Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Sponsored Content | Blog | Greg Freiherr, Industry Consultant | Contrast Media | July 31, 2019

BLOG: How Advances in Technology Help Patients and Providers

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

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.

 

Greg Freiherr is a contributing editor to ITN. Over the past three decades, he has served as business and technology editor for publications in medical imaging, as well as consulted for vendors, professional organizations, academia, and financial institutions.

 

Editor’s Note: This is the second blog in a series titled Using Contrast Media. The first blog, Why Power Injectors Are Needed for High-quality Imaging, can be found here. How customer needs factor into product innovation will be the focus of the next blog in this series.

 

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

 

Related Content

Researchers at Karolinska Institutet in Sweden and Tampere University in Finland have developed a method based on artificial intelligence (AI) for histopathological diagnosis and grading of prostate cancer

From left: Peter Ström, Martin Eklund, Kimmo Kartasalo, Henrik Olsson och Lars Egevad, researchers at Karolinska Institutet in Sweden. Photo courtesy of Stefan Zimmerman

News | Prostate Cancer | January 20, 2020
January 20, 2020 — Researchers at Karolinska Institutet in Sweden and...
Gadolinium based contrast dye in brain MRI

Gadolinium contrast agents (GBCAs) are partly retained in the brain, raising safety concerns, as seen in this MRI.

News | Contrast Media | January 17, 2020
January 17, 2020 — Bracco Diagnostics Inc., the U.
Trends in Overall Cancer Mortality Rates by Sex, United States, 1930 to 2017. Rates are age adjusted to the 2000 US standard population

Trends in Overall Cancer Mortality Rates by Sex, United States, 1930 to 2017. Rates are age adjusted to the 2000 US standard population. Chart courtesy of the American Cancer Society

News | Radiation Oncology | January 13, 2020
January 13, 2020 — The cancer death rate declined
Professor Samer Ezziddin, M.D., from Saarland University/Saarland University Hospital.

Professor Samer Ezziddin, M.D., from Saarland University/Saarland University Hospital. Image courtesy of Saarland University/Thorsten Mohr

 

News | Prostate Cancer | January 13, 2020
January 13, 2020 — When a non-scientist tries to imagine a scientist, the image that often arises is one of a somewha
Lung cancer patients who are inactive prior to chemoradiation are less likely to tolerate treatment and more likely to see their cancer return
News | Lung Cancer | January 08, 2020
January 8, 2020 — Numerous ...
Six of the top 20 radiotherapy stories in 2019 involved proton therapy. This includes two video inetrviews shot during a site visit to the Northwestern Medicine Proton Center in the Chicago suburb of Warrenville, Ill.

Six of the top 20 radiotherapy stories in 2019 involved proton therapy. This includes two video inetrviews shot during a site visit to the Northwestern Medicine Proton Center in the Chicago suburb of Warrenville, Ill.

Feature | Radiation Oncology | January 03, 2020 | Dave Fornell, Editor
January 3, 2020 — Here is the top 20 pieces of radiation oncology content on the Imaging Technology News (ITN) websit
Artificial intelligence was by far the hottest topic in both radiology and radiation oncology in 2019, and AI is the subject of 8 of the top 2019 ITN videos. This image is a prostate treatment plan created autonomously by an AI algorithm from RaySearch and is the subject of the No. 2 video on the list. Deep learning in radiology and radiation oncology.

Artificial intelligence was by far the hottest topic in both radiology and radiation oncology in 2019, and AI is the subject of 8 of the top 2019 ITN videos. This image is a prostate treatment plan created autonomously by a machine learning algorithm from RaySearch and is the subject of the No. 2 video on the list. 

Feature | December 30, 2019
Here are the top 20 best performing videos posted on the Imaging Technology News website (ITN) from the past year, ba
Ferrotran (formerly Combidex), based on Ferumoxtran-10, is the only contrast agent which can detect lymph node metastases as small as 2 mm diameter

Ferrotran (formerly Combidex), based on Ferumoxtran-10, is the only contrast agent which can detect lymph node metastases as small as 2 mm diameter. Standard MRI or CT are not able to detect lymph node metastases smaller than 7 – 8 mm. Since most of the oncologic patients are dying due to metastases, a precise diagnostic is of utmost importance. The detection of small metastases, combined with the very clear and contrast rich MRI image of Ferrotran, enables an earlier and more precise treatment. Therefore, Ferrotran gives the patient a much higher chance of recovery.

News | Prostate Cancer | December 24, 2019
December 24, 2019 — SPL Medical announced today that the first patient has been successfully diagnosed with suspected