Lauretti DL et al. Automated contrast medium monitoring system for computed tomography--Intra-institutional audit. Comput Med Imaging Graph. 2015;46 Pt 2:209-218.
https://doi.org/10.1016/j.compmedimag.2015.08.004
Background
The number of CT examinations is increasing, as is the average usage of iodinated contrast media. Optimizing contrast media injection protocols is therefore preferable for patient care and cost-effectiveness.
The contrast media monitoring software Certegra® documents the type of contrast medium and injection parameters. The software also has digital interfaces to RIS/PACS for retrieving and sending CT examination and patient data. System alerts draw attention to atypical events during the procedure.
Dario Luca Lauretti and colleagues, University of Pisa, Italy, analyzed more than 8,000 injection events with Certegra® in an intra-institutional audit. They tested for successful performance and data interoperability.
Conclusion
Automated monitoring of injection-related parameters and data transfer via the RIS/PACS interface increase radiologists' awareness of errors and on optimizing injection protocols. For example, system alerts due to high fluid pressure could be minimized by using larger catheter sizes and preheating contrast media. Also, wrongly filled fields in reports were fixed with an updated software release.
In the future, contrast monitoring systems could also take over structured reporting, thus further improving communication and traceability.
Value Proposition
The Certegra® Informatics Platform Application Entity (AE) and Medrad Stellant® DualFlow Power Injectors perform together in this audit. Lauretti et al. see the interaction of monitoring software, injector and RIS/PACS as an opportunity to improve the quality and consistency of CT exams in a clinical environment.
Methods
- Intra-institutional audit
- Data analysis of 8,609 injection protocols over a period of 19 months (June 2013-January 2015).
- Injectors: two Medrad Stellant® DualFlow Power injectors (Bayer)
- CT scanners: 16-row and 64-row
- Software platform: Certegra® Informatics Platform Application Entity (Bayer)
- CT studies: 6,497 chest-abdomen-pelvis CT, 155 coronary CT angiography, and 529 non-coronary CT angiography
- Data analysis:
- Injection parameters such as iodine concentration, average and highest injection volume and flow rate, iodine delivery rate (IDR), dose, injection pressure
- Patient parameters such as height and weight
Results
- 88.6% (7,629 of 8,609) were successful injection events.
- The system reported 331 alerts, of which:
- 40 were technical alerts, resulting in an interrupted exam 36 times (users disarmed the injector).
- 291 alerts were related to high fluid pressure, leading to a reduced flow rate.
- Data interoperability: In 319 reports, the system wrongly filled in the “Study Description” field
Certegra- Hub between input and output information
The Certegra® platform communicates with the injector and with the RIS/PACS. Procedure and injection parameters, patient and study data are sent and received. Certegra® generates a report of the injection event.
Additional information by the manufacturer, Bayer: Invoicing of procedures can be streamlined if a billing system is connected to the RIS.
Lauretti DL et al Comput Med Imaging Graph. 2015;46 Pt 2:209-218.