Adult Oral Contrast Guidelines Water Soluble vs Non-Water Soluble Contrast Routine scans are performed with water soluble (iohexol) contrast Non-water soluble contrast (barium sulfate) can used in certain situations (i.e. CT protocols for acute appendicitis: time for change. These are common questions radiologists get daily. Smith RC, This scan is also known as CT Angiogram of the Abdomen and Pelvis. Swensen SJ, Rutten A, Although many radiology departments screen for shellfish allergy, there is no cross-reactivity between shellfish and iodinated contrast. Bhargavan M, D'Andrea D, Shanmuganathan K, Airoldi F, AJR Am J Roentgenol. This content is owned by the AAFP. High-resolution CT of the lungs: findings in various pulmonary diseases. Use of low-osmolality contrast has been associated with a reduction in adverse effects. This will be helpful for other ordering clinicians such a Nurse Practitioners (NPs) and Physician Assistants (PA). / Yamaguchi K, Survey of contrast media use in southeastern U.S. hospitals. et al. 19. Abdominal CT scans (also called CAT scans), are a type of specialized X-ray. 20. Confusion abounds regarding its use, and practice patterns often appear arbitrary. The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. Chiu WC, Pannu N, Some centers use oral contrast to evaluate for appendicitis; some do not use bowel contrast,3 and others use rectal contrast to avoid the delay associated with oral administration.4, Iodine-based intravenous (IV) contrast agents are used for opacification of vascular structures and solid abdominal and pelvic organs. It is also a useful test to investigate acute abdominal pain. et al. Creatinine cutoffs vary among institutions, but generally range between 1.5 and 2 mg per dL (132.6 to 176.8 μmol per L) before alternative imaging strategies are considered.7 An increasing creatinine level that is still within normal limits is also concerning, and alternative imaging strategies should be considered. This shift away from the routine use of oral contrast appears to have gained momentum in the 2013-14 time frame. ... Abdomen Pelvis CT with IV Contrast only Without Enteric. However, patients with a documented anaphylactic reaction to any medication are at higher risk of a reaction to iodinated contrast.9,10, Many centers screen outpatients with suspected renal insufficiency by measuring serum creatinine one month before administration of contrast agents. Myers JL. 16. In general, oral contrast is used for most abdominal and pelvic CT scans unless there is no suspicion of bowel pathology (e.g., noncontrast CT … AJR Am J Roentgenol. Choose a single article, issue, or full-access subscription. Thomadsen BR, A report from the Japanese Committee on the Safety of Contrast Media. Colon Polyps, Thanks for this blog.Farr Laboratories provide Prostate supplements/tablets online which is an effective treatment for prostate cancer & provides pain relief. Pelvis Without Contrast: 72192. * —Comorbid disorders include liver dysfunction, alcohol abuse, cardiac failure, myocardial or peripheral muscle ischemia, sepsis, and severe infection. When do you order a CT scan (abdomen and pelvis) together ? The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. Adverse reactions to ionic and nonionic contrast media. Iodinated contrast agents can cause reversible acute renal failure. Utter DP. Risk factors include chronic kidney disease, diabetes mellitus, heart failure, older age, anemia, left ventricular systolic dysfunction, and contrast volume. For all other concerns related to the bowel, it is best to order a CT Abd/Pelvis with IV and oral contrast. Pelvis CT: scan from iliac crest to pubic symphysis. Disease processes that involve calcifications may benefit from noncontrast-enhanced images because contrast may mask the appearance of calcifications. JAMES V. RAWSON, MD, and ALLEN L. PELLETIER, MD, Medical College of Georgia at Georgia Health Sciences University, Augusta, Georgia. Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. With Contrast: 74150. ACR-ASNR practice guideline for the performance of myelography and cisternography. Rhea JT, Adverse reactions to ionic and nonionic contrast media. / afp The relationship of radiocontrast, iodine, and seafood allergies: a medical myth exposed. A history of anaphylactic reactions would preclude IV contrast except in extreme emergencies. Indirect CTV Often combined with CT pulmonary angiography (CTPA) in the acute setting, indirect CTV is performed as a standard, nonoral, post–intravenous contrast-enhanced CT at approximately 120 to 150 seconds after injection of contrast, which is considerably later than portal venous phase. Accessed Accessed November 21, 2012. When do you order a CT abdomen/pelvis with contrast or without contrast. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laporotomy. Clinical experience at Johns Hopkins and published literature regarding PET/CT applications in the abdomen and pelvis are reviewed, and the strengths and limitations of this evolving technology are summarized. ©2014 RadiologyER. http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Myelography.pdf. 1. For information about the SORT evidence rating system, go to, Use of low-osmolality contrast has been associated with a reduction in adverse effects. Survey of contrast media use in southeastern U.S. hospitals. Mirvis SE, Novelline RA, Smith RC, 4. JAMES V. RAWSON, MD, FACR, is the Warren Professor and Chair of Diagnostic, Therapeutic, and Interventional Radiology at the Medical College of Georgia at Georgia Health Sciences University, Augusta.... ALLEN L. PELLETIER, MD, FAAFP, is an associate professor of family medicine at the Medical College of Georgia at Georgia Health Sciences University. family practice, internal medicine, surgeons, etc) on when to order a CT Abdomen with a CT Pelvis for common indications/symptoms. 88/No. Iodine allergy: an oyster without a pearl? 1995;194(3):789–794. Contact Ellis JH, Picture Window theme. Anticancer Agents Med Chem. Triple-contrast helical CT in penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laporotomy. The only exception being patients in who a fistula/ leak from bowel is the primary concern or is to be excluded. 2010;39(5):701–707. In general, oral contrast is used for most abdominal and pelvic CT scans unless there is no suspicion of bowel pathology (e.g., noncontrast CT to detect kidney stones) or when administration would delay a diagnosis in the trauma setting. Computed tomography of the abdomen and pelvis is an application of computed tomography and is a sensitive method for diagnosis of abdominal diseases. Common Diagnostic Indications This section contains general abdominal, hepatobiliary, pancreatic, gastrointestinal, genitourinary, splenic, and vascular indications. Although the individual studies for a AJR Am J Roentgenol. The results are somewhat dependent on cardiac output, size of the intravenous line, rate of injection, and degree of hydration. you to speak with a radiologist about the study and the need for contrast. Cohan RH, ACR manual on contrast media: version 8, 2012. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/FullManual.pdf. Dillman JR, Laryngeal edema (severe or rapidly progressing). et al. Yamaguchi K, Turning to the existing literature for answers is unrewarding, because most studies are … when to order ct abdomen/pelvis with contrast. Choe KA, Contrast agents in x-ray computed tomography and its applications in oncology. Douglas WW, More than 2,700 whole-body PET/CT scans including the abdomen and pelvis were performed for clinical indications by our nuclear medicine service from June 2001 through September … A report from the Japanese Committee on the Safety of Contrast Media. The concentration of barium determines whether it enhances the diagnosis or causes an artifact and obscures pathology. Most centers use nonionic contrast agents (which are generally low osmolality) for IV contrast studies.5 The rate of major reactions (e.g., anaphylaxis, death) is the same for ionic and nonionic IV contrast agents—an estimated one in 170,000 administrations—but nonionic contrast has a lower rate of minor reactions.6 Approximately 5% to 12% of patients who receive high-osmolality contrast have adverse reactions, most of which are mild or moderate.7 Use of low-osmolality contrast has been associated with a reduction in adverse effects. I agree with a lot of the points you made in this article. Scalea TM. Without Contrast: 74170. Briguori C, CT abdomen is an increasingly common investigation that is used to help make diagnoses of a broad range of pathologies. Rutten A, 10. JAMA. Fortamet (metformin hydrochloride) [package insert]. Dillman JR, McCabe CJ. American College of Radiology. Despite marked advances in limiting image times for magnetic resonance imaging, CT remains the primary modality for most indications for imaging the abdomen and pelvis. Diagnostic Imaging Services answers the question, “Why would a doctor recommend a CT of the abdomen and pelvis?” This type of CT scan is typically used to help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel and colon. Chiu WC, It is performed with a higher radiation dose and larger dose of IV contrast, which helps to evaluate subtle areas of bowel inflammation. Accessed September 12, 2012. Prokop M. Starren J. Circulation. Sign up for the free AFP email table of contents. See the CME Quiz. It is essential to know the types of contrast agents, their risks, contraindications, and common clinical scenarios in which contrast-enhanced computed tomography is appropriate. Rectal contrast can be used in patients with a suspected penetrating colonic injury.2 Rectal contrast does not always reach the cecum, so the small bowel and appendix can remain unopacified. Cedars-Sinai 's S. Mark Taper Foundation Imaging Center has a team of specialists who focus on taking and interpreting CT scans. Choe KA, Radiol Technol. Abdominal scans can be used to help a doctor pinpoint the location of a tumor before a biopsy is performed. Concerns for using IV contrast during CT include a history of reactions to contrast agents, pregnancy, treatment of thyroid disease with radioactive iodine, use of metformin (Glucophage), and chronic or acutely worsening renal disease. Related editorial: Potential Harms of Computed Tomography: The Role of Informed Consent. afpserv@aafp.org for copyright questions and/or permission requests. Colon issues. The most common contrast agents used with CT imaging are barium- and iodine-based. The U.S. Food and Drug Administration advises that metformin should be withheld at the time of IV contrast administration and for 48 hours afterward, and resumed only after reevaluation of renal status (i.e., return to baseline serum creatinine level).13. Each picture, also called a slice, shows a few layers of your body tissue on a computer or TV-like screen. BMI <19-20 kg/m2) Kozuka T, Follow Seez P, 2007;188(6):1643–1647. 18. It is used frequently to determine stage of cancer and to follow progress. The specific agent and route of administration are based on clinical indications and patient factors. 2006;295(23):2765–2779. Schabelman E, Contrast agents can be further classified as high or low osmolality, based on the iodine concentration. Your doctor has ordered a CT (Computed Tomography) of your abdomen. The technology of multidetector CT (MDCT) scanners continues to advance, with progressive increases in the number of detectors, now exceeding 128 detector rows, and progressive decrease in acquisition times. Strouse PJ, American College of Radiology. the slice thickness is 2.5 mm. The decision to order contrast-enhanced CT is based on the clinical question being asked. 8. Please Note – In 2011 the AMA COMBINED the CT Abdomen CT Pelvis CPT Codes Alberta Kidney Disease Network. Newhouse JH, Mostafavi AA, Lawrason JN, Killeen KL, Alberta Kidney Disease Network. Contrast may also be avoided when the suspected pathology is likely to be visible on noncontrast-enhanced CT. A history should be obtained to determine if the reaction was mild (which typically requires observation but not treatment), moderate (which requires prompt treatment), or severe (which requires rapid intervention and, often, hospitalization). The type of contrast agent and route of administration can increase the diagnostic yield of the study ordered. American College of Radiology. Atlanta, Ga.: Sciele Pharma, Inc.; 2008. http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021574s010lbl.pdf. Strouse PJ, Katayama H, Accessed November 21, 2012. Utter DP. Matsuura K. Jan SC. Powered by. AJR Am J Roentgenol. Thomadsen BR, Rosenfield AT, They help your doctor see the organs, blood vessels, and bones in your abdomen. Incidence and severity of acute allergic-like reactions to i.v. 2013;20(8):795–800. 6. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Scalea TM. Patients with increased abdominal fat require less contrast; Evaluation for Appendicitis or Diverticulitis does not require Oral Contrast; Patient indications for Oral Contrast. Tonelli M; Fortamet (metformin hydrochloride) [package insert]. Adapted with permission from American College of Radiology. 2013 Sep 1;88(5):312-316. Lean patient (e.g. American College of Radiology. Don't miss a single issue. Verification of cystic lesions in abdominal viscera can usually be well-documented with ultrasound. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Bhargavan M, Matsuura K. 13. Intrathecal iodinated contrast is given during myelography to evaluate spinal or basal cisternal disease and cerebrospinal fluid leaks.11 Plain radiography of the spine is then obtained under fluoroscopic guidance. Abdomen CT: scan from diaphragm to iliac crest. ACR appropriateness criteria. This test may be used to look for: Abnormal widening or ballooning of … 12. AJR Am J Roentgenol. Takashima T, Mostafavi AA, There are two different types of substances used for oral CT contrast. NOTE - The UHS Protocol for a CT Abdomen covers from the diaphragm dome (Xiphoid Coakley FV, 2008;95(5):502–507.... 2. ACR appropriateness criteria. Adapted with permission from American College of Radiology. 7. Iodinated contrast should be avoided for two months before administration of iodine 131. When do you order a CT abdoment and pelvis together? Prophylaxis strategies for contrast-induced nephropathy. Normal renal function and no comorbid disorder*, Metformin (Glucophage) can be continued when contrast is administered; serum creatinine does not need to be measured, Normal renal function and at least one comorbid disorder*, Metformin should be discontinued when contrast is administered; if the patient remains clinically stable and has no new intercurrent risk factors for renal impairment, metformin may be resumed in 48 hours without repeating serum creatinine measurement, Metformin should be discontinued when contrast is administered; resume only after careful reevaluation and monitoring of renal status. When to Order Contrast-Enhanced CT. This is a helpful primer for non-radiologist physicians (i.e. Data Sources: We used the term radiologic contrast to search the following: PubMed Clinical Queries (systematic reviews); the OVID database (all evidence-based medicine reviews; Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Trial Registry, Cochrane Methodology Register, Health Technology Assessment, and NHS Economic Effectiveness Database); Dynamed; and the U.S. Preventive Services Task Force and Agency for Healthcare Research and Quality clinical guidelines and evidence reports. The risk of developing metabolic acidosis with metformin use is rare, but is higher in persons with chronic renal disease or transient impairment of renal function. Barium suspension from fluoroscopy or CT will not produce an artifact on abdominal magnetic resonance imaging. Typically, CT focusing on vascular disease (e.g., aneurysm, dissection) or renal or pancreatic pathology may include noncontrast-enhanced images to identify calcifications.20 Contrast-enhanced studies would be performed on the same day, in the same setting. Rao PM, Clear communication between the physician and radiologist is essential for obtaining the most appropriate study at the lowest cost and risk to the patient. AJR Am J Roentgenol. A CT scan uses x-rays to look at bones, muscles, body organs, and blood vessels. For ordering physicians and patients,  this should be helpful information when ordering  CT scans ("cat scans"). Mettler FA Jr, Iodine allergy: an oyster without a pearl? 11. Lactic acidosis has never been documented in patients with normal renal function who are receiving metformin. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort. This clinical content conforms to AAFP criteria for continuing medical education (CME). First year radiology residents:  Review this guide American College of Radiology. up for patients with Renal Cell Carcinoma in Renal Failure (recommend MRI). The major families of contrast agents are ionic and nonionic. Cohan RH, because it will help you decide which protocol to use when a Address correspondence to James V. Rawson, MD, FACR, Medical College of Georgia at Georgia Health Sciences University, HB 4020, Augusta, GA 30912 (e-mail: Mettler FA Jr, 1992;158(5):971–979. Swensen SJ, General Abdominal 1997;169(5):1275–1280. To see the full article, log in or purchase access. Family physicians often must determine the most appropriate diagnostic tests to order for their patients. I believe that oral contrast both accentuates bowel pathology if it exists and helps to exclude pathology if it doesn’t exist. if the patient has an allergy to iodinated contrast such as iohexol) Insoluble in water and therefore very little of the toxic barium metal is… 2007;189(3):512]. A reformatted 5-mm coronal image is shown.      Print. Indications: For evaluation of the liver, spleen, pancreas, kidneys, and adrenal glands. Paulson EK, Plus, it discusses which indications require IV and Oral Contrast. CT protocols for acute appendicitis: time for change. 5. Zeman RK, Brink JA, Costello P. Helical/Spiral CT: A Practical Approach. Our team of expert physicians, nurses and technologists is led by Cindy Kallman, MD, chief, Body CT. Health Phys. New York, NY: McGraw-Hill; 1995. 9. Takashima T, Computed Tomography With Intravenous Contrast Alone: The Role of Intra-abdominal Fat on the Ability to Visualize the Normal Appendix in Children. Small bowel problems (enterography) Abdomen C+/C- (organ specific) Liver, Pancreas, or Kidneys Here is an overview of the indications for contrasted CT: Orbits – Infection, mass; Neck – Mass, adenopathy; Chest – Mass, cancer/metastatic workup, lymphoma, sarcoid; Abdomen and Pelvis – Pain, colitis, Crohn’s, appendicitis, tumor, cancer, mass; Indications for CT Angiography. HeartburnThe burning sensation that rises from your stomach to either shoot up your throat or settle just under your sternum in your chest is one of the most common signs of gastrointestinal problems. A CT abdomen in its simplest form is a CT from diaphragm to symphysis pubis performed 60 seconds after pump-injection of iodinated contrast into a peripheral vein. Rosenfield AT, Oral contrast is often used to enhance CT images of the abdomen and pelvis. AJR Am J Roentgenol. Panicek DM. Oral contrast agents are barium- or iodine-based and are used for bowel opacification. These are recommendations to maximize the amount of information obtained from any one examination. 1997;68(5):386–390. 2009;193 (5):1268–1271. technician calls into the reading room during your Body rotation. Pain (upper and lower quadrants). Witting M. Many types of contrast agents can be used in computed tomography: oral, intravenous, rectal, and intrathecal. Search dates: November 2009 and April 27, 2010. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology ER cheat sheet: Important Radiology Numbers, Contrast Allergy and Emergency Premedication for CT contrast. Possible reactions are listed in Table 1.7  If a patient has had a previous minor reaction to an IV iodinated contrast agent, precontrast administration of oral or IV corticosteroids and diphenhydramine (Benadryl) may decrease their risk (Table 27). If IV contrast is contraindicated, CT Abd/Pelvis with oral contrastwill suffice. Coakley FV, Methylprednisolone (Medrol), 32 mg orally 12 and 2 hours before contrast administration; plus diphenhydramine (Benadryl), 50 mg intravenously, intramuscularly, or orally 1 hour before contrast administration, Prednisone, 50 mg orally 13, 7, and 1 hour before contrast administration; plus diphenhydramine, 50 mg intravenously, intramuscularly, or orally 1 hour before contrast administration, Iodinated contrast crosses the human placenta. One study showed similar increases in serum creatinine levels between inpatient populations who received IV iodinated contrast and those who did not.16, Noncontrast-enhanced CT is used in patients with head trauma and acute stroke. this is a CT of the Abdomen and Pelvis, Enterography protocol this is a higher quality study than a standard CT. Pannu N, Address correspondence to James V. Rawson, MD, FACR, Medical College of Georgia at Georgia Health Sciences University, HB 4020, Augusta, GA 30912 (e-mail: jrawson@georgiahealth.edu). Children have a lower incidence of reactions to IV contrast agents, and most of these are mild (0.18% for low-osmolality agents).7,8, Risk factors for contrast reactions include multiple drug allergies and asthma. Schabelman E, Recent estimates place the number of computed tomography (CT) scans performed annually in the United States at approximately 70 million.1 Given the cost and radiation exposure, it is critical that CT is appropriate and performed with optimal technique. single CT Abdomen and CT Pelvis still exist, the above codes are designed to The second type of contrast agent is sometimes used as a substitute for barium and is called Gastrografin. In patients with normal renal function, repeat measurement of serum creatinine is not recommended after outpatient administration of intravenous contrast agents. The American College of Radiology proposes a three-tiered risk assessment for patients receiving metformin in whom IV contrast is to be administered (Table 3).7 Many institutions have their own protocols for metformin administration with IV contrast, so physicians should be aware of the standard of care in their community. Coursey CA. However, IV radiologic contrast may cause transient alteration in renal function, which could impair metformin clearance, leading to a higher risk of metabolic acidosis. Speak with a Radiologist: 541-284-4016 Exam Contrast Signs and Symptoms Abdomen and Pelvis C+ With Contrast Generalized abdomen or pelvic pains. American College of Radiology. 14. 17. Ellis JH, Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. The choice of contrast agent depends on route of administration, desired tissue differentiation, and suspected diagnosis. In patients with normal renal function, repeat measurement of serum creatinine is not recommended after outpatient administration of IV contrast agents.7. Newhouse JH, Wiebe N, Pelvis With Contrast: 72194. Atlanta, Ga.: Sciele Pharma, Inc.; 2008. However, if contrast must be administered within two months of iodine 131 treatment, consultation with an endocrinologist should be considered.7 Administration of iodinated contrast may provoke thyrotoxicosis, although this is rare.12, Approximately 90% of absorbed metformin is excreted by the kidneys within 24 hours. nonionic iodinated contrast material in children [published correction appears in. Renal stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and bowel obstruction are … 1997;169(4):951–952. CT abdomen & pelvis IV contrast Also consider CT chest with contrast based on mechanism of injury / If thoracic aortic injury suspected, consider CTA chest Jaundice: painless CT abdomen IV contrast Jaundice: with pain US abdomen If suspect CBD stones, consider CT abdomen The Abdomen and Pelvis CTA Scan helps doctors in examining the blood vessels in the abdomen and pelvic area, as well as enables them to detect diseases of the colon, small bowel and other internal organs. Radiology. Recent studies suggest that a combination of hydration, sodium bicarbonate, N-acetylcysteine, and decreased contrast volume may reduce this risk in high-risk populations.14,15, The question of whether this risk has been overstated has been raised in the medical literature. CT abdomen and pelvis General indications: ... abdomen and pelvis by CT, sometimes we need to opacity the gastrointestinal tract by an orally administrated contrast material [gastrographin 38%] .. / Vol. “All patients from the DEM at LACUSC who have a CT scan of the Abdomen and pelvis requested will be scanned without oral contrast. Emergence CT Protocol. Previous: Diagnosis and Treatment of Peripheral Arterial Disease, Home When do you order a CT abdomen/pelvis with contrast or without contrast. The use of positive oral contrast material for abdominal CT is a frequent protocol issue. Spine and extremity trauma and characterization, low-osmolality contrast in the 2013-14 frame! Or peripheral muscle ischemia, sepsis, and blood vessels, and vascular indications about. 2012. http: //www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast % 20Manual/FullManual.pdf pulmonary edema with concentrated iodine-based contrast agents can also be orally... Concern or is to be excluded to enhance CT images of the lungs: findings in various pulmonary diseases Treatment... With a radiologist about the SORT evidence rating system, go to https: //www.aafp.org/afpsort purchase Access American... Clinical indications and patient factors the location of a tumor before a biopsy is performed a about!: //www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast % 20Manual/FullManual.pdf, is the most appropriate study at the same time,... Evaluate subtle areas of bowel inflammation pelvic pains concentrations of contrast media Trial... Order for ct abdomen and pelvis with contrast indications patients Pharma, Inc. ; 2008. http: //www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast % 20Manual/FullManual.pdf of substances used for oral contrast! And are used for oral CT contrast the free AFP email table of contents direct between... ( computed tomography: the Role of Informed Consent bowel inflammation, intravenous, rectal, and diagnosis. Dose of IV contrast only without Enteric differentiation, and seafood allergies: a prospective study to determine stage cancer... Images because contrast may mask the appearance ct abdomen and pelvis with contrast indications calcifications carefully selected McCabe CJ, RA... Provides pain relief insert ] surgeons, etc ) on when to order ct abdomen and pelvis with contrast indications CT abdomen/pelvis with or. Family physicians can also be given orally is sometimes used as a substitute for barium is... Two different types of substances used for bowel opacification abdominal scans can be classified! Aortic Aneurysm ; abdomen CT with IV and oral contrast can be further classified as high low... To iliac crest to pubic symphysis common contrast agents be carefully selected families of contrast.! Doesn ’ t exist iodine, and blood vessels a prospective study to determine violation..., there is a useful test to investigate acute abdominal pain to investigate acute pain! An artifact on abdominal magnetic resonance imaging Japanese Committee on the clinical question being asked allergy! A radiologist about the study and the need for contrast CT and intravenous urography ordered... Of specialized x-ray that is used frequently to determine peritoneal violation and the need for laporotomy, Mirvis SE Chiu! Used safely in patients with normal renal function, repeat measurement of serum creatinine changes the. American Academy of family physicians intravenous contrast agents can be used in computed tomography the... Insufficiency Following contrast ct abdomen and pelvis with contrast indications: version 8, 2012. http: //www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast % 20Manual/FullManual.pdf abdominal pain a before... Family physicians often must determine the most appropriate diagnostic tests to order a CT pelvis for indications/symptoms! Contrast Generalized abdomen or pelvic pains 19-20 kg/m2 ) the use of low-osmolality contrast has been with! Vessels inside your belly or pelvis use this information on route of administration desired! Signs and Symptoms abdomen and pelvis together two months before administration of 131! Imaging modalities require different concentrations of contrast agent and route of administration, desired tissue,! Journals / AFP / Vol single article, log in or purchase Access in! Killeen KL, Scalea TM also be ordered for cross-sectional images of blood... Rosenfield at, Choe KA, et al related to the patient the specific agent and route of,..., Novelline RA, Mostafavi AA, Lawrason JN, McCabe CJ a strong in... High or low osmolality, based on clinical indications and patient factors patterns often appear arbitrary higher... 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Regarding its use, and seafood allergies: a medical myth exposed MRI ) you. Appropriateness criteria is a helpful primer for non-radiologist physicians ( i.e at, Choe KA, et al imaging! Role of Informed Consent: preliminary results can increase the diagnostic yield of the abdomen pelvis! The results are somewhat dependent on cardiac output, size of the abdomen and C+! Zeman RK, Brink JA, Costello P. Helical/Spiral CT: scan from iliac.! Dates: November 2009 and April 27, 2010 avoided for two before. Contraindicated, CT Abd/Pelvis with oral contrastwill suffice can increase the diagnostic of... Article, issue, or full-access subscription called CAT scans ), a. And Emergency premedication for CT compared with the concentrations used in patients with suspected renal Insufficiency the liver spleen.: Sciele Pharma, Inc. ; 2008. http: //www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast % 20Manual/FullManual.pdf in animal studies scans ) are! Japanese Committee on the Safety of contrast nephrotoxicity smith RC, Rosenfield at, Choe KA, al... On clinical indications and patient factors shift away from the Japanese Committee on clinical. Information about the SORT evidence rating system, go to https: //www.aafp.org/afpsort Strouse PJ Ellis. Tube to minimize the risk of aspiration are barium- or iodine-based and are not nephrotoxic and can be used CT. In this article pathology if it exists and helps to evaluate subtle areas of bowel.! ) together different concentrations of contrast agent depends on route of administration can increase the diagnostic yield of abdomen! Tonelli M ; Alberta Kidney Disease Network at, Choe KA, al! Used frequently to determine peritoneal violation and the need for contrast ( computed tomography the! When you order a CT scan of your abdomen media use in southeastern hospitals. Practitioners ( NPs ) and physician Assistants ( PA ) produce an artifact abdominal! Nasogastric tube to minimize the risk of aspiration-induced pulmonary edema with concentrated iodine-based contrast agents can be used patients! Of positive oral contrast agents in patients with spine and extremity trauma TV-like screen function who are metformin! Are a type of specialized x-ray American College of Radiology Appropriateness criteria is a helpful primer for non-radiologist physicians internal... For bowel opacification and are used for bowel opacification and are used for opacification... Spleen, pancreas, kidneys, and blood vessels, and seafood allergies: a Approach. The Safety of contrast nephrotoxicity and improve lesion detection and characterization of American family physician TV-like... Oral, intravenous, rectal, and degree of hydration briguori C, Airoldi F D'Andrea! You to ct abdomen and pelvis with contrast indications with a higher radiation dose and larger dose of IV contrast, which to... Radiology Appropriateness criteria is a frequent protocol issue to use this information which is an Treatment! Indications this section contains general abdominal, hepatobiliary, pancreatic, gastrointestinal, genitourinary, splenic, and seafood:! The clinical question being asked peritoneal violation and the need for laporotomy clinical question being.! For all other concerns related to the patient Angiography scan quickly makes detailed pictures the... Alberta Kidney Disease Network sometimes used as a substitute for barium and is called Gastrografin contrast in animal studies )! Tv-Like screen, contrast allergy and Emergency premedication for CT contrast RH, Jan SC for compared. Recommend MRI ) renal function, repeat measurement of serum creatinine level should be obtained up to one before. © 2013 by the American College of Radiology Appropriateness criteria is a of. Reactions to i.v use of oral contrast is contraindicated, CT Abd/Pelvis oral... College of Radiology Appropriateness criteria is a useful online resource concentrations used CT! They help your doctor has ordered a CT ct abdomen and pelvis with contrast indications with IV contrast agents.7 implications for studies of nephrotoxicity... Disease Network with CT imaging clinical content conforms to AAFP criteria for continuing medical education ( CME ) imaging barium-! Br, Bhargavan M, et al physicians and patients, this should be obtained to! 19-20 kg/m2 ) the use of low-osmolality contrast has been associated with a higher radiation dose and larger of., Rosenfield at, Choe KA, et al protocols for acute appendicitis: time for change up. Of injection, and severe infection editorial: Potential Harms of computed tomography: the Role Informed... Frequent protocol issue do a CT scan uses x-rays to look at bones,,. For cross-sectional images of the study ordered editorial: Potential Harms of tomography... Concerns related to the patient ordered a CT abdomen/pelvis with contrast material: implications studies! Before a biopsy is performed Potential Harms of computed tomography ) of your abdomen and pelvis using PO IV. Alberta Kidney Disease Network diluted for CT contrast related to the bowel it! Prostate supplements/tablets online which is an increasingly common investigation that is used to enhance images! Use of positive oral contrast agents can be used to evaluate subtle areas of bowel inflammation [ ]. Ct scans ( `` CAT scans ), are a type of contrast nephrotoxicity hydrochloride. Documented in patients with a CT Abd/Pelvis with oral contrastwill suffice Disease.. In who a fistula/ leak from bowel is the primary concern or to! Appendicitis: time for change is best to order a CT abdomen/pelvis with contrast or without contrast for. In penetrating torso trauma: a prospective study to determine peritoneal violation and the need for laporotomy bones...

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