A quality-improvement project to enhance systemic arterial contrast opacification in CT for trans-catheter aortic valve implantation

• Published in: Clinical radiology 2022-09, Vol.77 (9), p.e697-e704
• Main Authors: Komber, H.M.E.I., Neumann, S., Paull, J., Andrade, M. Gesteira, Lyen, S.M., Manghat, N.E., Hamilton, M.C.K.
• Format: Article
• Language: English
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2022.05.017

To assess improvement in arterial opacification by optimising the contrast medium dosing protocol for computed tomography (CT) prior to trans-catheter aortic valve implantation (TAVI). A wide variation in arterial opacification was observed in the initial CT TAVI protocol (standard protocol). The practice was optimised by considering the time required for the examination and optimising contrast medium flux. This became the optimised protocol with a 30-second contrast medium bolus of iodine flux 15–19 mg iodine/kg body weight/second (mg/kg/s). Attenuation (mean HU) in (a) the ascending aorta (gated systolic acquisition) and (b) the ascending, descending thoracic (at carina), infra-renal abdominal aorta, and right common iliac artery (non-gated acquisition) was measured. Thirty-one sequential optimised examinations were compared to 31 prior standard protocol examinations. There was no difference between the standard and optimised groups regarding age, sex, weight, body mass index (BMI), or voltage. The mean bolus durations were 24.9±4.4 seconds for the standard and 30±0.3 seconds for the optimised protocols (p0.99), there was improvement at all other anatomical points in the non-gated examinations of the optimised protocol (p