The use of intraosseous needles for injection of contrast media for computed tomographic angiography of the thoracic aorta.
BACKGROUND
The objective of this study is to evaluate the safety and quality of computed tomographic angiography of the thoracic aorta (CTA-TA) exams performed using intraosseous needle intravenous access (ION-IVA) for contrast media injection (CMI).


METHODS
All CTA-TA exams at the study institution performed between 1/1/2013 and 8/14/2015 were reviewed retrospectively to identify those exams which had been performed using ION-IVA (ION-exams). ION-exams were then analyzed to determine aortic attenuation and contrast-to-noise ratio (CNR). Linear regression was used to determine how injection rate and other variables affected image quality for ION-exams. Patient electronic medical records were reviewed to identify any adverse events related to CTA-TA or ION-IVA.


RESULTS
17 (∼0.2%) of 7401 exams were ION-exams. ION-exam CMI rates varied between 2.5 and 4 ml/s. Mean attenuation was 312 HU (SD 88 HU) and mean CNR was 25 (SD 9.9). A strong positive linear association between attenuation and injection rate was found. No immediate or delayed complications related to the ION-exams, or intraosseous needle use in general, occurred.


CONCLUSIONS
For CTA-TA, ION-IVA appears to be a safe and effective route for CMI at rates up to 4 ml/s.
Department of Radiology, University of Kentucky, Lexington, KY, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA. Electronic address: michael.winkler@uky.edu.
Michael
M
Winkler
Department of Surgery, University of Kentucky, Lexington, KY, USA.
Cynthia
C
Talley
Department of Radiology, University of Kentucky, Lexington, KY, USA.
Connor
C
Woodward
Department of Radiology, University of Kentucky, Lexington, KY, USA.
Alexander
A
Kingsbury
Department of Radiology, University of Kentucky, Lexington, KY, USA.
Frank
F
Appiah
Department of Radiology, University of Kentucky, Lexington, KY, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
Hossam
H
Elbelasi
Department of Radiology, University of Kentucky, Lexington, KY, USA.
Kevin
K
Landwher
Department of Radiology, University of Kentucky, Lexington, KY, USA.
Xingzhe
X
Li
Department of Radiology, Stanford University, Stanford, CA, USA.
Dominik
D
Fleischmann
D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001027:Aortography / Q000295:instrumentation* / Q000379:methods; D000072226:Computed Tomography Angiography / Q000295:instrumentation*; D003287:Contrast Media / Q000008:administration & dosage*; D004867:Equipment Design; D006801:Humans; D007275:Injections, Intravenous; D009339:Needles; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D059629:Signal-To-Noise Ratio
D003287:Contrast Media
Angiography; Computed tomography; Contrast media; Emergency radiology; Injection; Intraosseous needle; Thoracic aorta; Traumatic aortic injury