Survey regarding the use of intravenous (IV) and ORAL Iodinated CT Contrast.
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1. IV Contrast Questionnaire

1. Please enter your contact info.

Please enter your contact info. Name:
Institution:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

2. Which contrast do you recommend for IV use for CT? (check all that apply)

Which contrast do you recommend for IV use for CT? (check all that apply) Omnipaque (Iohexol)

Visipaque (Iodixanol)

Optiray (Ioversol)

Isovue (Iopamidol)

Oxilan (Ioxilan)

Ultravist (Iopromide)

Other (please specify agent)

3. What concentration (180/240/270/300/320/350 mg Iodine/mL) of contrast do you recommend for IV use for CT? (check all that apply)

What concentration (180/240/270/300/320/350 mg Iodine/mL) of contrast do you recommend for IV use for CT? (check all that apply) 180

240

270

300

320

350

Other (please specify concentration)

4. What is the recommended dose of IV contrast for CT?

What is the recommended dose of IV contrast for CT? 1 cc/lb

2 cc/kg

Other (please specify)

5. Do you recommend half the calculated IV dose for patient with ONE functioning kidney?

Do you recommend half the calculated IV dose for patient with ONE functioning kidney? YES

6. What is the reference/normal range of serum creatinine in a Pediatric patient at your institution?

What is the reference/normal range of serum creatinine in a Pediatric patient at your institution?

7. Which contrast do you recommend for ORAL use for Pediatric abdominal CT?

Which contrast do you recommend for ORAL use for Pediatric abdominal CT? Barium(Readi-Cat)

Gastrografin

Gastroview

Water

Omnipaque

Volumen (Barium)

Other (please specify)

8. What dilution and dosage of ORAL contrast do you recommend for pediatric patients?

What dilution and dosage of ORAL contrast do you recommend for pediatric patients?

9. Do you recommend ORAL Iohexol (Omnipaque) for Pediatric CT?

Do you recommend ORAL Iohexol (Omnipaque) for Pediatric CT? YES

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