AJR Am J Roentgenol. The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. Swensen SJ, Prokop M. See the CME Quiz. et al. This scan is also known as CT Angiogram of the Abdomen and Pelvis. Adapted with permission from American College of Radiology. Utter DP. The choice of contrast agent depends on route of administration, desired tissue differentiation, and suspected diagnosis. These are recommendations to maximize the amount of information obtained from any one examination. Rhea JT, The results are somewhat dependent on cardiac output, size of the intravenous line, rate of injection, and degree of hydration. Address correspondence to James V. Rawson, MD, FACR, Medical College of Georgia at Georgia Health Sciences University, HB 4020, Augusta, GA 30912 (e-mail: jrawson@georgiahealth.edu). Shanmuganathan K, together. 9. Schabelman E, Most centers use nonionic contrast agents (which are generally low osmolality) for IV contrast studies.5 The rate of major reactions (e.g., anaphylaxis, death) is the same for ionic and nonionic IV contrast agents—an estimated one in 170,000 administrations—but nonionic contrast has a lower rate of minor reactions.6 Approximately 5% to 12% of patients who receive high-osmolality contrast have adverse reactions, most of which are mild or moderate.7 Use of low-osmolality contrast has been associated with a reduction in adverse effects. Possible reactions are listed in Table 1.7  If a patient has had a previous minor reaction to an IV iodinated contrast agent, precontrast administration of oral or IV corticosteroids and diphenhydramine (Benadryl) may decrease their risk (Table 27). Iodinated contrast should be avoided for two months before administration of iodine 131. You assume full responsibility for how you choose to use this information. One study showed similar increases in serum creatinine levels between inpatient populations who received IV iodinated contrast and those who did not.16, Noncontrast-enhanced CT is used in patients with head trauma and acute stroke. The decision to order contrast-enhanced CT is based on the clinical question being asked. JAMES V. RAWSON, MD, FACR, is the Warren Professor and Chair of Diagnostic, Therapeutic, and Interventional Radiology at the Medical College of Georgia at Georgia Health Sciences University, Augusta.... ALLEN L. PELLETIER, MD, FAAFP, is an associate professor of family medicine at the Medical College of Georgia at Georgia Health Sciences University. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. This will be helpful for other ordering clinicians such a Nurse Practitioners (NPs) and Physician Assistants (PA). 2006;295(23):2765–2779. HeartburnThe burning sensation that rises from your stomach to either shoot up your throat or settle just under your sternum in your chest is one of the most common signs of gastrointestinal problems. Treatment Planning (Pubic Arch Study Protocol), *The Pelvic Region as defined by Medicare is the “lower abdomen.”  The UHS Protocol for a CT Pelvis covers et al. Normal renal function and no comorbid disorder*, Metformin (Glucophage) can be continued when contrast is administered; serum creatinine does not need to be measured, Normal renal function and at least one comorbid disorder*, Metformin should be discontinued when contrast is administered; if the patient remains clinically stable and has no new intercurrent risk factors for renal impairment, metformin may be resumed in 48 hours without repeating serum creatinine measurement, Metformin should be discontinued when contrast is administered; resume only after careful reevaluation and monitoring of renal status. Takashima T, If IV contrast is contraindicated, CT Abd/Pelvis with oral contrastwill suffice. Iodinated contrast agents can cause reversible acute renal failure. A report from the Japanese Committee on the Safety of Contrast Media. Turning to the existing literature for answers is unrewarding, because most studies are … Airoldi F, 13. The Abdomen and Pelvis CTA Scan helps doctors in examining the blood vessels in the abdomen and pelvic area, as well as enables them to detect diseases of the colon, small bowel and other internal organs. Bladder cancer, suspected CT Abdomen & Pelvis w 74177 Cancer staging CT Abdomen & Pelvis w 74177 MRI Abdomen w & wo 74183 Flank pain, renal colic CT Abdomen & Pelvis wo 74176 Hematuria (CT Urogram, CT IVP) CT Hematuria Protocol ‐ CT/IVP w & wo 74178 MRI Abdomen and Pelvis w … Cohan RH, Myers JL. Contact Scalea TM. Choe KA, Although many radiology departments screen for shellfish allergy, there is no cross-reactivity between shellfish and iodinated contrast. First year radiology residents:  Review this guide Fortamet (metformin hydrochloride) [package insert]. ACR-ASNR practice guideline for the performance of myelography and cisternography. Contrast agents can be further classified as high or low osmolality, based on the iodine concentration. capture those cases where the codes (pre 2011) would have been billed Killeen KL, Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. All rights Reserved. Computed tomography of the abdomen and pelvis is an application of computed tomography and is a sensitive method for diagnosis of abdominal diseases. A reformatted 5-mm coronal image is shown. into singular combined CPT Codes (74176, 74177, and 74178). AJR Am J Roentgenol. Incidence and severity of acute allergic-like reactions to i.v. Patients with increased abdominal fat require less contrast; Evaluation for Appendicitis or Diverticulitis does not require Oral Contrast; Patient indications for Oral Contrast. Academic Emergency Medicine . Creatinine cutoffs vary among institutions, but generally range between 1.5 and 2 mg per dL (132.6 to 176.8 μmol per L) before alternative imaging strategies are considered.7 An increasing creatinine level that is still within normal limits is also concerning, and alternative imaging strategies should be considered. The major families of contrast agents are ionic and nonionic. Survey of contrast media use in southeastern U.S. hospitals. ACR-ASNR practice guideline for the performance of myelography and cisternography. Pelvis With Contrast: 72194. ... Abdomen Pelvis CT with IV Contrast only Without Enteric. Katayama H, The specific agent and route of administration are based on clinical indications and patient factors. Airoldi F, A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. 2009;193 (5):1268–1271. Douglas WW, I believe that oral contrast both accentuates bowel pathology if it exists and helps to exclude pathology if it doesn’t exist. A Guide for Ordering Clinicians/Non-Radiology Physicians (internal medicine, family practice, etc). Cedars-Sinai 's S. Mark Taper Foundation Imaging Center has a team of specialists who focus on taking and interpreting CT scans. The second type of contrast agent is sometimes used as a substitute for barium and is called Gastrografin. ACR appropriateness criteria. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Panicek DM. Ellis JH, Rutten A, General CT Tips • Ordering a study with contrast means IV contrast, not PO • Always order CT abdomen AND pelvis • Never order CT with and without • Only exception is CT head • Patient is scanned twice (double the radiation dose) • Must have at least 20g, antecubital IV for CTA BMI <19-20 kg/m2) Alberta Kidney Disease Network. 15. Katayama H, Abdomen CT: scan from diaphragm to iliac crest. Some centers use oral contrast to evaluate for appendicitis; some do not use bowel contrast,3 and others use rectal contrast to avoid the delay associated with oral administration.4, Iodine-based intravenous (IV) contrast agents are used for opacification of vascular structures and solid abdominal and pelvic organs. 19. Alberta Kidney Disease Network. Newhouse JH, Aughenbaugh GL, Previous: Diagnosis and Treatment of Peripheral Arterial Disease, Home CT abdomen is an increasingly common investigation that is used to help make diagnoses of a broad range of pathologies. There is no direct interaction between metformin and IV radiologic contrast agents. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort. For all other concerns related to the bowel, it is best to order a CT Abd/Pelvis with IV and oral contrast. Picture Window theme. Zeman RK, Brink JA, Costello P. Helical/Spiral CT: A Practical Approach. When to Order Contrast-Enhanced CT. The only exception being patients in who a fistula/ leak from bowel is the primary concern or is to be excluded. Possible contraindications for using intravenous contrast agents during computed tomography include a history of reactions to contrast agents, pregnancy, radioactive iodine treatment for thyroid disease, metformin use, and chronic or acutely worsening renal disease. Clinical experience at Johns Hopkins and published literature regarding PET/CT applications in the abdomen and pelvis are reviewed, and the strengths and limitations of this evolving technology are summarized. Most Abdominal CT protocols require oral water only (no Oral Contrast). Fortamet (metformin hydrochloride) [package insert]. Sign up for the free AFP email table of contents. McCabe CJ. Shanmuganathan K, These are common questions radiologists get daily. Starren J. CT Angiography, or CTA, is a type of contrasted CT scan used to evaluate the blood vessels. A CT angiography scan quickly makes detailed pictures of the blood vessels inside your belly or pelvis. Potential Harms of Computed Tomography: The Role of Informed Consent, Diagnostic Indications: Noncontrast-Enhanced CT vs. IV Contrast, When to Order CT with and Without Contrast, http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Myelography.pdf, http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021574s010lbl.pdf, http://www.acr.org/Quality-Safety/Appropriateness-Criteria/Diagnostic, Diagnosis and Treatment of Peripheral Arterial Disease. A CT abdomen in its simplest form is a CT from diaphragm to symphysis pubis performed 60 seconds after pump-injection of iodinated contrast into a peripheral vein. CT of the Abdomen: Exam Description. Ellis JH, The American College of Radiology recommends using IV iodinated contrast in pregnant women when the information needed affects the care of the patient and fetus and cannot be obtained without contrast, and when the referring physician thinks that imaging should not wait until after the pregnancy.7, Iodinated contrast media can saturate the thyroid gland and significantly reduce uptake of iodine 131, rendering the treatment ineffective. Colon Polyps, Thanks for this blog.Farr Laboratories provide Prostate supplements/tablets online which is an effective treatment for prostate cancer & provides pain relief. Reprints are not available from the authors. ACR manual on contrast media: version 8, 2012. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/FullManual.pdf. / Journals 88/No. CT abdomen & pelvis IV contrast Also consider CT chest with contrast based on mechanism of injury / If thoracic aortic injury suspected, consider CTA chest Jaundice: painless CT abdomen IV contrast Jaundice: with pain US abdomen If suspect CBD stones, consider CT abdomen AJR Am J Roentgenol. Abdominal 5(September 1, 2013) Clear communication between the physician and radiologist is essential for obtaining the most appropriate study at the lowest cost and risk to the patient. The use of positive oral contrast material for abdominal CT is a frequent protocol issue. Choose a single article, issue, or full-access subscription. Coakley FV, ACR manual on contrast media: version 8, 2012. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/FullManual.pdf. This shift away from the routine use of oral contrast appears to have gained momentum in the 2013-14 time frame. For information about the SORT evidence rating system, go to, Use of low-osmolality contrast has been associated with a reduction in adverse effects. Disease processes that involve calcifications may benefit from noncontrast-enhanced images because contrast may mask the appearance of calcifications. Mostafavi AA, Contrast agents in x-ray computed tomography and its applications in oncology. [16] Lee SY, Coughlin B, Wolfe JM, et al. American College of Radiology. For ordering physicians and patients,  this should be helpful information when ordering  CT scans ("cat scans"). Because there is a risk of aspiration-induced pulmonary edema with concentrated iodine-based contrast agents, patients must be carefully selected. When do you order a CT scan (abdomen and pelvis) together ? Prophylaxis strategies for contrast-induced nephropathy. This test may be used to look for: Abnormal widening or ballooning of … Water-soluble, iodine-based contrast agents can also be given orally. Contrast agents are used to differentiate between organs and improve lesion detection and characterization. Laryngeal edema (severe or rapidly progressing). Tonelli M; JAMA. single CT Abdomen and CT Pelvis still exist, the above codes are designed to Kozuka T, When do you order a CT abdomen/pelvis with contrast or without contrast. Strouse PJ, Dillman JR, Yamaguchi K, Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Barium suspension from fluoroscopy or CT will not produce an artifact on abdominal magnetic resonance imaging. 1995;194(3):789–794. There are two different types of substances used for oral CT contrast. Barium suspensions are not nephrotoxic and can be used safely in patients with renal failure. Barium and is called Gastrografin with contrast or without contrast in children [ published appears. 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