Aims of the study: To investigate the computed tomography (CT) density of frequently administered medications (1) for the better characterisation of substances on abdominal CT, (2) to allow radiologists to narrow down possibilities in the identification of hyperdense material in the bowel and (3) to provide forensic doctors with a tool to identify gastric contents before an autopsy.
Material and methods: From the list of the local hospital pharmacy, the 50 most frequently used medications were identified and scanned twice with a 128 row CT scanner (Acquillion, Toshiba, Tokyo, Japan). The protocol comprised two tube voltages of 100 kVp and 120 kVp, with a tube current of 100 mAs, a collimation of 0.5 mm and a slice thickness of 0.5 mm. Two readers were asked to measure the density (in Hounsfield units) and the noise (standard deviation of the Hounsfield units) of each pill in the two scans (100/120 kVp). After 4 weeks, both readers repeated the measurements to test repeatability (intra-rater agreement). The behaviour of each pill in hydrochloric acid (pH 2) was examined and the dissolution time was determined.
Results: The most dense pill was Cordarone (7265 HU), and the least was Perenterol (529 HU), with an attenuation that was lower than fat density (<120 HU). The standard deviation of pixel density (noise) reflects inhomogeneity of the pharmacological product, varying from 9 to 1592 HU among the different pills (at 120 kVp). The absolute average HU increase per pill when changing to lower voltage was 78 ± 253 HU, with a linear fitting line with a slope of 0.21 as a constant variable in the density spectroscopy. After 4 hours in hydrochloric acid, only six tablets were still intact, including Flagyl and Dafalgan. The intra- and inter-rater agreements for all measurements were nearly perfect, with a correlation coefficient r of ≥0.99 (p <0.0001).
Conclusion: Our data suggest that measuring the attenuation of drugs on CT images, including the homogeneity, and applying CT spectroscopy can narrow down possible identities of the most frequently medications. Other clinicians and forensic pathologists can perform this easy measurement, as the intra- and inter-reader variability is very small.