This month we have been asked to address a late-breaking topic and will be welcoming one of our radiology colleagues Dr. Anthony Trace who will assist us in helping to navigate selective use of unenhanced abdominal/pelvic CTs in the context of the national IV contrast shortage. The 64-slice CT certainly improved diagnostic accuracy however, there have been few prospective studies that compared IV contrast and non-contrast enhanced CT’s for abdominal and pelvic pathologies. The current Clinical Appropriateness Guidelines recommends IV contrast in a majority of vascular, gastrointestinal, infectious, malignant and visceral pathologies. Little did they anticipate our current “crisis”.  We did our very best to find articles that are worthy of your review. More importantly, we welcome having an informed discussion regarding how to make safe adjustments in our testing thresholds for omitting IV contrast while minimizing any patient harms from missed diagnoses.  Hope to see you there! Charlie 

Payor A et al. Efficacy of Noncontrast Computed Tomography of the Abdomen and Pelvis for Evaluating Nontraumatic Acute Abdominal Pain in the Emergency Department  J Emerg Med. 2015 Dec;49(6):886-92. Appraisal

 Thorisson A et al. Diagnostic accuracy of acute diverticulitis with unenhanced low-dose CT. BJS Open. 2020 Aug;4(4):659-665. Appraisal

Rud B et al. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev. 2019 Nov 19;2019(11) Appraisal