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Strategies to Reduce IV Contrast Use for CT Scans Compared

Greatest reduction would involve performing unenhanced CT assuming no more than moderate negative effect on diagnostic accuracy

MONDAY, June 13, 2022 (HealthDay News) — Intravenous contrast use for computed tomography (CT) scans could be reduced by about 80 percent using a combination of dose reduction strategies, according to a research letter published online June 9 in the Journal of the American Medical Association.

Noting that there is a global shortage of iodinated contrast media due to a COVID-19-induced supply chain disruption in China, Matthew S. Davenport, M.D., from Michigan Medicine in Ann Arbor, and colleagues considered five alternative strategies for conserving contrast during CT imaging: weight-based dosing (model A), reducing contrast dose while reducing tube voltage (model B), replacing contrast CT with unenhanced CT if no more than a moderate negative effect on diagnostic accuracy is predicted (model C), a combination of models A and C (model D), and a combination of models A, B, and C (model E). These rules were applied to observed contrast use in each examination in a sample of 1.04 million CT examinations performed Jan. 1, 2015, to March 11, 2021; the results were scaled to a hypothetical population of 1 million CT scans in adults.

The researchers found that 47.1 million mL of contrast was estimated to be used for the 1 million CT scans in the base case. A 12 percent reduction in use was estimated with weight-based dosing, while reducing tube voltage and contrast dose would yield a 25 percent reduction. The greatest reduction would involve performing unenhanced CT (model C; 78 percent reduction). Combining all three approaches (model E) would achieve an estimated 83 percent reduction.

“Adoption of some of the dose-reduction strategies beyond the current shortage could mitigate supply chain risk and remove waste,” the authors write.

Several authors disclosed financial ties to the medical device and other industries.

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