Experts Weigh In

 “The importance of this study is two-fold,” explained Jason Wilson, MD, FAAEM, in an interview with Clinical Pain Advisor. “From the patient perspective, the study allows many patients to avoid ingesting oral contrast. From a clinical (and patient) perspective, the avoidance of oral contrast when appropriate decreases the overall patient length of stay.”

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Dr. Wilson serves as associate medical director for TeamHealth at Tampa General Hospital, research director for the University of South Florida emergency medicine residency program, and clinical assistant professor at the Morisani College of Medicine at the University of South Florida.

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Although there are three routes of administration for contrast dye — oral, intravenous, and per rectum — intravenous agents are the most commonly used and most likely to have health consequences, especially with respect to nephrotoxicity, Jay Goldstein, MD, medical director of emergency medicine at Memorial Health, and academic chair of the department of emergency medicine at Mercer University in Savannah, Georgia, told Clinical Pain Advisor.

Although the study provides an “accurate assessment,” of NCCT capabilities, Dr. Goldstein notes that bias still exists in thinking that contrast CT studies are always ideal. Many radiologists feel that IV and oral contrast are the best for reads, and that a noncontrast study misses a lot, Dr. Goldstein said.

While experts have varying opinions about whether all patients with no contraindications or intolerances to contrast should be subjected to contrast CT scans, Dr. Goldstein points out that major technological advances over the last 2 decades have significantly improved NCCT accuracy, thereby decreasing the need for contrast agents.

And though not necessarily a source of bias, the experts agreed that study also overlooks one major safety consideration: The impact of radiation exposure through computed tomography.