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

AIM

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).

MATERIALS AND METHODS

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.

RESULTS

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 (p<0.001). Although there was no difference in the attenuation in the gated ascending aorta (p>0.99), there was improvement at all other anatomical points in the non-gated examinations of the optimised protocol (p<0.002).

CONCLUSION

Optimising contrast medium flux and matching bolus duration to the CT technology dramatically improves the vascular access component of TAVI planning and provides a reliable method to achieve objectively enhanced arterial opacification. This work highlights how to obtain good arterial contrast medium opacification in haemodynamically fragile patients without excessive contrast medium volumes.

Conformity in the Asch task as a function of age

The social conformity paradigm of Asch (1956) was replicated to investigate the relationship between age and conformist behavior. One hundred ten Australian school children and adolescents between 3 and 17 years of age participated in the study. Each participant was placed in the position of being a minority of 1 against a wrong but unanimous majority of 3. The results indicate that conformity decreases with age in perceptually unambiguous tasks. Conflicting evidence from earlier studies can be attributed to task ambiguity in those studies.