Beyond Guesswork: Addressing the Wide Variability in Pediatric Iodinated Contrast Media Delivery from an International Perspective

Beyond Guesswork: Addressing the Wide Variability in Pediatric Iodinated Contrast Media Delivery from an International Perspective | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond Guesswork: Addressing the Wide Variability in Pediatric Iodinated Contrast Media Delivery from an International Perspective Mohamed Zakaria El-Sayed, Mohammad Rawashdeh, Magdi A. Ali, Zakaria Bouhssine, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6931365/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Oct, 2025 Read the published version in Pediatric Radiology → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Radiographers play a crucial role in ensuring the safe and effective delivery of iodinated contrast media (ICM) in pediatric CT imaging. However, practice variability across institutions raises concerns about consistency, patient safety, and diagnostic quality. This study examines the range of real-world practices in pediatric ICM administration, focusing on protocol adherence and variations in technique. Methods: An international cross-sectional survey was conducted among 103 CT radiographers. The online questionnaire assessed demographic data, clinical practices, protocol modification behaviors, and institutional procedures. Data were collected over a nine-week period and analyzed using descriptive and comparative statistics to identify trends and practice variability. Results: The findings revealed considerable variability in ICM administration practices, including differences in injection rates, contrast volumes, catheter gauge selection, and use of saline flush techniques. Although 93.2% of participants reported confidence in modifying contrast protocols, knowledge assessments showed that 75.7% of radiographers scored in the "Poor" category, with no participants achieving an "Excellent" score. Additionally, many respondents reported relying on experience-based practices rather than standardized institutional guidelines, contributing to inconsistent contrast delivery approaches. No significant associations were found between demographic factors and reported practices, suggesting variability exists across all levels of education and experience. Conclusion: The study highlights inconsistencies in pediatric ICM delivery practices among CT radiographers, emphasizing the need for standardized protocols and structured training programs. Addressing these inconsistencies is crucial for improving diagnostic quality, patient safety, and promoting consistency in best practices across clinical settings. Pediatric CT Iodinated contrast media (ICM) Introduction Iodinated contrast media (ICM) enhance the visualization of anatomical structures and pathological conditions during computed tomography (CT) ( 1 ). While the clinical benefits of ICM are well established, ensuring safe and effective administration requires more than theoretical knowledge. It demands the consistent application of evidence-based practices, adherence to clinical protocols, and technical adjustments tailored to patient-specific needs ( 2 , 3 ). Pediatric imaging presents additional complexities due to the distinct anatomical and physiological characteristics of children, which necessitate highly individualized contrast administration strategies to optimize diagnostic outcomes while minimizing potential risks ( 4 ). Pediatric patients are particularly vulnerable to contrast-related complications, such as nephrotoxicity and extravasation, owing to their smaller vessel size, immature renal function, and variable metabolic profiles ( 5 ). Although weight-based dosing is commonly employed, its success relies on precise applications that account for factors such as lean body weight, injection rates, catheter size, and iodine delivery rate (IDR) ( 6 ). Failure to correctly apply these parameters can compromise image quality, diagnostic accuracy, and patient safety ( 7 , 8 ). Emerging technologies such as low-kVp imaging, iterative reconstruction with AI, bolus tracking, and saline chaser techniques offer opportunities to optimize contrast administration by reducing both iodine volume and radiation exposure without compromising image quality ( 9 – 11 ). However, the successful adoption of these methods depends on the availability of standardized practice guidelines, staff training, and institutional commitment to protocol enforcement. Additionally, the 2022 global ICM shortage highlighted the urgent need for resource-efficient practices, including the use of multi-dose vials, contrast volume reduction strategies, and sustainable waste management, to maintain clinical operations during supply constraints ( 9 – 11 ). Despite advancements in both technology and best practice recommendations, growing evidence suggests that radiographers' application of these practices remains inconsistent. Prior studies have identified variability in contrast administration techniques among less experienced radiographers, particularly in adult imaging contexts ( 9 ), yet limited research has explored how these inconsistencies affect pediatric imaging practices. Existing literature has primarily focused on risk management and adverse event prevention, with limited attention to the day-to-day operational practices that influence diagnostic quality and patient safety in pediatric CT ( 6 , 12 – 15 ). This study aims to investigate real-world practices, protocol adherence, and clinical decision-making behaviors among radiographers who administer ICM in pediatric CT imaging. By examining current patterns of practice, identifying barriers to guideline compliance, and documenting variability in technique, this research aims to inform the development of standardized, evidence-based protocols. Ultimately, these efforts are intended to support safer, more consistent, and more resource-conscious ICM administration in pediatric clinical practice. Methods Ethical Approval and Data Protection Approval of this study was granted by the XXXX Institutional Review Board (XXXX). All participants were provided with detailed information regarding the study’s purpose and procedures prior to participation, and digital informed consent was obtained. No personal identifiers, such as names or contact information, were collected to protect participant anonymity. Data collection was carried out between January 10 and March 20, 2025. All responses were anonymized and securely stored in an encrypted digital repository accessible only to the research team. Study Participants and Recruitment The target population consisted of international, licensed CT radiographers with active clinical roles in various healthcare institutions. Eligibility required participants to be currently practicing in CT imaging. Individuals who were not actively working in the field or who were outside the radiography profession were excluded. A voluntary participation approach was used, and respondents were recruited through digital channels, including professional mailing lists, social media (LinkedIn, Facebook, WhatsApp), and institutional networks. A snowball sampling strategy was employed to expand reach, encouraging initial participants to forward the survey to qualified colleagues. Participation rates were monitored in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) standards for online survey reporting ( 16 ). Survey Design and Content The data collection tool was an online questionnaire created using Google Forms. Its development was informed by a review of recent literature on pediatric CT practices and the administration of ICM ( 6 , 9 , 10 , 17 ). The questionnaire was divided into key sections covering demographic and professional background, routine clinical practices related to ICM delivery in pediatric CT, decision-making and protocol modification behaviors, as well as institutional policies and training experiences. The survey remained open for several weeks, and all questions were designed to ensure clarity and reduce response bias. Validation and Reliability Procedures A two-stage validation process was implemented. Initially, three academic experts in radiology, each with over 20 years of experience, reviewed the draft questionnaire to ensure relevance, clarity, and structure. Following their recommendations, the survey was refined and reassessed two weeks later by the same panel. Subsequently, face validity was evaluated by five practicing CT radiographers to confirm content clarity and applicability. Both the Content Validity Index and Face Validity Index exceeded 0.84, indicating high validity. Technical measures, such as IP address filtering and response review prompts, were built into the survey platform to prevent duplicate submissions and ensure data completeness. To evaluate reliability, a subset of three radiographers completed the survey twice, two weeks apart. The resulting Pearson correlation coefficient of 0.83 indicated strong test-retest reliability, in line with established benchmarks ( 18 ). These participants were excluded from the main study sample to maintain data integrity. Statistical Analysis Survey responses were exported into IBM SPSS Statistics Version 25.0 (IBM Corp., Armonk, NY, USA) for statistical processing. The Kolmogorov-Smirnov test was performed to evaluate the distribution of continuous variables. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participants’ demographic profiles and reported clinical practices. Clinical practice behavior was assessed by analyzing responses related to contrast injection rates, contrast volumes, catheter selections, and protocol modification behaviors across different pediatric CT procedures. Trends and practice variations were examined descriptively across demographic subgroups, including education level, professional experience, and country of practice. Chi-square (χ²) tests were conducted to explore relationships between reported practices and categorized knowledge levels. A significant threshold of p < 0.05 was used to interpret statistical results. Findings are presented as frequencies and percentages to illustrate the distribution of practices across the study population. Results A total of 103 CT radiographers from various international institutions participated in this study. Regarding educational attainment, 17.5% held a diploma, 57.3% had a bachelor’s degree, 19.4% held a master’s degree, and 5.8% held a PhD in radiography. In terms of professional experience, 26.2% had less than three years of practice, another 26.2% had between three and seven years, while 47.6% reported having more than seven years of experience. Participants represented 14 countries, with Egypt and the United Arab Emirates accounting for the largest groups, each representing 22.3% of the sample. Other represented countries included India (12.6%), Chile (6.8%), the United Kingdom (6.8%), Palestine (5.8%), Sudan (4.9%), Bangladesh (3.9%), Lebanon (3.9%), Pakistan (3.9%), Jordan (1.0%), Peru (1.9%), the Philippines (1.9%), and Portugal (1.9%). When asked about their workload, the majority (88.3%) reported performing between one and five pediatric contrast-enhanced CT scans per day, while 4.9% performed between six and ten cases daily, and 6.8% reported handling more than ten cases per day. Regarding specialized training, 41.7% of participants indicated they had received additional training or certification in ICM delivery beyond their initial education, while 58.3% had not. Institutional policy varied, with 61.2% of participants reporting that radiographer approval was required for pediatric CT ICM administration, compared to 38.8% who reported no such requirement. In terms of protocol modification behaviors, 62.1% of participants reported adjusting protocols based on patient weight, 54.4% based on age, and 37.9% based on both height and weight. Additionally, 26.2% reported modifying protocols based on body surface area, while 37.9% considered iodine delivery rate in their adjustments. The evaluation of participants’ knowledge on pediatric ICM delivery demonstrated an overall low level of performance. None of the participants attained an “Excellent” score (> 90%), while only 1.9% achieved a “Very Good” score (80–90%). Additionally, 4.9% of participants were classified within the “Good” category (70–79%), and 17.5% attained a “Fair” score (60–69%). Notably, the majority (75.7%) were classified in the “Poor” category, with scores falling below 60%. The mean knowledge score was 50.13% (SD ± 14.36), with individual scores ranging from 17–83%. The median score was 50% (IQR 42–58), corresponding to an average of 12 correct responses out of a possible 24, indicating a substantial knowledge gap across the participant group. In terms of reported clinical practice behaviors, considerable variability was observed across ICM injection parameters in pediatric CT procedures. For head CT, the most reported injection rate was 2.0 mL/s (40.8%), while 1.0 mL/s was the most frequent for neck CT (41.7%). For chest CT and abdomen/pelvis CT, 2.0 mL/s was the most reported rate by 47.6% and 49.5% of respondents, respectively. Peripheral CTA procedures were most frequently used at 2.0 mL/s (37.9%), while pulmonary CTA was most often performed at 3.0 mL/s (35.9%). The Neuro CTA showed a split between 2.0 mL/s and 3.0 mL/s, both of which were reported by 31.1% of respondents. Most participants (90.3%) confirmed the use of a saline bolus after contrast administration. Regarding IV gauge preferences, 22G catheters were mostly used for power injection (38.8%). Maximum injection rates varied by catheter size, with higher rates (≥ 5.0 cc/sec) most frequently used for 16G catheters (53.4%). Lower injection rates were preferred for smaller gauges, including 2.0 cc/sec for 22G (39.8%) and 24G (34.0%). In contrast, manual injection was predominantly reported for 26G (44.7%) Preferred contrast delay times for pediatric head and neck CT were most reported as 15–20 seconds (35.0%). For contrast dosing, 1–1.5 mL/kg was the most widely used volume for head and neck CTA (48.5%), while 2–2.5 mL/kg was most frequently used for chest CTA (47.6%) (Table 1 ). Table (1): Distribution of the participants according to Clinical Practice (n = 103) Table 1 presents the distribution of the participants (n = 103) based on their clinical practice characteristics. Clinical practices No. (%) What is the typical IV contrast media injection rate used in your department for pediatric head CT studies? 0.5 mL/s 14 (13.6%) 1.0 mL/s 38 (36.9%) 2.0 mL/s 42 (40.8%) 3.0 mL/s 8 (7.8%) > 3.0 mL/s 1 (1.0%) What is the typical IV contrast media injection rate used in your department for pediatric Neck CT studies? 0.5 mL/s 9 (8.7%) 1.0 mL/s 43 (41.7%) 2.0 mL/s 37 (35.9%) 3.0 mL/s 11 (10.7%) > 3.0 mL/s 3 (2.9%) What is the typical IV contrast media injection rate used in your department for pediatric Chest CT studies? 0.5 mL/s 7 (6.8%) 1.0 mL/s 38 (36.9%) 2.0 mL/s 49 (47.6%) 3.0 mL/s 7 (6.8%) > 3.0 mL/s 2 (1.9%) What is the typical IV contrast media injection rate used in your department for pediatric abdomen/pelvis CT studies? 0.5 mL/s 8 (7.8%) 1.0 mL/s 28 (27.2%) 2.0 mL/s 51 (49.5%) 3.0 mL/s 14 (13.6%) > 3.0 mL/s 2 (1.9%) What is the typical IV contrast media injection rate used in your department for pediatric peripheral CTA studies? 0.5 mL/s 5 (4.9%) 1.0 mL/s 19 (18.4%) 2.0 mL/s 39 (37.9%) 3.0 mL/s 30 (29.1%) > 3.0 mL/s 10 (9.7%) What is the typical IV contrast media injection rate used in your department for pulmonary CTA studies? 0.5 mL/s 5 (4.9%) 1.0 mL/s 14 (13.6%) 2.0 mL/s 30 (29.1%) 3.0 mL/s 37 (35.9%) > 3.0 mL/s 17 (16.5%) What is the typical IV contrast media injection rate used in your department for neuro CTA studies? 0.5 mL/s 3 (2.9%) 1.0 mL/s 20 (19.4%) 2.0 mL/s 32 (31.1%) 3.0 mL/s 32 (31.1%) > 3.0 mL/s 16 (15.5%) In the context of CT studies with a power injector, do you usually administer a saline bolus after every IV contrast injection? Yes 93 (90.3%) No 10 (9.7%) Using a power injector, what is the smallest gauge peripheral IV you would use to inject IV contrast? 18G 11 (10.7%) 20G 22 (21.4%) 22G 40 (38.8%) 24G 21 (20.4%) 26G 9 (8.7%) What is the maximum power injection rate for a 16-gauge angiocatheter in your department? Manual injection only 4 (3.9%) 1.0 cc/sec 7 (6.8%) 2.0 cc/sec 9 (8.7%) 3.0 cc/sec 13 (12.6%) 4.0 cc/sec 15 (14.6%) 5.0 cc/sec or greater 55 (53.4%) What is the maximum power injection rate for an 18-gauge angiocatheter in your department? Manual injection only 5 (4.9%) 1.0 cc/sec 2 (1.9%) 2.0 cc/sec 13 (12.6%) 3.0 cc/sec 16 (15.5%) 4.0 cc/sec 35 (34.0%) 5.0 cc/sec or greater 32 (31.1%) What is the maximum power injection rate for a 20-gauge angiocatheter in your department? Manual injection only 4 (3.9%) 1.0 cc/sec 8 (7.8%) 2.0 cc/sec 15 (14.6%) 3.0 cc/sec 44 (42.7%) 4.0 cc/sec 26 (25.2%) 5.0 cc/sec or greater 6 (5.8%) What is the maximum power injection rate for a 22-gauge angiocatheter in your department? Manual injection only 5 (4.9%) 1.0 cc/sec 10 (9.7%) 2.0 cc/sec 41 (39.8%) 3.0 cc/sec 35 (34.0%) 4.0 cc/sec 7 (6.8%) 5.0 cc/sec or greater 5 (4.9%) What is the maximum power injection rate for a 24-gauge angiocatheter in your department? Manual injection only 21 (20.4%) 1.0 cc/sec 30 (29.1%) 2.0 cc/sec 35 (34.0%) 3.0 cc/sec 9 (8.7%) 4.0 cc/sec 2 (1.9%) 5.0 cc/sec or greater 6 (5.8%) What is the maximum power injection rate for a 26-gauge angiocatheter in your department? Manual injection only 46 (44.7%) 1.0 cc/sec 24 (23.3%) 2.0 cc/sec 11 (10.7%) 3.0 cc/sec 8 (7.8%) 4.0 cc/sec 4 (3.9%) 5.0 cc/sec or greater 10 (9.7%) What is the preferred delay time post-injection for head and neck CT to allow the contrast to reach its plasma peak in pediatrics? 5–10 seconds 30 (29.1%) 15–20 seconds 36 (35.0%) 25–30 seconds 16 (15.5%) 45–60 seconds 21 (20.4%) What volume of ICM concentration do you use for head and neck CTA in pediatrics? 1–1.5 mL/kg 50 (48.5%) 2–2.5 mL/kg 35 (34.0%) 3–3.5 mL/kg 15 (14.6%) 4–5 mL/kg 3 (2.9%) What volume of ICM concentration do you use for chest CTA in pediatrics? 1–1.5 mL/kg 41 (39.8%) 2–2.5 mL/kg 49 (47.6%) 3–3.5 mL/kg 10 (9.7%) 4–5 mL/kg 3 (2.9%) When comparing knowledge levels with reported clinical practices, no statistically significant associations were identified across all assessed parameters (p > 0.05), indicating that practice variability exists independently of knowledge performance (Table 2 ). Table (2 ): Relation between Categorization of Knowledge with Clinical practices (n = 103) Table 2 presents the relationship between knowledge categories and clinical practice among the participants (n = 103). Clinical practices Categorization of Knowledge χ 2 MC p Very Good (80–90%) (n = 2) Good (70–79%) (n = 5) Fair (60–69%) (n = 18) Poor ( 3.0 mL/s 0 (0.0%) 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 4 (80.0%) 1 (20.0%) 0 (0.0%) 0 (0.0%) 3 (16.7%) 7 (38.9%) 7 (38.9%) 1 (50.0%) 0 (0.0%) 11 (14.1%) 26 (33.3%) 34 (43.6%) 6 (7.7%) 1 (1.3%) 11.975 0.592 What is the typical IV contrast media injection rate used in your department for pediatric Neck CT studies? 0.5 mL/s 1.0 mL/s 2.0 mL/s 3.0 mL/s > 3.0 mL/s 0 (0.0%) 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 2 (40.0%) 3 (60.0%) 0 (0.0%) 0 (0.0%) 2 (11.1%) 10 (55.6%) 6 (33.3%) 0 (0.0%) 0 (0.0%) 7 (9.0%) 30 (38.5%) 28 (35.9%) 10 (12.8%) 3 (3.8%) 9.985 0.635 What is the typical IV contrast media injection rate used in your department for pediatric Chest CT studies? 0.5 mL/s 1.0 mL/s 2.0 mL/s 3.0 mL/s > 3.0 mL/s 0 (0.0%) 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 2 (40.0%) 3 (60.0%) 0 (0.0%) 0 (0.0%) 1 (5.6%) 8 (44.4%) 7 (38.9%) 1 (5.6%) 1 (5.6%) 6 (7.7%) 27 (34.6%) 39 (50.0%) 5 (6.4%) 1 (1.3%) 10.883 0.602 What is the typical IV contrast media injection rate used in your department for pediatric abdomen/pelvis CT studies? 0.5 mL/s 1.0 mL/s 2.0 mL/s 3.0 mL/s > 3.0 mL/s 0 (0.0%) 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 2 (40.0%) 3 (60.0%) 0 (0.0%) 0 (0.0%) 2 (11.1%) 5 (27.8%) 10 (55.6%) 1 (5.6%) 0 (0.0%) 6 (7.7%) 20 (25.6%) 38 (48.7%) 12 (15.4%) 2 (2.6%) 9.103 0.792 What is the typical IV contrast media injection rate used in your department for pediatric peripheral CTA studies? 0.5 mL/s 1.0 mL/s 2.0 mL/s 3.0 mL/s > 3.0 mL/s 0 (0.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 4 (80.0%) 1 (20.0%) 0 (0.0%) 0 (0.0%) 4 (22.2%) 6 (33.3%) 7 (38.9%) 1 (5.6%) 5 (6.4%) 15 (19.2%) 28 (35.9%) 22 (28.2%) 8 (10.3%) 8.858 0.728 What is the typical IV contrast media injection rate used in your department for pulmonary CTA studies? 0.5 mL/s 1.0 mL/s 2.0 mL/s 3.0 mL/s > 3.0 mL/s 0 (0.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 2 (40.0%) 2 (40.0%) 1 (20.0%) 0 (0.0%) 2 (11.1%) 6 (33.3%) 7 (38.9%) 3 (16.7%) 5 (6.4%) 12 (15.4%) 21 (26.9%) 28 (35.9%) 12 (15.4%) 6.228 0.964 What is the typical IV contrast media injection rate used in your department for neuro CTA studies? 0.5 mL/s 1.0 mL/s 2.0 mL/s 3.0 mL/s > 3.0 mL/s 0 (0.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 2 (40.0%) 2 (40.0%) 1 (20.0%) 1 (5.6%) 3 (16.7%) 7 (38.9%) 6 (33.3%) 1 (5.6%) 2 (2.6%) 17 (21.8%) 22 (28.2%) 24 (30.8%) 13 (16.7%) 8.792 0.780 In the context of CT studies with a power injector, do you usually administer a saline bolus after every IV contrast injection? Yes No 2 (100.0%) 0 (0.0%) 4 (80.0%) 1 (20.0%) 17 (94.4%) 1 (5.6%) 70 (89.7%) 8 (10.3%) 1.702 0.614 Using a power injector, what is the smallest gauge peripheral IV you would use to inject IV contrast? 18G 20G 22G 24G 26G 0 (0.0%) 0 (0.0%) 1 (50.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 2 (40.0%) 2 (40.0%) 1 (20.0%) 0 (0.0%) 0 (0.0%) 2 (11.1%) 6 (33.3%) 7 (38.9%) 3 (16.7%) 11 (14.1%) 18 (23.1%) 31 (39.7%) 12 (15.4%) 6 (7.7%) 12.293 0.281 What is the maximum power injection rate for a 16-gauge angiocatheter in your department? Manual injection only 1.0 cc/sec 2.0 cc/sec 3.0 cc/sec 4.0 cc/sec 5.0 cc/sec or greater 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (100.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (20.0%) 0 (0.0%) 4 (80.0%) 0 (0.0%) 0 (0.0%) 1 (5.6%) 0 (0.0%) 2 (11.1%) 15 (83.3%) 4 (5.1%) 7 (9.0%) 8 (10.3%) 12 (15.4%) 13 (16.7%) 34 (43.6%) 13.701 0.469 What is the maximum power injection rate for an 18-gauge angiocatheter in your department? Manual injection only 1.0 cc/sec 2.0 cc/sec 3.0 cc/sec 4.0 cc/sec 5.0 cc/sec or greater 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (100.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (20.0%) 0 (0.0%) 1 (20.0%) 3 (60.0%) 0 (0.0%) 0 (0.0%) 1 (5.6%) 1 (5.6%) 8 (44.4%) 8 (44.4%) 5 (6.4%) 2 (2.6%) 11 (14.1%) 15 (19.2%) 24 (30.8%) 21 (26.9%) 13.616 0.589 What is the maximum power injection rate for a 20-gauge angiocatheter in your department? Manual injection only 1.0 cc/sec 2.0 cc/sec 3.0 cc/sec 4.0 cc/sec 5.0 cc/sec or greater 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (100.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 3 (60.0%) 1 (20.0%) 1 (20.0%) 0 (0.0%) 0 (0.0%) 1 (5.6%) 1 (5.6%) 9 (50.0%) 6 (33.3%) 1 (5.6%) 4 (5.1%) 7 (9.0%) 11 (14.1%) 32 (41.0%) 19 (24.4%) 5 (6.4%) 11.725 0.713 What is the maximum power injection rate for a 22-gauge angiocatheter in your department? Manual injection only 1.0 cc/sec 2.0 cc/sec 3.0 cc/sec 4.0 cc/sec 5.0 cc/sec or greater 0 (0.0%) 0 (0.0%) 1 (50.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (40.0%) 2 (40.0%) 1 (20.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (11.1%) 8 (44.4%) 7 (38.9%) 1 (5.6%) 0 (0.0%) 5 (6.4%) 6 (7.7%) 30 (38.5%) 26 (33.3%) 6 (7.7%) 5 (6.4%) 9.682 0.900 What is the maximum power injection rate for a 24-gauge angiocatheter in your department? Manual injection only 1.0 cc/sec 2.0 cc/sec 3.0 cc/sec 4.0 cc/sec 5.0 cc/sec or greater 0 (0.0%) 1 (50.0%) 0 (0.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 2 (40.0%) 2 (40.0%) 1 (20.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 4 (22.2%) 6 (33.3%) 8 (44.4%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 15 (19.2%) 21 (26.9%) 26 (33.3%) 9 (11.5%) 1 (1.3%) 6 (7.7%) 15.709 0.364 What is the maximum power injection rate for a 26-gauge angiocatheter in your department? Manual injection only 1.0 cc/sec 2.0 cc/sec 3.0 cc/sec 4.0 cc/sec 5.0 cc/sec or greater 1 (50.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 5 (100.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 9 (50.0%) 6 (33.3%) 2 (11.1%) 0 (0.0%) 0 (0.0%) 1 (5.6%) 31 (39.7%) 18 (23.1%) 9 (11.5%) 8 (10.3%) 3 (3.8%) 9 (11.5%) 13.842 0.462 What is the preferred delay time post-injection for head and neck CT to allow the contrast to reach its plasma peak in pediatrics? 5–10 seconds 15–20 seconds 25–30 seconds 45–60 seconds 0 (0.0%) 2 (100.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 3 (60.0%) 2 (40.0%) 0 (0.0%) 3 (16.7%) 8 (44.4%) 2 (11.1%) 5 (27.8%) 27 (34.6%) 23 (29.5%) 12 (15.4%) 16 (20.5%) 10.455 0.190 What volume of ICM concentration do you use for head and neck CTA in pediatrics? 1–1.5 mL/kg 2–2.5 mL/kg 3–3.5 mL/kg 4–5 mL/kg 1 (50.0%) 0 (0.0%) 1 (50.0%) 0 (0.0%) 4 (80.0%) 0 (0.0%) 1 (20.0%) 0 (0.0%) 12 (66.7%) 4 (22.2%) 2 (11.1%) 0 (0.0%) 33 (42.3%) 31 (39.7%) 11 (14.1%) 3 (3.8%) 10.486 0.264 What volume of ICM concentration do you use for chest CTA in pediatrics? 1–1.5 mL/kg 2–2.5 mL/kg 3–3.5 mL/kg 4–5 mL/kg 1 (50.0%) 0 (0.0%) 0 (0.0%) 1 (50.0%) 3 (60.0%) 2 (40.0%) 0 (0.0%) 0 (0.0%) 8 (44.4%) 9 (50.0%) 0 (0.0%) 1 (5.6%) 29 (37.2%) 38 (48.7%) 10 (12.8%) 1 (1.3%) 12.394 0.142 χ 2 : Chi square test MC: Monte Carlo p: p-value for the Relation between Categorization of Knowledge and Clinical practices Discussion This study highlights the considerable variability in pediatric ICM administration practices among radiographers across different institutions globally. Despite the recognized importance of protocol standardization in enhancing patient safety and diagnostic consistency, the findings reveal a wide range of injection rates, contrast volumes, catheter gauge selections, and delay times used in pediatric CT procedures. Such variability suggests the absence of unified practice guidelines and raises concerns about the potential risks of inconsistent ICM administration on diagnostic quality and patient outcomes. The inconsistency observed in clinical practices mirrors the knowledge gaps identified in previous research, where the majority of radiographers demonstrated poor knowledge of pediatric ICM administration despite expressing high confidence in their ability to modify protocols ( 9 ). Similar to earlier findings, this study revealed that while 93.2% of participants reported being comfortable modifying contrast delivery parameters, actual practices varied widely, particularly in the selection of injection rates and contrast volumes. This disconnect between perceived and actual competence has been previously reported as a risk factor for unsafe or suboptimal practice in both pediatric and adult imaging settings ( 19 ). Notably, while low-kVp imaging, saline chaser use, and bolus tracking have been recommended as best practices for reducing contrast volume and improving image quality ( 10 , 11 ), their adoption appeared inconsistent in the reported clinical practices. These findings align with the limited awareness and application of contrast optimization strategies previously identified ( 9 ). This suggests a gap between technological advancements and their routine clinical implementation, potentially due to a lack of formal training or institutional support. Moreover, the study highlights the underutilization of individualized dosing strategies based on body surface area or lean body weight, despite evidence supporting their role in achieving more accurate and safer contrast dosing in pediatric imaging ( 14 , 15 ). The frequent reliance on generalized weight-based dosing without consideration of patient-specific factors such as vessel size or IDR further underscores the need for enhanced training and protocol refinement ( 12 , 20 ). The 2022 global ICM shortage emphasized the importance of adopting resource-efficient practices, including the use of multi-dose vials, reduced contrast protocols, and environmentally sustainable disposal methods ( 3 , 21 ). However, the variability observed in this study suggests that these practices have not been consistently implemented across institutions, reflecting missed opportunities for improving sustainability and supply resilience ( 22 , 23 ). In addition, the study highlights the clinical risks associated with inconsistent power injection parameters, particularly in the selection of maximum injection rates based on catheter size. Incorrect settings may increase the risk of catheter damage, extravasation, or suboptimal vascular enhancement, particularly in smaller pediatric patients with fragile veins. These findings are consistent with previous literature emphasizing the importance of matching injection pressure and flow rates to catheter specifications to prevent mechanical complications ( 24 , 25 ). Furthermore, the finding that many respondents rely on personal or institutional habits rather than established evidence-based protocols suggests that workplace culture influences practice variability. This reinforces the need for leadership engagement and institutional accountability to ensure that best practices are not only developed but also actively implemented and audited. Importantly, the absence of statistically significant associations between knowledge levels and specific clinical practices indicates that variability exists regardless of educational background or years of experience. This finding reinforces previous recommendations that professional expertise alone is insufficient to ensure adherence to best practices ( 9 ). Structured, standardized education and ongoing Continuing Professional Development (CPD) are therefore essential to bridge the gap between knowledge and practice ( 26 , 27 ). Finally, the variability identified in this study may have implications for health equity. Inconsistent practices across institutions and countries could lead to disparities in care quality, particularly in resource-limited settings where access to training and advanced technology may be constrained. This underscores the importance of developing globally applicable guidelines that consider both high-resource and low-resource clinical environments. Ultimately, the study supports calls for the development of pediatric-specific practice guidelines, co-designed by multidisciplinary teams including radiologists, radiographers, and contrast manufacturers ( 24 , 28 ). International collaboration through research networks, webinars, and professional forums is also critical to promote knowledge exchange and drive global improvements in pediatric ICM administration. Based on the variability and risks identified in this study, several strategic recommendations are proposed to advance the standardization and safety of pediatric ICM administration practices in CT imaging. First, healthcare institutions should prioritize the development and enforcement of pediatric-specific contrast administration protocols. These protocols should define standardized parameters for injection rates, contrast volumes, catheter selection, and saline chaser use, tailored to patient size and clinical indication. To be effective, these protocols must be supported by regular staff training, accessible in daily practice, and monitored through routine clinical audits to ensure compliance. Second, mandatory structured training programs should be established at both local and national levels, focusing on advanced contrast delivery techniques such as bolus tracking, IDR optimization, low-kVp imaging, and safe power injector use. These programs should be integrated into both initial radiography education and ongoing CPD requirements to ensure that radiographers maintain current competencies across their careers. Practical, simulation-based training should also be considered to bridge the gap between theoretical knowledge and clinical application. Third, institutional leadership and clinical governance teams should actively support a culture of evidence-based practice, ensuring that radiographers are empowered to question outdated methods and implement best practices. This includes providing access to up-to-date guidelines, mentorship programs, and peer-review mechanisms to foster continuous learning and professional accountability. Fourth, international professional societies and regulatory bodies should collaborate to develop globally applicable pediatric contrast administration benchmarks. These benchmarks should consider the realities of both high-resource and low-resource settings and be disseminated through multi-center collaborations, webinars, and professional conferences to encourage adoption across diverse healthcare environments. Fifth, institutions should adopt resource management strategies that promote ICM conservation and environmental sustainability. This includes transitioning to multi-dose vial systems, reducing unnecessary contrast volumes, and implementing sustainable waste management practices, especially in light of recent global supply chain challenges ( 3 ) ( 21 ). Finally, recognizing the potential for practice variability to contribute to health inequities, efforts should be made to ensure that all radiographers, regardless of geographic location or institutional resources, have equitable access to high-quality training, protocols, and support systems. This global perspective is essential to advancing both clinical consistency and patient safety in pediatric ICM administration worldwide. While this study offers valuable insights into the variability of pediatric CM administration practices, several limitations should be acknowledged. First, reliance on self-reported data introduces the potential for response bias, as participants may overestimate their adherence to best practices or underreport unsafe behaviors. Second, the use of voluntary, convenience sampling through digital platforms may limit the representativeness of the sample, potentially excluding radiographers from regions with limited internet access or those less engaged in professional networks. Third, although this study explored reported practices, it did not directly assess clinical outcomes, such as image quality or patient safety incidents, which would have provided a more objective measure of practice effectiveness. Additionally, institutional variability in resources, technologies, and policies was not fully accounted for, which may have influenced the reported practices. Finally, the cross-sectional design of the study provides a snapshot in time but does not capture longitudinal changes in practice or the impact of recent training initiatives. Future research should include observational studies, clinical audits, and multi-center interventions to validate these findings and explore the direct relationship between practice variability and clinical outcomes. In conclusion, this study highlights the widespread variability in pediatric ICM administration practices among CT radiographers, raising concerns about consistency, patient safety, and diagnostic reliability. Despite high levels of self-reported confidence, the findings demonstrate that many radiographers rely on non-standardized, experience-based practices rather than evidence-based protocols, increasing the risk of suboptimal care. Addressing this variability requires a multi-level approach, including the development of pediatric-specific guidelines, structured training programs, and institutional support for continuous professional development. Additionally, promoting international collaboration and resource-conscious practices is essential to advancing standardization, sustainability, and health equity in pediatric imaging. By prioritizing these actions, healthcare institutions and professional bodies can strengthen the safety, quality, and efficiency of pediatric ICM administration, ultimately improving patient outcomes and operational resilience in both routine and resource-constrained environments. Declarations Funding Declaration This research received no external funding. Author Contribution Mohammad Rawashdeh conceptualized the study, supervised the research design, and provided critical revisions. Magdi A. Ali contributed to methodology development and data validation. Zakaria Bouhssine and Sumayya Monir assisted with data collection and analysis. Reem Mohamed Ali contributed to the literature review and drafting of the manuscript. C. Saade provided expert consultation on international practices and critically reviewed the final manuscript. Daniah Kashabash supported data curation and visual presentation of results. Mohamed Zakaria El-Sayed coordinated the project, led the manuscript writing, and served as the corresponding author. All authors have read and approved the final version of the manuscript. References Parillo M, van der Molen AJ, Asbach P, Elsholtz FHJ, Laghi A, Ronot M, et al. The role of iodinated contrast media in computed tomography structured Reporting and Data Systems (RADS): a narrative review. Quantitative Imaging in Medicine and Surgery. 2023;13(11):7621. Koo JH, Lee M, Kim EH, Oh HJ, Lim JS, Hyung WJ, et al. Harmful effect of repetitive intravenous iodinated contrast media administration on the long-term renal function of patients with early gastric cancer. Scientific reports. 2023;13(1):19448. Amukotuwa SA, Bammer R, Jackson DM, Sutherland T. Iodinated contrast media shortage: Insights and guidance from two major public hospitals. Journal of medical imaging and radiation oncology. 2022;66(7):946-56. Bailliard F, Hughes ML, Taylor AM. Introduction to cardiac imaging in infants and children: techniques, potential, and role in the imaging work-up of various cardiac malformations and other pediatric heart conditions. European Journal of Radiology. 2008;68(2):191-8. Cohen MD. Safe use of imaging contrast agents in children. Journal of the American College of Radiology. 2009;6(8):576-81. Callahan MJ, Servaes S, Lee EY, Towbin AJ, Westra SJ, Frush DP. Practice patterns for the use of iodinated iv contrast media for pediatric CT studies: a survey of the Society for Pediatric Radiology. American journal of roentgenology. 2014;202(4):872-9. Elicker BM, Cypel YS, Weinreb JC. IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. American journal of roentgenology. 2006;186(6):1651-8. Reddan D, Fishman EK. Radiologists’ knowledge and perceptions of the impact of contrast-induced nephropathy and its risk factors when performing computed tomography examinations: a survey of European radiologists. European journal of radiology. 2008;66(2):235-45. Rawashdeh M, Kashabash D, Kumar P, Saade C. The diverse utility of contrast media delivery and dosing during computed tomography: an international assessment of knowledge and practices. Current Radiopharmaceuticals. 2024;17(4):364-70. Zhu S, Zhang B, Tian Q, Li A, Liu Z, Hou W, et al. Reduced-dose deep learning iterative reconstruction for abdominal computed tomography with low tube voltage and tube current. BMC Medical Informatics and Decision Making. 2024;24(1):389. Den Harder AM, Willemink MJ, De Ruiter QM, Schilham AM, Krestin GP, Leiner T, et al. Achievable dose reduction using iterative reconstruction for chest computed tomography: a systematic review. European journal of radiology. 2015;84(11):2307-13. Henning MK, Gunn C, Arenas-Jiménez J, Johansen S. Strategies for calculating contrast media dose for chest CT. European Radiology Experimental. 2023;7(1):29. Aoun J, Nicolas D, Brown JR, Jaber BL. Maximum allowable contrast dose and prevention of acute kidney injury following cardiovascular procedures. Current opinion in nephrology and hypertension. 2018;27(2):121-9. Kessler R, Hegenscheid K, Fleck S, Khaw A, Kirsch M, Hosten N, et al. Patient body weight-tailored contrast medium injection protocol for the craniocervical vessels: a prospective computed tomography study. PloS one. 2014;9(2):e88867. Yanaga Y, Awai K, Nakaura T, Utsunomiya D, Oda S, Hirai T, et al. Contrast material injection protocol with the dose adjusted to the body surface area for MDCT aortography. American Journal of Roentgenology. 2010;194(4):903-8. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Gunther Eysenbach Centre for Global eHealth Innovation, Toronto, Canada; 2004. p. e34. Martens B, Hendriks BM, Eijsvoogel NG, Wildberger JE, Mihl C. Individually body weight–adapted contrast media application in computed tomography imaging of the liver at 90 kVp. Investigative Radiology. 2019;54(3):177-82. Skirrow C, Cashdollar N, Granger K, Jennings S, Baker E, Barnett J, et al. Test-retest reliability on the Cambridge Neuropsychological Test Automated Battery: comment on Karlsen et al.(2020). Applied Neuropsychology: Adult. 2022;29(5):889-92. Jaspan O, Wysocka A, Sanchez C, Schweitzer AD. Improving the relationship between confidence and competence: implications for diagnostic radiology training from the psychology and medical literature. Academic Radiology. 2022;29(3):428-38. Rengo M, Dharampal A, Lubbers M, Kock M, Wildberger JE, Das M, et al. Impact of iodine concentration and iodine delivery rate on contrast enhancement in coronary CT angiography: a randomized multicenter trial (CT-CON). European radiology. 2019;29:6109-18. Cavallo JJ, Pahade JK. Practice management strategies for imaging facilities facing an acute iodinated contrast media shortage. American Journal of Roentgenology. 2022;219(4):666-70. Rawashdeh M, Ali M, McEntee M, El-Sayed M, Saade C, Kashabash D, et al. Green radiography: exploring perceptions, practices, and barriers to sustainability. Radiography. 2024;30:62-73. Rawashdeh M, Ali M, McEntee M, El-Sayed M, Saade C, Kashabash D, et al. Assessment of the role of experience in shaping sustainability perceptions within radiography. Radiography. 2025;31(1):103-11. Beckett KR, Moriarity AK, Langer JM. Safe use of contrast media: what the radiologist needs to know. Radiographics. 2015;35(6):1738-50. Saade C, Deeb IA, Mohamad M, Al-Mohiy H, El-Merhi F. Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know. Diagnostic and interventional Radiology. 2016;22(2):116. Stevens BJ. Radiographers' commitment to continuing professional development: a single-centre evaluation. Radiography. 2016;22(3):e166-e77. Grehan J, Butler M-L, Last J, Rainford L. The introduction of mandatory CPD for newly state registered diagnostic radiographers: An Irish perspective. Radiography. 2018;24(2):115-21. Kahlon P, McCullough K, Gazelle GS. Enhancing patient safety: standardization of CT contrast media practices. Journal of the American College of Radiology. 2009;6(8):562-6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Oct, 2025 Read the published version in Pediatric Radiology → Version 1 posted Editorial decision: Revision requested 05 Aug, 2025 Reviews received at journal 11 Jul, 2025 Reviews received at journal 26 Jun, 2025 Reviewers agreed at journal 26 Jun, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 23 Jun, 2025 Submission checks completed at journal 23 Jun, 2025 First submitted to journal 19 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6931365","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477413682,"identity":"3220a51b-023b-434a-b1f7-7ac96de4a3fd","order_by":0,"name":"Mohamed Zakaria El-Sayed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYDCCA1CCjYH5AMla2BJI1MLAwGNAnA6+2weYP/w4Y5fPx37m86ubbQzy/A3MDx/g0yJ5LoHBsOdGsmUbT+4269w2BsMZB9iM8dpncIaBIYHnA7MBG0PuNmOgFsYNDAxmEoS0HPzzod6Ajf/NM5AW+w0M7N9/ENDC2Mxz47ABm0QO82OglsQNDDxm+HQwSJ5hbGaWOXMcqOWZGXPOOYnkGYd5ivE6jO8M8+GPb45VG8j3Jz/+nFNmY9vf3r7xA15rGBgbYCw2oOFAxIxfPQpgJmD4KBgFo2AUjFQAAAXXR1Utew+BAAAAAElFTkSuQmCC","orcid":"","institution":"Gulf Medical University","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"Zakaria","lastName":"El-Sayed","suffix":""},{"id":477413685,"identity":"075b394d-9b28-415e-b8a6-ce00328ef0be","order_by":1,"name":"Mohammad Rawashdeh","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Rawashdeh","suffix":""},{"id":477413686,"identity":"0787ae0a-ac8c-4412-892a-a562d53be852","order_by":2,"name":"Magdi A. Ali","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Magdi","middleName":"A.","lastName":"Ali","suffix":""},{"id":477413688,"identity":"961ef0d2-af74-465a-90be-56f903b4c707","order_by":3,"name":"Zakaria Bouhssine","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zakaria","middleName":"","lastName":"Bouhssine","suffix":""},{"id":477413689,"identity":"05439984-9720-42e1-b3fc-d7c8e87d4ebf","order_by":4,"name":"Sumayya Monir","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Sumayya","middleName":"","lastName":"Monir","suffix":""},{"id":477413695,"identity":"7deef288-3f57-4283-8db3-34eb6c585061","order_by":5,"name":"Reem Mohamed Ali","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Reem","middleName":"Mohamed","lastName":"Ali","suffix":""},{"id":477413696,"identity":"e58c1e95-7f02-4dd0-ace1-03682bf90391","order_by":6,"name":"Charbel Saade","email":"","orcid":"","institution":"The Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork","correspondingAuthor":false,"prefix":"","firstName":"Charbel","middleName":"","lastName":"Saade","suffix":""},{"id":477413697,"identity":"1aa2f0c7-75a8-44a4-9e2c-80672b727cf6","order_by":7,"name":"Daniah Kashabash","email":"","orcid":"","institution":"Gulf Medical University","correspondingAuthor":false,"prefix":"","firstName":"Daniah","middleName":"","lastName":"Kashabash","suffix":""}],"badges":[],"createdAt":"2025-06-19 12:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6931365/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6931365/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00247-025-06411-2","type":"published","date":"2025-10-29T15:57:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95039913,"identity":"244ff360-1de4-4c74-ade8-6fbfdc7f1d5a","added_by":"auto","created_at":"2025-11-03 16:05:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3031202,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6931365/v1/c1c4472c-b245-46d6-a46c-6b32cf63f884.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond Guesswork: Addressing the Wide Variability in Pediatric Iodinated Contrast Media Delivery from an International Perspective","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIodinated contrast media (ICM) enhance the visualization of anatomical structures and pathological conditions during computed tomography (CT) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). While the clinical benefits of ICM are well established, ensuring safe and effective administration requires more than theoretical knowledge. It demands the consistent application of evidence-based practices, adherence to clinical protocols, and technical adjustments tailored to patient-specific needs (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Pediatric imaging presents additional complexities due to the distinct anatomical and physiological characteristics of children, which necessitate highly individualized contrast administration strategies to optimize diagnostic outcomes while minimizing potential risks (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePediatric patients are particularly vulnerable to contrast-related complications, such as nephrotoxicity and extravasation, owing to their smaller vessel size, immature renal function, and variable metabolic profiles (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Although weight-based dosing is commonly employed, its success relies on precise applications that account for factors such as lean body weight, injection rates, catheter size, and iodine delivery rate (IDR) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Failure to correctly apply these parameters can compromise image quality, diagnostic accuracy, and patient safety (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEmerging technologies such as low-kVp imaging, iterative reconstruction with AI, bolus tracking, and saline chaser techniques offer opportunities to optimize contrast administration by reducing both iodine volume and radiation exposure without compromising image quality (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, the successful adoption of these methods depends on the availability of standardized practice guidelines, staff training, and institutional commitment to protocol enforcement. Additionally, the 2022 global ICM shortage highlighted the urgent need for resource-efficient practices, including the use of multi-dose vials, contrast volume reduction strategies, and sustainable waste management, to maintain clinical operations during supply constraints (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite advancements in both technology and best practice recommendations, growing evidence suggests that radiographers' application of these practices remains inconsistent. Prior studies have identified variability in contrast administration techniques among less experienced radiographers, particularly in adult imaging contexts (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), yet limited research has explored how these inconsistencies affect pediatric imaging practices. Existing literature has primarily focused on risk management and adverse event prevention, with limited attention to the day-to-day operational practices that influence diagnostic quality and patient safety in pediatric CT (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aims to investigate real-world practices, protocol adherence, and clinical decision-making behaviors among radiographers who administer ICM in pediatric CT imaging. By examining current patterns of practice, identifying barriers to guideline compliance, and documenting variability in technique, this research aims to inform the development of standardized, evidence-based protocols. Ultimately, these efforts are intended to support safer, more consistent, and more resource-conscious ICM administration in pediatric clinical practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eEthical Approval and Data Protection\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Approval of this study was granted by the XXXX Institutional Review Board (XXXX). All participants were provided with detailed information regarding the study\u0026rsquo;s purpose and procedures prior to participation, and digital informed consent was obtained. No personal identifiers, such as names or contact information, were collected to protect participant anonymity. Data collection was carried out between January 10 and March 20, 2025. All responses were anonymized and securely stored in an encrypted digital repository accessible only to the research team.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants and Recruitment\u003c/h2\u003e \u003cp\u003eThe target population consisted of international, licensed CT radiographers with active clinical roles in various healthcare institutions. Eligibility required participants to be currently practicing in CT imaging. Individuals who were not actively working in the field or who were outside the radiography profession were excluded. A voluntary participation approach was used, and respondents were recruited through digital channels, including professional mailing lists, social media (LinkedIn, Facebook, WhatsApp), and institutional networks. A snowball sampling strategy was employed to expand reach, encouraging initial participants to forward the survey to qualified colleagues. Participation rates were monitored in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) standards for online survey reporting (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey Design and Content\u003c/h3\u003e\n\u003cp\u003eThe data collection tool was an online questionnaire created using Google Forms. Its development was informed by a review of recent literature on pediatric CT practices and the administration of ICM (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The questionnaire was divided into key sections covering demographic and professional background, routine clinical practices related to ICM delivery in pediatric CT, decision-making and protocol modification behaviors, as well as institutional policies and training experiences. The survey remained open for several weeks, and all questions were designed to ensure clarity and reduce response bias.\u003c/p\u003e\n\u003ch3\u003eValidation and Reliability Procedures\u003c/h3\u003e\n\u003cp\u003eA two-stage validation process was implemented. Initially, three academic experts in radiology, each with over 20 years of experience, reviewed the draft questionnaire to ensure relevance, clarity, and structure. Following their recommendations, the survey was refined and reassessed two weeks later by the same panel. Subsequently, face validity was evaluated by five practicing CT radiographers to confirm content clarity and applicability. Both the Content Validity Index and Face Validity Index exceeded 0.84, indicating high validity.\u003c/p\u003e \u003cp\u003eTechnical measures, such as IP address filtering and response review prompts, were built into the survey platform to prevent duplicate submissions and ensure data completeness. To evaluate reliability, a subset of three radiographers completed the survey twice, two weeks apart. The resulting Pearson correlation coefficient of 0.83 indicated strong test-retest reliability, in line with established benchmarks (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These participants were excluded from the main study sample to maintain data integrity.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eSurvey responses were exported into IBM SPSS Statistics Version 25.0 (IBM Corp., Armonk, NY, USA) for statistical processing. The Kolmogorov-Smirnov test was performed to evaluate the distribution of continuous variables. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participants\u0026rsquo; demographic profiles and reported clinical practices.\u003c/p\u003e \u003cp\u003eClinical practice behavior was assessed by analyzing responses related to contrast injection rates, contrast volumes, catheter selections, and protocol modification behaviors across different pediatric CT procedures. Trends and practice variations were examined descriptively across demographic subgroups, including education level, professional experience, and country of practice. Chi-square (χ\u0026sup2;) tests were conducted to explore relationships between reported practices and categorized knowledge levels. A significant threshold of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used to interpret statistical results. Findings are presented as frequencies and percentages to illustrate the distribution of practices across the study population.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 103 CT radiographers from various international institutions participated in this study. Regarding educational attainment, 17.5% held a diploma, 57.3% had a bachelor\u0026rsquo;s degree, 19.4% held a master\u0026rsquo;s degree, and 5.8% held a PhD in radiography. In terms of professional experience, 26.2% had less than three years of practice, another 26.2% had between three and seven years, while 47.6% reported having more than seven years of experience. Participants represented 14 countries, with Egypt and the United Arab Emirates accounting for the largest groups, each representing 22.3% of the sample. Other represented countries included India (12.6%), Chile (6.8%), the United Kingdom (6.8%), Palestine (5.8%), Sudan (4.9%), Bangladesh (3.9%), Lebanon (3.9%), Pakistan (3.9%), Jordan (1.0%), Peru (1.9%), the Philippines (1.9%), and Portugal (1.9%). When asked about their workload, the majority (88.3%) reported performing between one and five pediatric contrast-enhanced CT scans per day, while 4.9% performed between six and ten cases daily, and 6.8% reported handling more than ten cases per day. Regarding specialized training, 41.7% of participants indicated they had received additional training or certification in ICM delivery beyond their initial education, while 58.3% had not. Institutional policy varied, with 61.2% of participants reporting that radiographer approval was required for pediatric CT ICM administration, compared to 38.8% who reported no such requirement. In terms of protocol modification behaviors, 62.1% of participants reported adjusting protocols based on patient weight, 54.4% based on age, and 37.9% based on both height and weight. Additionally, 26.2% reported modifying protocols based on body surface area, while 37.9% considered iodine delivery rate in their adjustments.\u003c/p\u003e \u003cp\u003eThe evaluation of participants\u0026rsquo; knowledge on pediatric ICM delivery demonstrated an overall low level of performance. None of the participants attained an \u0026ldquo;Excellent\u0026rdquo; score (\u0026gt;\u0026thinsp;90%), while only 1.9% achieved a \u0026ldquo;Very Good\u0026rdquo; score (80\u0026ndash;90%). Additionally, 4.9% of participants were classified within the \u0026ldquo;Good\u0026rdquo; category (70\u0026ndash;79%), and 17.5% attained a \u0026ldquo;Fair\u0026rdquo; score (60\u0026ndash;69%). Notably, the majority (75.7%) were classified in the \u0026ldquo;Poor\u0026rdquo; category, with scores falling below 60%. The mean knowledge score was 50.13% (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;14.36), with individual scores ranging from 17\u0026ndash;83%. The median score was 50% (IQR 42\u0026ndash;58), corresponding to an average of 12 correct responses out of a possible 24, indicating a substantial knowledge gap across the participant group.\u003c/p\u003e \u003cp\u003eIn terms of reported clinical practice behaviors, considerable variability was observed across ICM injection parameters in pediatric CT procedures. For head CT, the most reported injection rate was 2.0 mL/s (40.8%), while 1.0 mL/s was the most frequent for neck CT (41.7%). For chest CT and abdomen/pelvis CT, 2.0 mL/s was the most reported rate by 47.6% and 49.5% of respondents, respectively. Peripheral CTA procedures were most frequently used at 2.0 mL/s (37.9%), while pulmonary CTA was most often performed at 3.0 mL/s (35.9%). The Neuro CTA showed a split between 2.0 mL/s and 3.0 mL/s, both of which were reported by 31.1% of respondents. Most participants (90.3%) confirmed the use of a saline bolus after contrast administration. Regarding IV gauge preferences, 22G catheters were mostly used for power injection (38.8%). Maximum injection rates varied by catheter size, with higher rates (\u0026ge;\u0026thinsp;5.0 cc/sec) most frequently used for 16G catheters (53.4%). Lower injection rates were preferred for smaller gauges, including 2.0 cc/sec for 22G (39.8%) and 24G (34.0%). In contrast, manual injection was predominantly reported for 26G (44.7%) Preferred contrast delay times for pediatric head and neck CT were most reported as 15\u0026ndash;20 seconds (35.0%). For contrast dosing, 1\u0026ndash;1.5 mL/kg was the most widely used volume for head and neck CTA (48.5%), while 2\u0026ndash;2.5 mL/kg was most frequently used for chest CTA (47.6%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(1): Distribution of the participants according to Clinical Practice (n\u0026thinsp;=\u0026thinsp;103)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epresents the distribution of the participants (n\u0026thinsp;=\u0026thinsp;103) based on their clinical practice characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical practices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric head CT studies?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (36.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric Neck CT studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (35.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric Chest CT studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (36.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric abdomen/pelvis CT studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric peripheral CTA studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pulmonary CTA studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (35.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for neuro CTA studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (31.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (31.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIn the context of CT studies with a power injector, do you usually administer a saline bolus after every IV contrast injection?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (90.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUsing a power injector, what is the smallest gauge peripheral IV you would use to inject IV contrast?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 16-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (14.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (53.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for an 18-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (31.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 20-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (14.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 22-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (39.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 24-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 26-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (10.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the preferred delay time post-injection for head and neck CT to allow the contrast to reach its plasma peak in pediatrics?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;20 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;30 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;60 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (20.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat volume of ICM concentration do you use for head and neck CTA in pediatrics?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;1.5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;2.5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;3.5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (14.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat volume of ICM concentration do you use for chest CTA in pediatrics?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;1.5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (39.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;2.5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;3.5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen comparing knowledge levels with reported clinical practices, no statistically significant associations were identified across all assessed parameters (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that practice variability exists independently of knowledge performance (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(2\u003c/b\u003e): Relation between Categorization of Knowledge with Clinical practices (n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epresents the relationship between knowledge categories and clinical practice among the participants (n\u0026thinsp;=\u0026thinsp;103).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClinical practices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eCategorization of Knowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003csup\u003eMC\u003c/sup\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery Good (80\u0026ndash;90%)\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003cp\u003e (70\u0026ndash;79%)\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003cp\u003e(60\u0026ndash;69%)\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePoor (\u0026lt;\u0026thinsp;60%)\u003c/p\u003e \u003cp\u003e (n\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric head CT studies?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (16.7%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (14.1%)\u003c/p\u003e \u003cp\u003e26 (33.3%)\u003c/p\u003e \u003cp\u003e34 (43.6%)\u003c/p\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003cp\u003e1 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.975\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric Neck CT studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e10 (55.6%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (9.0%)\u003c/p\u003e \u003cp\u003e30 (38.5%)\u003c/p\u003e \u003cp\u003e28 (35.9%)\u003c/p\u003e \u003cp\u003e10 (12.8%)\u003c/p\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric Chest CT studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003cp\u003e27 (34.6%)\u003c/p\u003e \u003cp\u003e39 (50.0%)\u003c/p\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003cp\u003e1 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric abdomen/pelvis CT studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e5 (27.8%)\u003c/p\u003e \u003cp\u003e10 (55.6%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003cp\u003e20 (25.6%)\u003c/p\u003e \u003cp\u003e38 (48.7%)\u003c/p\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pediatric peripheral CTA studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e4 (22.2%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003cp\u003e15 (19.2%)\u003c/p\u003e \u003cp\u003e28 (35.9%)\u003c/p\u003e \u003cp\u003e22 (28.2%)\u003c/p\u003e \u003cp\u003e8 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for pulmonary CTA studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e3 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003cp\u003e21 (26.9%)\u003c/p\u003e \u003cp\u003e28 (35.9%)\u003c/p\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the typical IV contrast media injection rate used in your department for neuro CTA studies?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 mL/s\u003c/p\u003e \u003cp\u003e1.0 mL/s\u003c/p\u003e \u003cp\u003e2.0 mL/s\u003c/p\u003e \u003cp\u003e3.0 mL/s\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.0 mL/s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e3 (16.7%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003cp\u003e17 (21.8%)\u003c/p\u003e \u003cp\u003e22 (28.2%)\u003c/p\u003e \u003cp\u003e24 (30.8%)\u003c/p\u003e \u003cp\u003e13 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIn the context of CT studies with a power injector, do you usually administer a saline bolus after every IV contrast injection?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (100.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (94.4%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (89.7%)\u003c/p\u003e \u003cp\u003e8 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUsing a power injector, what is the smallest gauge peripheral IV you would use to inject IV contrast?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18G\u003c/p\u003e \u003cp\u003e20G\u003c/p\u003e \u003cp\u003e22G\u003c/p\u003e \u003cp\u003e24G\u003c/p\u003e \u003cp\u003e26G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e3 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (14.1%)\u003c/p\u003e \u003cp\u003e18 (23.1%)\u003c/p\u003e \u003cp\u003e31 (39.7%)\u003c/p\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 16-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e15 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (5.1%)\u003c/p\u003e \u003cp\u003e7 (9.0%)\u003c/p\u003e \u003cp\u003e8 (10.3%)\u003c/p\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003cp\u003e13 (16.7%)\u003c/p\u003e \u003cp\u003e34 (43.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for an 18-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (100.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003cp\u003e11 (14.1%)\u003c/p\u003e \u003cp\u003e15 (19.2%)\u003c/p\u003e \u003cp\u003e24 (30.8%)\u003c/p\u003e \u003cp\u003e21 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 20-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (100.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e9 (50.0%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (5.1%)\u003c/p\u003e \u003cp\u003e7 (9.0%)\u003c/p\u003e \u003cp\u003e11 (14.1%)\u003c/p\u003e \u003cp\u003e32 (41.0%)\u003c/p\u003e \u003cp\u003e19 (24.4%)\u003c/p\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 22-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003cp\u003e7 (38.9%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003cp\u003e30 (38.5%)\u003c/p\u003e \u003cp\u003e26 (33.3%)\u003c/p\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003cp\u003e5 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 24-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (22.2%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (19.2%)\u003c/p\u003e \u003cp\u003e21 (26.9%)\u003c/p\u003e \u003cp\u003e26 (33.3%)\u003c/p\u003e \u003cp\u003e9 (11.5%)\u003c/p\u003e \u003cp\u003e1 (1.3%)\u003c/p\u003e \u003cp\u003e6 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the maximum power injection rate for a 26-gauge angiocatheter in your department?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual injection only\u003c/p\u003e \u003cp\u003e1.0 cc/sec\u003c/p\u003e \u003cp\u003e2.0 cc/sec\u003c/p\u003e \u003cp\u003e3.0 cc/sec\u003c/p\u003e \u003cp\u003e4.0 cc/sec\u003c/p\u003e \u003cp\u003e5.0 cc/sec or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (100.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (50.0%)\u003c/p\u003e \u003cp\u003e6 (33.3%)\u003c/p\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (39.7%)\u003c/p\u003e \u003cp\u003e18 (23.1%)\u003c/p\u003e \u003cp\u003e9 (11.5%)\u003c/p\u003e \u003cp\u003e8 (10.3%)\u003c/p\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003cp\u003e9 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the preferred delay time post-injection for head and neck CT to allow the contrast to reach its plasma peak in pediatrics?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 seconds\u003c/p\u003e \u003cp\u003e15\u0026ndash;20 seconds\u003c/p\u003e \u003cp\u003e25\u0026ndash;30 seconds\u003c/p\u003e \u003cp\u003e45\u0026ndash;60 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e2 (100.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (16.7%)\u003c/p\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e5 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (34.6%)\u003c/p\u003e \u003cp\u003e23 (29.5%)\u003c/p\u003e \u003cp\u003e12 (15.4%)\u003c/p\u003e \u003cp\u003e16 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat volume of ICM concentration do you use for head and neck CTA in pediatrics?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;1.5 mL/kg\u003c/p\u003e \u003cp\u003e2\u0026ndash;2.5 mL/kg\u003c/p\u003e \u003cp\u003e3\u0026ndash;3.5 mL/kg\u003c/p\u003e \u003cp\u003e4\u0026ndash;5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (66.7%)\u003c/p\u003e \u003cp\u003e4 (22.2%)\u003c/p\u003e \u003cp\u003e2 (11.1%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (42.3%)\u003c/p\u003e \u003cp\u003e31 (39.7%)\u003c/p\u003e \u003cp\u003e11 (14.1%)\u003c/p\u003e \u003cp\u003e3 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat volume of ICM concentration do you use for chest CTA in pediatrics?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;1.5 mL/kg\u003c/p\u003e \u003cp\u003e2\u0026ndash;2.5 mL/kg\u003c/p\u003e \u003cp\u003e3\u0026ndash;3.5 mL/kg\u003c/p\u003e \u003cp\u003e4\u0026ndash;5 mL/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (60.0%)\u003c/p\u003e \u003cp\u003e2 (40.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (44.4%)\u003c/p\u003e \u003cp\u003e9 (50.0%)\u003c/p\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (37.2%)\u003c/p\u003e \u003cp\u003e38 (48.7%)\u003c/p\u003e \u003cp\u003e10 (12.8%)\u003c/p\u003e \u003cp\u003e1 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e: Chi square test MC: Monte Carlo\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003cp\u003ep: p-value for the Relation between Categorization of Knowledge and Clinical practices\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the considerable variability in pediatric ICM administration practices among radiographers across different institutions globally. Despite the recognized importance of protocol standardization in enhancing patient safety and diagnostic consistency, the findings reveal a wide range of injection rates, contrast volumes, catheter gauge selections, and delay times used in pediatric CT procedures. Such variability suggests the absence of unified practice guidelines and raises concerns about the potential risks of inconsistent ICM administration on diagnostic quality and patient outcomes.\u003c/p\u003e \u003cp\u003eThe inconsistency observed in clinical practices mirrors the knowledge gaps identified in previous research, where the majority of radiographers demonstrated poor knowledge of pediatric ICM administration despite expressing high confidence in their ability to modify protocols (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similar to earlier findings, this study revealed that while 93.2% of participants reported being comfortable modifying contrast delivery parameters, actual practices varied widely, particularly in the selection of injection rates and contrast volumes. This disconnect between perceived and actual competence has been previously reported as a risk factor for unsafe or suboptimal practice in both pediatric and adult imaging settings (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNotably, while low-kVp imaging, saline chaser use, and bolus tracking have been recommended as best practices for reducing contrast volume and improving image quality (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), their adoption appeared inconsistent in the reported clinical practices. These findings align with the limited awareness and application of contrast optimization strategies previously identified (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This suggests a gap between technological advancements and their routine clinical implementation, potentially due to a lack of formal training or institutional support.\u003c/p\u003e \u003cp\u003eMoreover, the study highlights the underutilization of individualized dosing strategies based on body surface area or lean body weight, despite evidence supporting their role in achieving more accurate and safer contrast dosing in pediatric imaging (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The frequent reliance on generalized weight-based dosing without consideration of patient-specific factors such as vessel size or IDR further underscores the need for enhanced training and protocol refinement (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 2022 global ICM shortage emphasized the importance of adopting resource-efficient practices, including the use of multi-dose vials, reduced contrast protocols, and environmentally sustainable disposal methods (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, the variability observed in this study suggests that these practices have not been consistently implemented across institutions, reflecting missed opportunities for improving sustainability and supply resilience (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, the study highlights the clinical risks associated with inconsistent power injection parameters, particularly in the selection of maximum injection rates based on catheter size. Incorrect settings may increase the risk of catheter damage, extravasation, or suboptimal vascular enhancement, particularly in smaller pediatric patients with fragile veins. These findings are consistent with previous literature emphasizing the importance of matching injection pressure and flow rates to catheter specifications to prevent mechanical complications (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, the finding that many respondents rely on personal or institutional habits rather than established evidence-based protocols suggests that workplace culture influences practice variability. This reinforces the need for leadership engagement and institutional accountability to ensure that best practices are not only developed but also actively implemented and audited.\u003c/p\u003e \u003cp\u003eImportantly, the absence of statistically significant associations between knowledge levels and specific clinical practices indicates that variability exists regardless of educational background or years of experience. This finding reinforces previous recommendations that professional expertise alone is insufficient to ensure adherence to best practices (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Structured, standardized education and ongoing Continuing Professional Development (CPD) are therefore essential to bridge the gap between knowledge and practice (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, the variability identified in this study may have implications for health equity. Inconsistent practices across institutions and countries could lead to disparities in care quality, particularly in resource-limited settings where access to training and advanced technology may be constrained. This underscores the importance of developing globally applicable guidelines that consider both high-resource and low-resource clinical environments.\u003c/p\u003e \u003cp\u003eUltimately, the study supports calls for the development of pediatric-specific practice guidelines, co-designed by multidisciplinary teams including radiologists, radiographers, and contrast manufacturers (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). International collaboration through research networks, webinars, and professional forums is also critical to promote knowledge exchange and drive global improvements in pediatric ICM administration.\u003c/p\u003e \u003cp\u003eBased on the variability and risks identified in this study, several strategic recommendations are proposed to advance the standardization and safety of pediatric ICM administration practices in CT imaging.\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFirst, healthcare institutions should prioritize the development and enforcement of pediatric-specific contrast administration protocols. These protocols should define standardized parameters for injection rates, contrast volumes, catheter selection, and saline chaser use, tailored to patient size and clinical indication. To be effective, these protocols must be supported by regular staff training, accessible in daily practice, and monitored through routine clinical audits to ensure compliance.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSecond, mandatory structured training programs should be established at both local and national levels, focusing on advanced contrast delivery techniques such as bolus tracking, IDR optimization, low-kVp imaging, and safe power injector use. These programs should be integrated into both initial radiography education and ongoing CPD requirements to ensure that radiographers maintain current competencies across their careers. Practical, simulation-based training should also be considered to bridge the gap between theoretical knowledge and clinical application.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThird, institutional leadership and clinical governance teams should actively support a culture of evidence-based practice, ensuring that radiographers are empowered to question outdated methods and implement best practices. This includes providing access to up-to-date guidelines, mentorship programs, and peer-review mechanisms to foster continuous learning and professional accountability.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFourth, international professional societies and regulatory bodies should collaborate to develop globally applicable pediatric contrast administration benchmarks. These benchmarks should consider the realities of both high-resource and low-resource settings and be disseminated through multi-center collaborations, webinars, and professional conferences to encourage adoption across diverse healthcare environments.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFifth, institutions should adopt resource management strategies that promote ICM conservation and environmental sustainability. This includes transitioning to multi-dose vial systems, reducing unnecessary contrast volumes, and implementing sustainable waste management practices, especially in light of recent global supply chain challenges (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFinally, recognizing the potential for practice variability to contribute to health inequities, efforts should be made to ensure that all radiographers, regardless of geographic location or institutional resources, have equitable access to high-quality training, protocols, and support systems. This global perspective is essential to advancing both clinical consistency and patient safety in pediatric ICM administration worldwide.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eWhile this study offers valuable insights into the variability of pediatric CM administration practices, several limitations should be acknowledged. First, reliance on self-reported data introduces the potential for response bias, as participants may overestimate their adherence to best practices or underreport unsafe behaviors. Second, the use of voluntary, convenience sampling through digital platforms may limit the representativeness of the sample, potentially excluding radiographers from regions with limited internet access or those less engaged in professional networks. Third, although this study explored reported practices, it did not directly assess clinical outcomes, such as image quality or patient safety incidents, which would have provided a more objective measure of practice effectiveness. Additionally, institutional variability in resources, technologies, and policies was not fully accounted for, which may have influenced the reported practices. Finally, the cross-sectional design of the study provides a snapshot in time but does not capture longitudinal changes in practice or the impact of recent training initiatives. Future research should include observational studies, clinical audits, and multi-center interventions to validate these findings and explore the direct relationship between practice variability and clinical outcomes.\u003c/p\u003e \u003cp\u003eIn conclusion, this study highlights the widespread variability in pediatric ICM administration practices among CT radiographers, raising concerns about consistency, patient safety, and diagnostic reliability. Despite high levels of self-reported confidence, the findings demonstrate that many radiographers rely on non-standardized, experience-based practices rather than evidence-based protocols, increasing the risk of suboptimal care. Addressing this variability requires a multi-level approach, including the development of pediatric-specific guidelines, structured training programs, and institutional support for continuous professional development. Additionally, promoting international collaboration and resource-conscious practices is essential to advancing standardization, sustainability, and health equity in pediatric imaging. By prioritizing these actions, healthcare institutions and professional bodies can strengthen the safety, quality, and efficiency of pediatric ICM administration, ultimately improving patient outcomes and operational resilience in both routine and resource-constrained environments.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003cb\u003eFunding Declaration\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMohammad Rawashdeh conceptualized the study, supervised the research design, and provided critical revisions. Magdi A. Ali contributed to methodology development and data validation. Zakaria Bouhssine and Sumayya Monir assisted with data collection and analysis. Reem Mohamed Ali contributed to the literature review and drafting of the manuscript. C. Saade provided expert consultation on international practices and critically reviewed the final manuscript. Daniah Kashabash supported data curation and visual presentation of results. Mohamed Zakaria El-Sayed coordinated the project, led the manuscript writing, and served as the corresponding author. All authors have read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eParillo M, van der Molen AJ, Asbach P, Elsholtz FHJ, Laghi A, Ronot M, et al. The role of iodinated contrast media in computed tomography structured Reporting and Data Systems (RADS): a narrative review. Quantitative Imaging in Medicine and Surgery. 2023;13(11):7621.\u003c/li\u003e\n\u003cli\u003eKoo JH, Lee M, Kim EH, Oh HJ, Lim JS, Hyung WJ, et al. Harmful effect of repetitive intravenous iodinated contrast media administration on the long-term renal function of patients with early gastric cancer. Scientific reports. 2023;13(1):19448.\u003c/li\u003e\n\u003cli\u003eAmukotuwa SA, Bammer R, Jackson DM, Sutherland T. Iodinated contrast media shortage: Insights and guidance from two major public hospitals. Journal of medical imaging and radiation oncology. 2022;66(7):946-56.\u003c/li\u003e\n\u003cli\u003eBailliard F, Hughes ML, Taylor AM. Introduction to cardiac imaging in infants and children: techniques, potential, and role in the imaging work-up of various cardiac malformations and other pediatric heart conditions. European Journal of Radiology. 2008;68(2):191-8.\u003c/li\u003e\n\u003cli\u003eCohen MD. Safe use of imaging contrast agents in children. Journal of the American College of Radiology. 2009;6(8):576-81.\u003c/li\u003e\n\u003cli\u003eCallahan MJ, Servaes S, Lee EY, Towbin AJ, Westra SJ, Frush DP. Practice patterns for the use of iodinated iv contrast media for pediatric CT studies: a survey of the Society for Pediatric Radiology. American journal of roentgenology. 2014;202(4):872-9.\u003c/li\u003e\n\u003cli\u003eElicker BM, Cypel YS, Weinreb JC. IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. American journal of roentgenology. 2006;186(6):1651-8.\u003c/li\u003e\n\u003cli\u003eReddan D, Fishman EK. Radiologists\u0026rsquo; knowledge and perceptions of the impact of contrast-induced nephropathy and its risk factors when performing computed tomography examinations: a survey of European radiologists. European journal of radiology. 2008;66(2):235-45.\u003c/li\u003e\n\u003cli\u003eRawashdeh M, Kashabash D, Kumar P, Saade C. The diverse utility of contrast media delivery and dosing during computed tomography: an international assessment of knowledge and practices. Current Radiopharmaceuticals. 2024;17(4):364-70.\u003c/li\u003e\n\u003cli\u003eZhu S, Zhang B, Tian Q, Li A, Liu Z, Hou W, et al. Reduced-dose deep learning iterative reconstruction for abdominal computed tomography with low tube voltage and tube current. BMC Medical Informatics and Decision Making. 2024;24(1):389.\u003c/li\u003e\n\u003cli\u003eDen Harder AM, Willemink MJ, De Ruiter QM, Schilham AM, Krestin GP, Leiner T, et al. Achievable dose reduction using iterative reconstruction for chest computed tomography: a systematic review. European journal of radiology. 2015;84(11):2307-13.\u003c/li\u003e\n\u003cli\u003eHenning MK, Gunn C, Arenas-Jim\u0026eacute;nez J, Johansen S. Strategies for calculating contrast media dose for chest CT. European Radiology Experimental. 2023;7(1):29.\u003c/li\u003e\n\u003cli\u003eAoun J, Nicolas D, Brown JR, Jaber BL. Maximum allowable contrast dose and prevention of acute kidney injury following cardiovascular procedures. Current opinion in nephrology and hypertension. 2018;27(2):121-9.\u003c/li\u003e\n\u003cli\u003eKessler R, Hegenscheid K, Fleck S, Khaw A, Kirsch M, Hosten N, et al. Patient body weight-tailored contrast medium injection protocol for the craniocervical vessels: a prospective computed tomography study. PloS one. 2014;9(2):e88867.\u003c/li\u003e\n\u003cli\u003eYanaga Y, Awai K, Nakaura T, Utsunomiya D, Oda S, Hirai T, et al. Contrast material injection protocol with the dose adjusted to the body surface area for MDCT aortography. American Journal of Roentgenology. 2010;194(4):903-8.\u003c/li\u003e\n\u003cli\u003eEysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Gunther Eysenbach Centre for Global eHealth Innovation, Toronto, Canada; 2004. p. e34.\u003c/li\u003e\n\u003cli\u003eMartens B, Hendriks BM, Eijsvoogel NG, Wildberger JE, Mihl C. Individually body weight\u0026ndash;adapted contrast media application in computed tomography imaging of the liver at 90 kVp. Investigative Radiology. 2019;54(3):177-82.\u003c/li\u003e\n\u003cli\u003eSkirrow C, Cashdollar N, Granger K, Jennings S, Baker E, Barnett J, et al. Test-retest reliability on the Cambridge Neuropsychological Test Automated Battery: comment on Karlsen et al.(2020). Applied Neuropsychology: Adult. 2022;29(5):889-92.\u003c/li\u003e\n\u003cli\u003eJaspan O, Wysocka A, Sanchez C, Schweitzer AD. Improving the relationship between confidence and competence: implications for diagnostic radiology training from the psychology and medical literature. Academic Radiology. 2022;29(3):428-38.\u003c/li\u003e\n\u003cli\u003eRengo M, Dharampal A, Lubbers M, Kock M, Wildberger JE, Das M, et al. Impact of iodine concentration and iodine delivery rate on contrast enhancement in coronary CT angiography: a randomized multicenter trial (CT-CON). European radiology. 2019;29:6109-18.\u003c/li\u003e\n\u003cli\u003eCavallo JJ, Pahade JK. Practice management strategies for imaging facilities facing an acute iodinated contrast media shortage. American Journal of Roentgenology. 2022;219(4):666-70.\u003c/li\u003e\n\u003cli\u003eRawashdeh M, Ali M, McEntee M, El-Sayed M, Saade C, Kashabash D, et al. Green radiography: exploring perceptions, practices, and barriers to sustainability. Radiography. 2024;30:62-73.\u003c/li\u003e\n\u003cli\u003eRawashdeh M, Ali M, McEntee M, El-Sayed M, Saade C, Kashabash D, et al. Assessment of the role of experience in shaping sustainability perceptions within radiography. Radiography. 2025;31(1):103-11.\u003c/li\u003e\n\u003cli\u003eBeckett KR, Moriarity AK, Langer JM. Safe use of contrast media: what the radiologist needs to know. Radiographics. 2015;35(6):1738-50.\u003c/li\u003e\n\u003cli\u003eSaade C, Deeb IA, Mohamad M, Al-Mohiy H, El-Merhi F. Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know. Diagnostic and interventional Radiology. 2016;22(2):116.\u003c/li\u003e\n\u003cli\u003eStevens BJ. Radiographers\u0026apos; commitment to continuing professional development: a single-centre evaluation. Radiography. 2016;22(3):e166-e77.\u003c/li\u003e\n\u003cli\u003eGrehan J, Butler M-L, Last J, Rainford L. The introduction of mandatory CPD for newly state registered diagnostic radiographers: An Irish perspective. Radiography. 2018;24(2):115-21.\u003c/li\u003e\n\u003cli\u003eKahlon P, McCullough K, Gazelle GS. Enhancing patient safety: standardization of CT contrast media practices. Journal of the American College of Radiology. 2009;6(8):562-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prad","sideBox":"Learn more about [Pediatric Radiology](http://link.springer.com/journal/247)","snPcode":"247","submissionUrl":"https://submission.nature.com/new-submission/247/3","title":"Pediatric Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Pediatric CT, Iodinated contrast media (ICM)","lastPublishedDoi":"10.21203/rs.3.rs-6931365/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6931365/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eRadiographers play a crucial role in ensuring the safe and effective delivery of iodinated contrast media (ICM) in pediatric CT imaging. However, practice variability across institutions raises concerns about consistency, patient safety, and diagnostic quality. This study examines the range of real-world practices in pediatric ICM administration, focusing on protocol adherence and variations in technique.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAn international cross-sectional survey was conducted among 103 CT radiographers. The online questionnaire assessed demographic data, clinical practices, protocol modification behaviors, and institutional procedures. Data were collected over a nine-week period and analyzed using descriptive and comparative statistics to identify trends and practice variability.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe findings revealed considerable variability in ICM administration practices, including differences in injection rates, contrast volumes, catheter gauge selection, and use of saline flush techniques. Although 93.2% of participants reported confidence in modifying contrast protocols, knowledge assessments showed that 75.7% of radiographers scored in the \"Poor\" category, with no participants achieving an \"Excellent\" score. Additionally, many respondents reported relying on experience-based practices rather than standardized institutional guidelines, contributing to inconsistent contrast delivery approaches. No significant associations were found between demographic factors and reported practices, suggesting variability exists across all levels of education and experience.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study highlights inconsistencies in pediatric ICM delivery practices among CT radiographers, emphasizing the need for standardized protocols and structured training programs. Addressing these inconsistencies is crucial for improving diagnostic quality, patient safety, and promoting consistency in best practices across clinical settings.\u003c/p\u003e","manuscriptTitle":"Beyond Guesswork: Addressing the Wide Variability in Pediatric Iodinated Contrast Media Delivery from an International Perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-30 09:36:49","doi":"10.21203/rs.3.rs-6931365/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-05T19:38:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-12T01:06:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T11:58:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169106475508317560215270310966398465202","date":"2025-06-26T11:52:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"110493412464245947431965323872888018713","date":"2025-06-26T01:37:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175399279046027151129185327660930837189","date":"2025-06-25T17:10:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-25T11:45:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-23T14:45:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-23T14:45:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Radiology","date":"2025-06-19T12:37:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prad","sideBox":"Learn more about [Pediatric Radiology](http://link.springer.com/journal/247)","snPcode":"247","submissionUrl":"https://submission.nature.com/new-submission/247/3","title":"Pediatric Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ffde860d-315e-456e-b2b2-7f3961d985cd","owner":[],"postedDate":"June 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T16:00:19+00:00","versionOfRecord":{"articleIdentity":"rs-6931365","link":"https://doi.org/10.1007/s00247-025-06411-2","journal":{"identity":"pediatric-radiology","isVorOnly":false,"title":"Pediatric Radiology"},"publishedOn":"2025-10-29 15:57:17","publishedOnDateReadable":"October 29th, 2025"},"versionCreatedAt":"2025-06-30 09:36:49","video":"","vorDoi":"10.1007/s00247-025-06411-2","vorDoiUrl":"https://doi.org/10.1007/s00247-025-06411-2","workflowStages":[]},"version":"v1","identity":"rs-6931365","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6931365","identity":"rs-6931365","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}