Does oral radiocontrast affect image quality of abdominal sonography?

Dang, Christopher; Dickman, Eitan; Tessaro, Mark O.; Patel, Pranjal; Dzeba, Maxim; Likourezos, Antonios; Pushkar, Illya; Homel, Peter; Haines, Lawrence

doi:10.1016/j.ajem.2017.11.025

Cited by 3 publications

(6 citation statements)

References 1 publication

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“…Regarding the non-inferiority margin, we set this at the point of –0.40, which is the same as a depiction rate of –10%, because we had considered a larger difference as clinically relevant. Furthermore, in the AUS studies after administration of oral radiocontrast, a one-point score difference in the five-point Likert scale was selected [ 7 , 8 ]. Because the present –0.40-point margin of a four-point Likert-like scale is quite small compared with these reports, it is hard to say that our margin is too generous.…”

Section: Discussionmentioning

confidence: 99%

“…Increasing examination efficiency will become even more important in the future. In addition to endoscopy, there is concern that materials such as oral radiocontrast can deteriorate the image quality of AUS performed subsequently, and previous studies have investigated whether such materials affect the image quality of AUS from the perspective of a time-saving strategy in the emergent situation [7,8]. Room air, which is widely used for GI luminal distension in EGD, has the advantages of universal availability and low cost.…”

Section: Discussionmentioning

confidence: 99%

“…A method for objectively estimating the quality of AUS images has not been established. Previous studies [3,4,[7][8][9] have used three-to five-point Likert scales such as 1-not interpretable, 2-barely interpretable, 3-adequate for interpretation but of poor quality, 4-interpretable and of average quality, 5-interpretable and of superior quality. In this study, we developed a more objective scale by replacing the abstract evaluation with the depiction rate as an interval scale suitable for statistical analysis [10].…”

Section: Review Of Ultrasonogramsmentioning

confidence: 99%

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Image quality of abdominal ultrasonography after esophagogastroduodenoscopy is preserved by using carbon dioxide insufflation: A non-inferiority test in the same subject

et al. 2022

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Because bowel gas deteriorates the image quality of abdominal ultrasonography (AUS), it is common to perform AUS prior to esophagogastroduodenoscopy (EGD). This one-way order limits the availability of examination appointments. To evaluate whether EGD using insufflation of carbon dioxide (CO2), which is rapidly absorbed by the gastrointestinal mucosa, preserves the image quality of AUS performed subsequently, we designed a non-inferiority test in which each subject underwent AUS, EGD with CO2 insufflation, and a second AUS, in that order. All saved AUS moving images were randomized and imaging quality was evaluated at 16 organs using a four-point Likert-like scale that divides the depiction rate by 25%. Sample size was calculated to be 26 using the following: non-inferiority margin of –0.40 corresponding to depiction rate of –10%, difference of means of 0.40, common standard deviation of 1.25, power of 90%, and 1-sided α-level of 0.025. We enrolled 30 subjects. The mean and 95% confidence interval (CI) of the image quality score of all 16 organs at pre- and post-EGD AUS in the 30 subjects were 3.54 [3.48–3.60] and 3.46 [3.39–3.52], respectively. The difference in the means was 0.08 of the scores, corresponding to a 2% depiction rate. The effect size was 0.172. The image quality of post-EGD AUS was not inferior, as demonstrated by the 97.5% CI of the difference, which did not cross the non-inferiority margin of –0.40. In conclusion, the use of CO2 for insufflation in EGD does not cause much deterioration in the image quality of AUS performed subsequently. Therefore, it is permissible to perform EGD prior to AUS, which is expected to improve the efficiency of examination setup.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Review Of Ultrasonogramsmentioning

confidence: 99%

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Image quality of abdominal ultrasonography after esophagogastroduodenoscopy is preserved by using carbon dioxide insufflation: A non-inferiority test in the same subject

et al. 2022

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“…This has prompted the practice of delaying the administration of ORC until after US completion. The only prior study related to this issue that we identified was by Dang et al, 18 who recently reported results in adults who received ORC with comparison of abdominal US image quality pre-and post-ORC. They found no statistical or clinical difference in image quality obtained at each of the three time points: pre-ORC, followed by both one and two hours post-ORC.…”

Section: Discussionmentioning

confidence: 99%

“…They found no statistical or clinical difference in image quality obtained at each of the three time points: pre-ORC, followed by both one and two hours post-ORC. 18 We know of no other study that similarly assesses this issue in children.…”

Section: Discussionmentioning

confidence: 99%

Does Orally-Administered Radiocontrast Impair Ultrasound Image Quality in Pediatric Patients?

Patel

Levine

Dickman

et al. 2020

WestJEM

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Introduction: It is commonly assumed that orally-administered radiocontrast material (ORC) preceding abdominal ultrasound (US) performance can obscure image quality and potentially impair diagnostic accuracy when assessing patients with abdominal pain. Due to this concern, ORC administration per protocol for computed tomography (CT) is often delayed until after US performance, potentially contributing to prolonged length of stay in the emergency department (ED) in patients with concern for abdominal pathology. The objective of this study was to evaluate whether early administration of ORC in children with abdominal pain receiving abdominal CT for possible appendicitis obscures subsequent abdominal US image quality. Methods: We designed a prospective observational study of children <18 years of age presenting to a pediatric ED with abdominal pain who were set to receive ORC prior to obtaining an abdominal CT. These patients received a point-of-care ultrasound (POCUS) of the abdomen to assess the abdominal aorta and right lower quadrant (RLQ) structures (psoas muscle and iliac vessels) pre-and post-ORC administration. Images were compared independently by two blinded emergency US-certified physician-assessors for quality, specifically to determine whether ORC obscured the anatomical structures in question. Results: A total of 17 subjects were enrolled, and each subject had two POCUS studies of the abdomen, one pre-and one post-ORC administration looking to visualize the anatomy of the RLQ and abdominal aorta in both studies. Statistical analysis showed no significant differences in mean values of POCUS image quality scoring by two blinded US-trained physician-assessors for either RLQ structures or abdominal aorta when performed pre-and post-administration of ORC. Conclusion: Early ORC administration in children with abdominal pain does not adversely affect image quality of a subsequently performed abdominal US. Patients who may require abdominal CT to determine the etiology of abdominal pain can receive early administration of ORC prior to US performance to help minimize ED length of stay without impairing US diagnostic accuracy.

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Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study

Cho

Lee²,

Ryu³

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group. METHODS: Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade. RESULTS: CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group − NPO group) was 0.04 (95% confidence interval [CI], −1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, −20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0–1) in NPO group and 0.5 (0–1) in NO-NPO group (P = .871). CONCLUSIONS: Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.

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Does oral radiocontrast affect image quality of abdominal sonography?

Cited by 3 publications

References 1 publication

Image quality of abdominal ultrasonography after esophagogastroduodenoscopy is preserved by using carbon dioxide insufflation: A non-inferiority test in the same subject

Image quality of abdominal ultrasonography after esophagogastroduodenoscopy is preserved by using carbon dioxide insufflation: A non-inferiority test in the same subject

Does Orally-Administered Radiocontrast Impair Ultrasound Image Quality in Pediatric Patients?

Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study

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