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 | October 15, 2019

BLOG: How Customer Needs Impact Product Innovation

A volume of contrast agent lingers near the injection site, creating an artifact that can block the visualization of structures

A volume of contrast agent lingers near the injection site, creating an artifact that can block the visualization of structures. Graphic courtesy of Lior Molvin

When it comes to listing needs, patient safety ranks at the top. Just ask an imaging administrator.

“There is no way we can provide good quality customer care any other way,” said Brent Purscelley, director of ambulatory services at the Frederick Regional Health System.

But even when it comes to patient safety, distinguishing between needs and wants can get tricky. This is especially so when the frequency of patient complications gets very low.

Take CT contrast extravasations, for example. The leakage of contrast media from an intended blood vessel occurs very infrequently, only between 0.1 and 1.2 percent of administrations, according to the 2018 edition of the American College of Radiology (ACR) Manual on Contrast Media (version 10.3). Severe injuries due to extravasation may occur even more rarely.

“We have the technology today to monitor patients via sensors,” Purscelley said, “but it (extravasation) doesn’t happen often enough to really justify spending the additional money to do (the monitoring).”

The Role Of Smart Injectors

That’s where “smart” injectors come in. Not only do they alert technologists to ongoing problems, but –like black boxes on commercial airliners – they can record the data surrounding events, helping administrators understand the circumstances that led to them. Applied with preventative measures, these smart injectors can make a huge difference in patient safety.

To reduce the risk of extravasation, technologists at Frederick Regional Health System use a large gauge IV needle and tube; make sure needle placement is optimal; and assess patients for risk factors prior to contrast-enhanced scans, according to Christopher Nield, imaging supervisor there. The techs also use saline to test IV lines for stability prior to the injection of contrast agents. Additionally, the health system uses power injectors that alert techs to events that could indicate an ongoing extravasation.

The amount of time expended to do a procedure is also a factor. Increased turnaround time can decrease patient satisfaction, as it can increase provider and technologist frustration, according to Nield.

Bracco-made injectors record and display data about their performance. The appearance of a pressure spike on an injector display may indicate the occurrence of an extravasation. A networked smart injector can alert techs, radiologists and administrators to an ongoing event. The injector data can be interpreted in the context of the patient’s physical signs and the type of contrast-enhanced examination.

SmartInject solutions, built into Bracco-made injectors, display and document CT and MRI contrast administrations. These injectors can inject saline bolus chasers to push the contrast agent. If such a chaser is not used, a substantial amount of the contrast agent may linger near the injection site, potentially causing artifacts that block the visualization of important structures. Saline injections, before administration of the contrast medium, may also be used to test the stability of the IV needle and its placement in the vein.

Tracking Radiation Dose

Keeping track of radiation dose is critically important to minimizing the amount of patient radiation, which is essential to patient safety. Bracco’s NEXO information system for dose can track patient radiation exposure automatically regardless of the type of imaging system used. The multimodality radiation informatics system monitors and analyzes exposure data in real time and across the enterprise. When those data veer outside set parameters, NEXO sends an alert to physicians, technologists or administrators – whoever the system has been assigned to notify.

Similar capabilities regarding contrast media is achieved with the NEXO Contrast Management System, which uses SmartInject technology. As with the dose-oriented software, NEXO updates patient records by synchronizing with the RIS/PACS, EMR, or voice dictation system used in radiology.

The two systems – one for managing contrast, the other for keeping track of radiation – help meet not only patient needs but needs of the provider. Among provider needs is compliance with requirements, for example, ones set by The Joint Commission.

Because neither MRI nor ultrasound exposes patients to ionizing radiation, their use negates the need to track ionizing radiation, which accompanies CT and radiography/fluoroscopy. Issues surrounding contrast media, however, remain. Providers, therefore, must consider all sorts of risks. Among them is the lack of reliability.

Besides being easy to use, power injectors have to be rugged enough to stand up to the beatings that can be dished out in emergency rooms. Overall reliability, according to Nield, is critically important. “If we have an injector down, the scanner is out for some studies,” he said. “Then we have real issues.”

Editor’s Note: This is the third blog in a series titled Using Contrast Media. The first blog, Why Power Injectors Are Needed for High-quality Imaging, can be found here. The second blog, How Advances in Technology Help Patients and Providers, can be found here. The final blog in this four-part series will consider the value derived from smart injectors and informatics.

 

Related content:

BLOG: Why Power Injectors Are Needed for High-Quality Imaging

BLOG: How Advances in Technology Help Patients and Providers

Manual on Contrast Media

Related Content

The contrast agents global market is expected to grow at a high single digit CAGR from 2020 to 2027 to reach $7,033.5 million by 2027 due to the increasing incidence and prevalence of chronic diseases and demand for diagnostic and interventional radiology procedures, increase in aging population, expansion of contrast agent indications, the growth of medical imaging in the emerging market, increasing research activities and favorable reimbursement

image courtesy of Guerbet

News | Contrast Media | May 03, 2021
Chemical substances that improve the visibility of specific organs, tissues, or blood vessels during a diagnostic or
Despite receiving high radiation doses to their tumors, lung cancer patients treated with technique that spares a large part of the esophagus did not develop severe inflammation of the esophagus

Getty Images

News | Lung Imaging | April 30, 2021
April 30, 2021 — For many patients with localized lung cance...
Gadopiclenol is a high-relaxivity macrocyclic contrast agent used for magnetic resonance imaging (MRI)
News | Contrast Media | March 24, 2021
March 24, 2021 — Guerbet announced positive results from two...
(a) High-resolution 3D MRI brain vascular map using SAIO. Various blood vessels in the rat brain can be visualized. In addition to clinically important brain vessels including anterior cerebral artery, middle cerebral artery, posterior cerebral artery, fine vessel structures as thin as ~ 100 microns in diameter can be clearly visualized. (b) 3D MRI brain vascular map using Dotarem (gadolinium-based contrast agent). Resolution is low and microvessels are not visible. (c) For 3D reconstruction, multiple slice

(a) High-resolution 3D MRI brain vascular map using SAIO. Various blood vessels in the rat brain can be visualized. In addition to clinically important brain vessels including anterior cerebral artery, middle cerebral artery, posterior cerebral artery, fine vessel structures as thin as ~ 100 microns in diameter can be clearly visualized. (b) 3D MRI brain vascular map using Dotarem (gadolinium-based contrast agent). Resolution is low and microvessels are not visible. (c) For 3D reconstruction, multiple slices of MRI images of the rat heart were obtained after injection of SAIO. Rat coronary arteries (180 microns) which are 10 times thinner than human coronary arteries were successfully visualized. Coronary arteries supply blood to the heart muscle and the blockage or narrowing of such arteries causes myocardial infarction or angina, but visualizing these arteries was impossible due to the limited resolution of current MRI contrast agents. Image courtesy of Institute for Basic Science

News | Contrast Media | March 12, 2021
March 12, 2021 — Heart attack and stroke are the first and second leading causes of death in developed countries, res
CT imaging radiation dose tracking software from Imalogix displayed at RSNA 2019.

CT imaging radiation dose tracking software from Imalogix displayed at RSNA 2019. Photo by Dave Fornell.

Feature | Radiation Dose Management | March 04, 2021 | By Dave Fornell
More than a decade ago, there was an alarming, rapid rise in ionizing radiation exposure in the U.S.
Guerbet announced the launch of OptiProtect 3S, a new range of technical services for its injection solutions. OptiProtect 3S is designed to support imaging centers in the daily use and protection of their injection solutions.
News | Contrast Media Injectors | February 25, 2021
February 25, 2021 — Guerbet announced the launch of ...
Real Time Imaging Technologies LLC iannounced that it has received U.S. Patent No. 10,898,070 IMAGING APPARATUS AND METHODS which covers the company’s methods for incorporating microlens into X-ray imaging detectors that enables significantly lower radiation dose without compromising image resolution.

Getty Images

News | Radiation Dose Management | February 05, 2021
February 5, 2021 — 
Steinberg Diagnostic Medical Imaging headquarters.

Steinberg Diagnostic Medical Imaging headquarters.

Sponsored Content | Case Study | Contrast Media Injectors | January 21, 2021
Steinberg Diagnostic Medical Imaging (SDMI) was founded 30 years a
According to a new research report1 on the contrast media injectors published by MarketsandMarkets, the market was estimated to be $1.3 billion in 2020 and projected to reach $1.9 billion by 2025, at a compound annual growth rate (CAGR) of 7.4 percent over 2020-2025.

The ulrich CTmotion

Feature | Contrast Media Injectors | January 20, 2021 | By Melinda Taschetta-Millane
According to a new...