|Covidien Optistar LE and Covidien OptiStat CT9000|
Today’s contrast delivery systems are no longer just power injectors. They are an integral part of any cardiovascular practice, delivering time and cost savings by ensuring precise timing and consistent and reproducible images.
In the Cath Lab
The use of automated contrast delivery systems in the cath lab varies, and yet, their necessity and reliability are consistently touted.
Lawrence Luce, director of cath lab services at Mount Carmel East in Columbus, Ohio, which has four cath labs, says that his facility performs about 85 to 90 procedures a week utilizing Covidien injectors. Most often, he says the systems are used for cardiac ventriculography, aortic root injections and some peripheral vascular interventions.
“Contrast injectors are a necessary part of our daily operations—in order to obtain full opacification of the ventricle—as well as for other procedures,” Luce says. He adds that the systems cut down on waste by enabling optimal opacification with a reduced amount of contrast.
Some studies have found that the systems also manage to assist workflow for the cath lab. In a study led by Craig Lehman, PhD, from the Health Science Center, State University of New York at Stony Brook, researchers found that power contrast injection in the cath lab is about 31 percent (or five minutes) more efficient than the traditional manual method in terms of procedure room workflow (J Inv Card 2005;17:118-122).
Specifically, when “both coronary angiography and ventriculography are performed, the five-minutes time saving is realized in procedure room activities, including (four minutes) shorter arterial times, a more streamlined contrast injection set-up (one minute) and reduced contrast waste,” according to Lehman et al.
Luce notes that savings on contrast do not only provide a clinical benefit, but a pecuniary advantage as well. In fact, Lehman et al found that a power injection system set-up with the multi-case contrast syringe can potentially save about 130 mL of contrast ($45.50) for each normal diagnostic case. The study also said that if the facility has three cath labs, the annualized additional revenue rises to $794,772 with the use of automated systems.
Joanna Wessel, RN, clinical supervisor of the cath labs and interventional unit at St. Rita’s Medical Center in Lima, Ohio, which has three cath labs (with Covidien injectors) and performs approximately 65 procedures weekly, suggests that her facility has difficulty gauging its cost savings because a bottle of contrast is opened for each patient. The center has looked into using bulk contrast, but found that the cost savings were similar to its current costs because it only charges for the amount injected.
Both Luce and Wessel note how the physical presence of the injector can be intrusive because of the natural lack of space in a cath lab. Wessel points out that in their third and newest cath lab, the injector is not portable, which reduces its footprint. It is set up on the table, and a small unit is mounted on the wall for programming.
In the Diagnostic Lab
“Contrast injectors are particularly effective with CT and MRI studies. As both these technologies advance with faster scanning, contrast agents need to be administered in smaller amounts, but very precisely and very quickly, and as a result, the purpose of the injector continues to increase in importance,” says Richard D. White, MD, chairman of the department of radiology at the University of Florida, College of Medicine in Jacksonville, Fla., who uses Medrad injectors. “In days gone by, the imaging process was so slow that the injector had to, in turn, inject contrast in an equally slow manner. If all you have to do is a slow injection, there is less of a need for an injector. However, now there is a total reliance on the injector because the demands for fast imaging and very tight bolusing are such that a human could not do it,” White says.
According to a study in Controversies and Consensus in Imaging and Intervention, “CTA of the abdominal aorta with 64-channel CT currently takes 5 seconds or less, in comparison with 40 seconds that a single detector machine took in 1998,” (C2I2 2006; 4: 22-26).
“Now, one technologist and an injector perform much more efficiently than two or three technologists,” requiring less personnel and producing more reliability, according to White.
James K. Min, MD, director of cardiac CT at Weill Cornell Medical College at New York Presbyterian Hospital in New York City, says that contrast injectors (Medrad, in his case) also ease workflow because “they help tweak contrast protocols, so that the area being viewed is optimally imaged.”
He notes that with dual-head injectors, in particular, the technologist can start altering the contrast protocols to administer contrast only, followed by saline or a mixture of both. “We usually administer the contrast, followed by a mixture of saline and contrast because it decreases the artifacts, while optimizing the areas of interest,” Min adds.
Min says that generally (in nine out of 10 cases), the contrast protocols remain the same from case to case, meaning “the injectors are pre-programmed to a specific protocol and we can just start scanning,” equating to a reduction in procedure room activities.
Reduced toxicity & artifacts
The injector technology also alleviates some concerns about contrast-induced nephropathy and nephrogenic systemic fibrosis because both conditions can be minimized with less contrast.
Cost savings also are gained because the sophistication of the injectors help to reduce artifacts, which enhances scan quality, leading to less uninterpretable scans.
“It’s somewhat difficult to attribute specific cost savings to the use of an injector, because you have the technologist undergoing more training and the changing scanners, but the injector is a key component to making savings possible,” White says. “There is no question there has been a decline in contrast volume, which will translate into savings. Previously, I would report approximately 150 to 200 milliliters of iodinated contrast, and now it’s routine to report 100—approaching a 50 percent reduction from case to case.”
In the future, there will be a lot more interfacing between the scanner and injector, to the point where one will control the other, says White. “I believe the injector will be the brain when this occurs—it will be more of a physiologic monitor. I could foresee the injector having the capabilities to profile the patient, and actually make decisions on how much contrast to give the patient and at what time. The injector will therefore direct the actions of the scanner.”
The injector has become an indispensable part of the imaging process, says White. “It’s no longer a question of whether you need the system or not, it’s a question of how far you can go with it to make the studies better and less costly and risky to the patient and to the healthcare system.”