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1
Department of Radiology, New York University Medical Center, 550 First Ave.,
Rm. HW 205, New York, NY 10016.
2
Berlex Laboratories, 340 Changebridge Rd., Montville, NJ 07045-1000.
3
Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO
63110.
4
Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC
27710.
5
Department of Radiology, H066, Pennsylvania State University College of
Medicine, P. O. Box 850, Hershey, PA 17033.
6
Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston,
MA 02115.
7
Department of Radiology, Massachusetts General Hospital, 32 Fruit St., Boston,
MA 02114.
8
Department of Radiology, Hospital of the University of Pennsylvania, 3400
Spruce St., Philadelphia, PA 19104.
9
Charlotte Radiology Associates, P.O. Box 30488, Charlotte, NC
28230-0488.
10
Department of Radiology, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore,
MD 21287.
OBJECTIVE. The purpose of our study was to determine the minimum optimal dose of IV contrast medium for helical CT that can preserve image quality while reducing cost.
SUBJECTS AND METHODS. Four hundred sixty-three patients from six centers were enrolled in a prospective trial in which patients were randomized into one of four weight-based dose categories of iopromide, 300 mg I/mL: 1.25, 1.50, 1.75, and 2.0 mL/kg. Six of 463 patients were excluded from analysis. A radiologist at each center who was unaware of the volume of contrast medium administered determined whether the scans were acceptable. The responses were analyzed by dose, in aggregate, and by weight. Enhancement values (in Hounsfield units) in regions of interest in the liver, pancreas, aorta, and kidneys were obtained at a single time during the scan. The participating radiologist was unaware of these values. Finally, three additional nonparticipating site observers assessed the images for acceptability, diagnostic quality, and overall level of confidence. A cost model comparing incurred charges in using 150 or 100 mL, or 1.5 mL/kg, of low osmolality contrast medium was developed from experience in an additional 303 patients.
RESULTS. We found no clinically significant difference in acceptability of scans at doses greater than 1.5 mL/kg. However, significant variability occurred among the centers. The use of 1.5 mL/kg led to a savings of $9927.16 for 303 patients when compared with the use of 150 mL at list price. The cost is the same for 1.5 mL/kg or use of 100 mL of contrast medium.
CONCLUSION. A weight-based dose at 1.5 mL/kg of low osmolality contrast medium can provide acceptable scans in most patients, with a significant cost savings.
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