title: Comparison of Mechanical Versus Hand Administration of IV Contrast Agents for Pediatric Pulmonary CT Angiography.
abstract: OBJECTIVE
  The purpose of this study was to assess the difference between mechanical versus hand administration of IV contrast agents on the diagnostic quality of pediatric pulmonary CT angiography (CTA).
  
  
  METHODS
  A retrospective review of the medical records was performed to detect pediatric patients (≤ 18 years) with pulmonary CTA performed between September 2012 and March 2015. Patients were placed into two cohorts on the basis of the method of contrast administration (mechanical vs hand). Additional information obtained included IV size or gauge, IV site, amount and type of contrast agent administered, and rate of administration (mL/s). The quality of the CT images was independently evaluated by two pediatric radiologists using a qualitative 4-point visual assessment scale and quantitatively with attenuation (HU). An ANOVA controlling for age compared the contrast enhancement in the central pulmonary arteries between the cohorts.
  
  
  RESULTS
  One hundred forty-eight consecutive pediatric patients (71 boys and 77 girls; mean age, 11.1 years; age range, 8 days-17.9 years) were identified between September 2012 and March 2015. Mechanical administration of contrast material was performed in 117 patients (79.1%; mean age [± SD], 13.7 ± 3.7 years), and hand administration of contrast material was performed in 31 patients (20.9%; mean age, 1.6 ± 1.8 years). After adjusting for age, the degree of enhancement within the pulmonary arteries was not statistically different between the two IV contrast administration methods at the main pulmonary artery (mechanical vs hand administration: mean attenuation, 310 ± 128 vs 338 ± 142 HU, respectively, p = 0.505), right pulmonary artery (305 ± 124 vs 329 ± 146 HU, p = 0.556), and left pulmonary artery (303 ± 125 vs 340 ± 151 HU, p = 0.349).
  
  
  CONCLUSIONS
  It is possible to perform diagnostic-quality pulmonary CTA for the assessment of the central pulmonary arteries with hand administration of IV contrast material in pediatric patients with small-gauge IV catheters.
authors.affiliation: 1 Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA.|2 Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St, San Francisco, CA 94158.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Zapala
authors.affiliation: 3 Department of Anesthesiology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: 1 Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014652:Vascular Diseases / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media
keywords: bolus tracking; children; hand injection; mechanical injection; pulmonary CT angiography