Computed tomography and magnetic resonance imaging contrast media injectors: technical feature review – what is really needed?

Figures & data

Figure 1 Typical syringe and tubing set for CT/MRI contrast media injection.

Notes: The syringes are specified for single use, but often employed for multiple patients, despite potential hygienic issues. The tubing has to be changed for every patient (left: Medtron; right: Medrad).
Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.

Figure 2 CT dual volume injector using bottles instead of syringes.

Note: CT Expres, Bracco Injeneering, Lausanne, Switzerland.
Abbreviation: CT, computed tomography.

Figure 3 Single head injector for CT injections with injector head, syringe, and the control computer system.

Note: APO100 CT Injector, Apollo RT, Hong Kong, People’s Republic of China.
Abbreviation: CT, computed tomography.

Figure 4 Effect of MRI contrast agent.

Note: T1-weighted images; left image without, right image with contrast medium administration show defect of the blood–brain barrier after stroke. Reproduced from wikimedia.org (http://creativecommons.org/licenses/by-sa/3.0/).¹⁰
Abbreviation: MRI, magnetic resonance imaging.

Table 1 MRI contrast media injection protocols – standard contrast media volume and standard flow rate for all manufacturers – only 1 or 2 mL/s flow rates are recommended

Manufacturer	Body weight (mmol/kg, intravenous)	Body weight (mL/kg)	Flow rate (mL/s)	Reference
Magnevist (Bayer AG, Leverkusen, Germany)	0.1	0.2–0.4	1–2	^Citation12
Dotarem (Guerbet, Villepinte, France)	0.1	0.2	1–2	^Citation13
Multihance (Bracco Injeneering, Lausanne, Switzerland)	0.1	0.2	2	^Citation14
Omniscan (GE Healthcare Inc., Princeton, NJ, USA)	0.1	0.2	2	^Citation15

Abbreviation: MRI, magnetic resonance imaging.

Table 2 MRI CMI manufacturers and some important specifications

MRI CMI (Reference)	Ulrich^Citation17	Medtron^Citation18	Nemoto^Citation19	Medrad^Citation20	Bracco^Citation21
Compatible up to X T magnetic field	3	3	3	3	7 (9.4)^Citation22
Weight of injector head (kg)	35	30	10	30	7
Battery for injector head required	No	Yes	No	Yes	No
Number of total components	3	2	3	2	3
Proprietary consumables	No	Yes	Yes	Yes	Yes
Contrast media volume (mL)	Bottles (2×100)	65	100	65	50
Saline volume (mL)	Bottles (1,000)	65	100	115	100
Prefilled syringes available	Bottles	Yes	Yes	No	No
Injector drive technology	Roller/peristaltic	Electromechanic	Ultrasonic	Electromechanic	Hydraulic

Notes: Weight is important as it is a safety and handling issue. Battery-operated systems need to be recharged and systems that are conventionally powered need an electric outlet in the MRI suite.

Abbreviations: CMI, contrast media injector; MRI, magnetic resonance imaging.

Figure 5 Magnetic Resonance CMI operating at magnetic field strength of up to 9.4 T due to a hydraulic drive.

Note: For other ultra-high field MRI issues see Scannexus.²²
Abbreviation: CMI, contrast media injector.

Figure 6 3 T MRI systems – oxygen tank was pulled into the magnet.

Notes: The MRI injector on the left was not a problem being located at ~0.5 m from the magnet bore. For further details on MRI related accidents see MRI patient safety blog.²⁹
Abbreviation: MRI, magnetic resonance imaging.

Table 3 What is really needed and what is optional for a CT/MRI power injector?

	Must have	Should have	Nice to have	Not needed
CT injectors	Dual volume injection 3 and 5 mL/s flow rate CMV >150 mL SV >150 mL Data on CMV and SV injection, including date and time (forensic) Air removal and detection Closed CMV and SV Overpressure detection and automatic shutdown Emergency shutdown button Remote control to start the injection Touch-panel control and/or control PC Portable and/or easily moveable Easy to use and cost-efficient consumables	Multiphase protocols Protocol storage Light weight (<10 kg) and easy to use system Independent power source Extravasation detection 1–7 mL/s in 0.5 mL/s steps KVO Prefilled syringes or larger volume CMV/SV containers	Dual flow (should have with majority cardiac imaging) Remote diagnostics (for remote servicing) RIS/PACS connection Contrast media leak	Prevention of multiuse for single use syringes
MRI injectors	Dual volume injection 1 and 2 mL/s flow rate CMV >25 mL SV >50 mL Data on CMV and SV injection, including date and time (forensic) Air removal and detection Closed CMV and SV Overpressure detection and automatic shutdown Emergency shutdown button Full MRI compatible to at least 3 T Portable and/or easily moveable Easy to use and cost-efficient consumables	Light weight and easy to use system (<10 kg) Independent power source RIS/PACS connection Remote control to start the injection Prefilled syringes or larger volume CMV/SV containers	Multiphase protocols Protocol storage Remote diagnostics (for remote servicing) Touch-panel control or computer control Attachable directly to the magnet or ceiling mounted option	Extravasation detection Contrast media leak detection Prevention of multiuse for single use syringes Integrated infusion pump Two different CM volumes

Abbreviations: CM, contrast media; CT, computed tomography; CMV, contrast media volume; KVO, keep vein open; MRI, magnetic resonance imaging; PC, personal computer; RIS/PACS, Radiology Information Systems/Patient Archival and Communication System; SV, saline volume.

wikimedia.org [webpage on the Internet]Defect of the blood-brain barrier after stroke shown in MRIHellerhoff2010 Available from: https://commons.wikimedia.org/wiki/File:Bluthirnschranke_nach_Infarkt_nativ_und_KM.pngAccessed February 11, 2016

 Google Scholar

emcBayer Magnevist Available from: http://www.medicines.org.uk/EMC/medicine/1825/SPC/Magnevist/Accessed February 2, 2016

 Google Scholar

GuerbetDotarem Available from: http://www.guerbet-us.com/products/dotarem.htmlAccessed February 2, 2016

 Google Scholar

Bracco DiagnosticsMultihance Available from: http://braccoimaging.com/sites/braccoimaging.com/files/technica_sheet_pdf/MultiHance%20Prescribing%20Information.pdfAccessed February 2, 2016

 Google Scholar

GE HealthcareOmniscan Available from: http://www3.gehealthcare.com/en/products/categories/contrast_media/omniscan#tabs/tab488621DA-BE7848C7837C18A88CFE9FFFAccessed February 2, 2016

 Google Scholar

Ulrich Medical3T tennessee Available from: http://www.ulrichmedi-cal.de/de/3t-tennessee.htmlAccessed February 2, 2016

 Google Scholar

MedtronAGAccutron MR3 Available from: http://www.medtron.de/en/magnetic-resonance-imaging/accutron-mr3.htmlAccessed February 2, 2016

 Google Scholar

NemotoSonic Shot 7 Available from: http://www.nemoto-do.co.jp/nemoto_en/pr_mr/moreinfo/ss_7.htmlAccessed February 2, 2016

 Google Scholar

Bayer Vital GmbHMEDRAD® Spectris Solaris™ Available from: http://www.radiologie.bayer.de/medizintechnik/mrt/medrad-solarisAccessed February 2, 2016

 Google Scholar

Bracco Diagnostic IncEmpowerMR Available from: http://brac-coimaging.com/us-en/products-and-solutions/injectors/empowermrAccessed February 2, 2016

 Google Scholar

ScannexusEmpower your MRI research, even at 9.4TMaastricht, the Netherlandsscannexus2014 [May 12]. Available from: http://www.scannexus.nl/news/bericht-quot_empower_your_mri_research__even_at_9_4t_quotAccessed February 3, 2016

 Google Scholar

MRI Patient Safety BlogImplementation > documentation in MRI safety Available from: http://mripatientsafety.com/blog/?p=285Accessed February 4, 2016

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