Proactive Air Management in CT Power Injections: A Comprehensive Approach to Reducing Air Embolization

Objective: Venous air embolism as a complication of contrast media administration from power injection systems in CT is found to occur in 7%-55% of patients, impacting patient safety, diagnostic image quality, workflow efficiency, and patient and radiographer satisfaction. This study reviews the challenges associated with reactive air management approaches employed on contemporary systems, proposes a novel air management approach using proactive methods, and compares the impact of reactive and proactive approaches on injected air volumes under simulated clinical use. Methods: Injected air volumes from three power injection systems were measured under simulated clinical use via custom air trap fixture. Two of the systems employed reactive air management approaches, while a new system implemented the proposed proactive air management approach. Results: The proactive system injected significantly less air (average of 0.005 mL ± 0.006 mL with a maximum of 0.017 mL) when compared to two systems with reactive approaches (averages of 0.130 mL ± 0.082 mL and 0.106 mL ± 0.094 mL with maximums of 0.259 mL and 0.311 mL, respectively) (p <; 0.05). CT images were taken of static and dynamic 0.1 mL air bubbles inside of a vascular phantom, both of which were clearly visible. Additionally, the dynamic bubble was shown to introduce image artifacts similar to those observed clinically. Conclusion: Comparison of the injected air volumes show that a system with a proactive air management approach injected significantly less air compared to tested systems employing reactive approaches. Significance: The results indicate that the use of a proactive approach could significantly reduce the prevalence of observable, and potentially artifact-inducing, venous air embolism in contrast-enhanced CT procedures.