Jeffrey David Robinson MD, Presenter: Consultant, HealthHelp

Lee M. Mitsumori MD, MS, Abstract Co-Author: Nothing to Disclose

Ken Floris Linnau MD, MS, Abstract Co-Author: Nothing to Disclose

Intravenous contrast enhancement of vascular and solid organs varies with patient weight. However, contrast administration protocols have tended to be determined by the size of commercially available single-use vials, with tiered protocols typically calling for volumes of 100cc or 150cc. Recently, larger 500cc multi-dose packaging units of contrast have become available, which allow specific weight-based contrast protocols. Injectors can be loaded with precisely the desired volume of contrast without waste. We present an economic model of the potential cost savings if intravenous contrast dose is administered based on specific patient weight using multi-dose contrast packaging in comparison to (1) the same weight-based protocol using single-dose packaging and (2) a traditional tiered contrast protocol in CT of the abdomen and pelvis.  

Over a five-month period, 1359 consecutive successful weight-based contrast injections for abdomino-pelvic CT scans were reviewed.  Cost estimates for the multi-dose, multi-use packing scenario assumed consecutive 500cc bottles of contrast, with 5cc waste between patients. The single-use scenario (1) assumed use of 100cc bottles to deliver the same contrast volume, with surplus contrast discarded between exams. The tiered model (2) assumed administration of 100 cc of contrast if patient weight was less than 188 pounds (n=812), or 150cc if greater (n=547). Actual institutional contrast cost was used, while all other costs (such as shipping, technologist time) were assumed to be equal among all scenarios.

The average contrast volume per exam was 126cc (range 65-186 cc). For the reference scenario, 356 multi-use 500cc bottles of contrast would have been required at a cost of $22,253. Administration of the same injection volumes using 100cc bottles (comparison scenario 1) would have required 2501 100cc bottles, at a cost of $35,014. Using a traditional tiered approach (scenario 2), 1906 100cc bottles would have been required at a cost of $26,684.

Weight-based contrast dosing protocols using multi-dose packaging has the potential for substantial cost savings in the performance of body CT.

Using multi-use bottles of intravenous contrast, substantial cost savings can accrue while simultaneously improving the consistency of contrast enhancement.

Robinson, J, Mitsumori, L, Linnau, K, Improved CT Enhancement with Reduced Cost Using Multi-Dose Contrast Bottles.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013969.html