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Oral contrast in IV enhanced CT, is it necessary?
Hello every body
I'm investigating the use of positive oral contrast in IV enhanced CT. Is it mandatory for every patient especially the out patients? or could it be only confined to in patients with particular question such as leak, fistula..etc?
My rational behind that thought is the following: barium or iodine based oral contrast doesn't cause good bowel distention. Even we have a good bowel distention what is the aim of opacifying the bowel.
Is it to opacify the small bowel? usually small bowel pathology is rare and not easy to diagnose on CT in addition when it is there we don't know what it is. of course with rare exceptions such as ascariasis and round worm.
is it to opacify the large bowel, usually patients are not well prebed.
Then why we do give it? it is waste of time 2 hours at least for each examination? waste of time each patient costs approximately 2$ for each examination with little if any benefit.
Just refer to the study done in England and published in Radiology Jan 09.
I would be happy to hear your thoughts..
Thanks
I'm investigating the use of positive oral contrast in IV enhanced CT. Is it mandatory for every patient especially the out patients? or could it be only confined to in patients with particular question such as leak, fistula..etc?
My rational behind that thought is the following: barium or iodine based oral contrast doesn't cause good bowel distention. Even we have a good bowel distention what is the aim of opacifying the bowel.
Is it to opacify the small bowel? usually small bowel pathology is rare and not easy to diagnose on CT in addition when it is there we don't know what it is. of course with rare exceptions such as ascariasis and round worm.
is it to opacify the large bowel, usually patients are not well prebed.
Then why we do give it? it is waste of time 2 hours at least for each examination? waste of time each patient costs approximately 2$ for each examination with little if any benefit.
Just refer to the study done in England and published in Radiology Jan 09.
I would be happy to hear your thoughts..
Thanks
Views: 465
Replies to This Discussion
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Permalink Reply by James Lindsay on
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I don't believe it is mandatory for ALL patients. It should be used if you are looking for fluid collections or GI tract pathology. (and leak + fistula as you say). Do you guys use volumen? Someone once did a study on milk. In fact, water is not a bad negative contrast agent.
I think that it can help in some cases but people need to think more about when to use it.
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Thanks James for your reply: I would add tht GIT pathology is not an indication from my point of view, Small bowel pathology, apart from Chron's disease, oral contrast is not greatly helpful as we in radiology score bad with small bowel pathology. in more than 90% of the cases are not well preped with a lot of stool in the colon which hinders the analysis. In addition, the contrast dosen't reach to the rectum in most of the patients.
The center i was wroking before they used Volumen, great contrast, you have good distention and you still see with great confidence the mucosa enhancement ( most of the GIT pathology is mucosal). the problem with the water that some of the patients escpcially cardiac and renal have a water resteriction. I read also sutdy where Gripfurit was used with satisfactory results.
i think it helps but shouldn't be used routinely.
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Permalink Reply by Gloria on
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For me I think that Volumen is great for most purposes---we use it quite a bit although some of the older radiologists HATE volumen.
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I see the most value with oral contrast when the patients are very thin. This does help to distinguish the organ structures within the bowel much better than with only IV contrast.
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Permalink Reply by Dr Manoranjan Chowhan on
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I hope this will pave the way for good evidence based radiology practice as Oral contrast if not useful to get additional clinical benefit should be given up.I invite comments on this excellent topic.
with thanks from Dr M Chowhan
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