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Everything you need to know about Computed Tomography (CT) & CT Scanning


Introduction

question1. What are the common contrast agents used in Body CT Scanning?
question2. Why do we routinely use oral and IV contrast for CT scanning?
questionThe role of oral and IV contrast is to help the radiologist detect the presence of disease. Regardless of the clinical application contrast may prove to be the key parameter in arriving at the right diagnosis.
 

Several articles in CT literature make it clear why contrast is so important and how errors are not uncommon.


"Errors in oncologic CT can be reduced by means of standardized imaging protocols that use intravenous and oral contrast material. Attention should be paid to optimal imaging techniques. Images should be analyzed systematically, with different window settings, and particular attention should be paid to known problem areas and pitfalls according to the underlying disease."

Missed Lesions at Abdominal Oncologic CT: Lessons Learned from Quality Assurance
Siewart B et al.
RadioGraphics 2008; 28:623-638


"Discordant interpretation of computed tomographic (CT) scans are common and have been reported in 31-37% of cases. Major discrepancies have been reproted in up to 17% of cases, resulting in a change in radiologic staging in 19%."

Missed Lesions at Abdominal Oncologic CT: Lessons Learned from Quality Assurance
Siewart B et al.
RadioGraphics 2008; 28:623-638


"One study showed that management was was affected in 7% of cases with a change in treatment being initiated in 4% of patients."

Missed Lesions at Abdominal Oncologic CT: Lessons Learned from Quality Assurance
Siewart B et al.
RadioGraphics 2008; 28:623-638


"More recent multicenter trials have reported changes in patient treatment in as many as 23% of patients due to discordant readings. Cleatly discordant readings affect patient care and treatment."

Missed Lesions at Abdominal Oncologic CT: Lessons Learned from Quality Assurance
Siewart B et al.
RadioGraphics 2008; 28:623-638


"The majority of errors are false-negative interpretations and occur during interpretation of CT examinations. Recurring false-negative CT errors include failure to appreciate unexpected bowel or pancreatic malignancy, incidental pulmonary emboli, abnormality of vascular structures, bone lesions, omental disease, incidental abnormality present on targeted examinations on the periphery of the field of view."

Eight CT lessons that we learned the hard way: an analysis of current patterns of radiological error and discrepancy with particular emphasis on CT
McCreadie G, Oliver TB
Clinical Radiology (2009) 64, 491-499


"In the daily radiology practice, the rate of interpretation error is between 3% and 4%; however, of the radiology studies that contain abnormalities, the error rate is even higher, averaging in the 30% range."

Fool Me Twice: Delayed Diagnoses in Radiology With Emphasis on Perpetuated Errors
Kim YW, Mansfield LT
AJR 2014;202:465-470


"In our study, the majority of errors made were errors of underreading (42%), where the finding was simply missed."
Fool Me Twice: Delayed Diagnoses in Radiology With Emphasis on Perpetuated Errors
Kim YW, Mansfield LT
AJR 2014;202:465-470

question3. Do we always use IV and oral contrast in “every” patient?
question4. Who decides on the use of oral and IV contrast in a specific patient?

 

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