More high value radiology! Topic: PO contrast for abdominal & pelvic CT in adult patients. Invite comments on the debate about positive PO contrast, PO water and no PO at the end, but arm tweets with evidence! #tweetorial #highvaluehealthcare
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Quick poll to gauge your understanding. Which of the following is used for oral contrast with adult CT abdomen & pelvis (CT AP)?
Quick poll to gauge your understanding. Which of the following is used for oral contrast with adult CT abdomen & pelvis (CT AP)?
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Background: Positive (+) PO contrast is either iodine-based or barium-based. Ordering providers need to know when to order PO & when to avoid, particularly for ED & inpatients. For some indications, radiologists now use PO water & rads should be involved in decision-making.
Background: Positive (+) PO contrast is either iodine-based or barium-based. Ordering providers need to know when to order PO & when to avoid, particularly for ED & inpatients. For some indications, radiologists now use PO water & rads should be involved in decision-making.
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Why are we using PO water for CT AP?
1⃣ Enables visualization of bowel mucosa, which is obscured by (+) PO
2⃣ Better tolerated by pts than (+) PO
3⃣ No risks. Allergic pts can react to iodine-based PO, including anaphylaxis
4⃣ Lower cost
Nice resource: epmonthly.com
Why are we using PO water for CT AP?
1⃣ Enables visualization of bowel mucosa, which is obscured by (+) PO
2⃣ Better tolerated by pts than (+) PO
3⃣ No risks. Allergic pts can react to iodine-based PO, including anaphylaxis
4⃣ Lower cost
Nice resource: epmonthly.com
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Diagnosis of appendicitis & diverticulitis can be made without (+) PO contrast, but IV contrast is important. Waiting for PO to reach the cecum or distal colon adds hours & delays dx.
Landmark appendicitis CT protocol paper by Jill Jacobs @NYURadiology
ncbi.nlm.nih.gov
Diagnosis of appendicitis & diverticulitis can be made without (+) PO contrast, but IV contrast is important. Waiting for PO to reach the cecum or distal colon adds hours & delays dx.
Landmark appendicitis CT protocol paper by Jill Jacobs @NYURadiology
ncbi.nlm.nih.gov
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When is (+) PO contrast helpful for CT AP?
☑️ ileus vs. obstruction
☑️ post-op abscess
☑️ enterocutaneous fistula
☑️ prior intestinal surgery
☑️ cancer follow up
☑️ low BMI
☑️ patients who can't get IV contrast*
*If allergic to iodine, avoid iodinated-PO
When is (+) PO contrast helpful for CT AP?
☑️ ileus vs. obstruction
☑️ post-op abscess
☑️ enterocutaneous fistula
☑️ prior intestinal surgery
☑️ cancer follow up
☑️ low BMI
☑️ patients who can't get IV contrast*
*If allergic to iodine, avoid iodinated-PO
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When should (+) PO contrast be avoided? High grade SBO.
1⃣ contrast won't reach transition
2⃣ increases patient discomfort
3⃣ increases risk of vomiting & aspiration
4⃣ delays diagnosis
Resource for using PO contrast in ileus vs SBO & low grade SBO:
acsearch.acr.org
When should (+) PO contrast be avoided? High grade SBO.
1⃣ contrast won't reach transition
2⃣ increases patient discomfort
3⃣ increases risk of vomiting & aspiration
4⃣ delays diagnosis
Resource for using PO contrast in ileus vs SBO & low grade SBO:
acsearch.acr.org
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When is (+) PO contrast contraindicated? GI bleeding.
In setting of GIB, we make dx by identifying IV contrast leakage into bowel lumen from bowel wall, which is obscured if (+) PO in the lumen. pubs.rsna.org
Also: no (+) PO with CTA & CT urogram. Compromises 3Ds.
When is (+) PO contrast contraindicated? GI bleeding.
In setting of GIB, we make dx by identifying IV contrast leakage into bowel lumen from bowel wall, which is obscured if (+) PO in the lumen. pubs.rsna.org
Also: no (+) PO with CTA & CT urogram. Compromises 3Ds.
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Curious: Does your hospital perform CT AP for lower GI bleeding?
Curious: Does your hospital perform CT AP for lower GI bleeding?
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In closing, radiologists should be engaged in CT protocol design for each patient. Great resource on all things contrast from @RadiologyACR
acr.org
Invite comments from nonradiologists & radiologists, preferably with evidence-based resources! #tweetorial
In closing, radiologists should be engaged in CT protocol design for each patient. Great resource on all things contrast from @RadiologyACR
acr.org
Invite comments from nonradiologists & radiologists, preferably with evidence-based resources! #tweetorial
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