Food and Drug Administration for enteric use and are commonly used in adults for abdominal CT. As such, the potential benefit of enteric contrast media for pediatric abdominal CT studies generally outweighs the small potential risk from any marginal increase in radiation dose.ĭilute high-osmolar contrast media (HOCM) such as diatrizoate meglumine (Gastrografin, Bracco Diagnostics Gastro-view, Covidien) are approved by the U.S.

In our opinion, enteric contrast media can facilitate certain image diagnoses while maintaining lower radiation doses for pediatric patients. Second, images obtained at low-kilovoltage settings are more susceptible to streak and beam hardening artifact and should be limited to small patients to avoid tube-peaking. First, a noise limit exists where improvements in image contrast do not improve image quality for small structures, which can be masked by image noise. This approach comes with several important caveats. Image contrast can be improved further with low-kilovoltage imaging (e.g., 80–100 kV), particularly in smaller patients. This improved contrast potentially affords a decrease in patient radiation dose because image noise can be increased while maintaining the contrast-to-noise ratio. The presence of enteric contrast media inherently increases subject contrast due to increased overlap of the CT energy spectrum and the k edge of iodine and barium. However, the resulting modest radiation dose increase is similar to other sources of variation in AEC algorithms, such as patient positioning, number of localizer images, and localizer technical factors.

As a result, studies have shown that the presence of attenuating enteric contrast media can cause a nominal increase in prescribed tube current compared with an unenhanced scan when automated exposure control (AEC) is used. Iodine and barium have relatively large atomic numbers of 53 and 56, respectively, which result in an increase in the photoelectric effect when imaging with CT, substantially increasing the linear attenuation coefficient of the target tissues.

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