison Chart
This article served as an introduction for a comparison chart of automated contrast media injectors. Click on the comparison chart tab at the top of the page to access the online version of the chart. Participating companies include:
 
Acist Medical Systems
 
Bayer Healthcare
 
Bracco Diagnostics
 
Mallinckrodt Pharmaceuticals
 
Nemoto Kyorindo
 
Reference:

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