An audit of the adequacy of contrast enhancement in CT pulmonary angiograms in a South African tertiary academic hospital setting

SA Journal of Radiology

Field Value
Title An audit of the adequacy of contrast enhancement in CT pulmonary angiograms in a South African tertiary academic hospital setting
Creator Basson, Derik J. Moodley, Halvani
Subject Radiology contrast enhancement; audit; CT pulmonary angiogram; pulmonary embolism; flow rate
Description Background: Undiagnosed pulmonary embolism carries high mortality and morbidity. Computed tomography pulmonary angiogram (CTPA) is the diagnostic method of choice for accurate diagnosis. Inadequate contrast opacification is the second most common cause of indeterminate CTPAs.Objectives: Audit the adequacy of CTPA contrast enhancement and determine whether inadequate enhancement is affected by the size and site of the intravenous cannula, flow rate, contrast volume, contrast leakage and day shift versus after hours services.Method: Retrospective and prospective audits of the adequacy of contrast enhancement of CTPAs at the Charlotte Maxeke Johannesburg Academic Hospital were conducted using the Royal College of Radiologists guidelines (≤ 11% of studies with 210 HU). Protocol variables were collected prospectively from questionnaires completed by radiographers performing the CTPAs. Adequate versus inadequate groups were analysed.Results: A total of 63 (retrospective) and 130 (prospective) patients were included with inadequate contrast enhancement rates of 19% (12/63) and 20.8% (27/130), respectively. The majority of CTPAs were performed during the day 56.2% (73/130) with a 20G cannula 66.2% (86/130) in the forearm 33.8% (44/130) injecting 100 mL – 120 mL contrast 43.1% (56/130) at 3 mL/s 63.1% (82/130). The median flow rate (3 mL/s) and contrast volume (80 mL) were identical in both adequate and inadequate groups, while the remaining variables showed no statistical difference.Conclusion: The rate of inadequately enhanced CTPAs in this study was high. The protocol variables did not have a significant influence on the rate of inadequate enhancement. Further research, particularly using flow rates 4 mL/s, is required for protocol optimisation.
Publisher AOSIS
Contributor CT radiography staff Maryn Viljoen
Date 2022-03-24
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Audit
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajr.v26i1.2350
Source South African Journal of Radiology; Vol 26, No 1 (2022); 6 pages 2078-6778 1027-202X
Language eng
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Coverage South Africa; Gauteng 2020 Adults
Rights Copyright (c) 2022 Derik Jacobus Basson, Halvani Moodley