Effect of intravenous contrast for CT abdomen and pelvis on detection of urgent and non-urgent pathology: can repeat CT within 72 hours be avoided?

PURPOSE: To determine if administering IV contrast for CT abdomen and pelvis improves detection of urgent and clinically important non-urgent pathology in patients with urgent clinical symptoms compared to patients not receiving IV contrast, and in turn to determine whether repeat CT exams on the same patient within 72 h were of low diagnostic benefit if the first CT was performed with IV contrast. METHODS: We evaluated 400 consecutive patients who had CT abdomen and pelvis (CT AP) examinations repeated within 72 h. For each patient, demographic data, reason for examination, examination time stamps, and examination technique were documented. CT AP radiology reports were reviewed and both urgent and non-urgent pathology was extracted. RESULTS: Of 400 patients, 63% had their initial CT AP without contrast. Administration of IV contrast for the first CT AP was associated with increased detection of urgent findings compared with non-contrast CT (p = 0.004) and a contrast-enhanced CT AP following an initial non-contrast CT AP examination better characterized both urgent (p = 0.002) and non-urgent findings (p < 0.001). Adherence to ACR appropriateness criteria for IV contrast administration was associated with increased detection of urgent pathology on the first CT (p = 0.02), and the second CT was more likely to be performed with IV contrast if recommended by the radiologist reading the first CT (p = 0.0006). CONCLUSION: In the absence of contraindications, encouraging urgent care physicians to preferentially order IV contrast-enhanced CT AP examinations in adherence with ACR appropriateness criteria may increase detection of urgent pathology and avoid short-term repeat CT AP.

The Benefit of a Triage System to Expedite Acute Stroke Head Computed Tomography Interpretations.

BACKGROUND AND PURPOSE: We developed and tested a triage system to accelerate the interpretation of stroke head computed tomographies (CTs), with the goal of optimizing the time available for acute stroke therapy. MATERIALS AND METHODS: In our practice, acute stroke protocol head CTs have been given the highest reading priority. We implemented a technologically enabled prioritization infrastructure to consistently present these critical cases to our radiologists so they are evaluated before other examinations. In our 1-year retrospective multicenter study of 350,495 head CT examinations, we compared the reading time of stroke protocol head CTs to our next highest priority head CT. RESULTS: Our average acute stroke head CT reading turnaround time was 6.5 minutes. This represented a 17.3-minute improvement over the next highest priority head CT in our practice (confidence interval: 17.2-17.4 minutes, P < .001). CONCLUSIONS: A technologically enabled acute stroke protocol CT triage system consistently improves the reading times of critically time-dependent head CT examinations. As a result, this system has the potential to improve treatment times, treatment eligibility, and clinical outcomes.