Cost-effectiveness and patient tolerance of low-attenuation oral contrast material: milk versus VoLumen

AJR Am J Roentgenol. 2008 May;190(5):1307-13. doi: 10.2214/AJR.07.3193.


Objective: The purpose of our study was to prospectively compare the cost, effectiveness, and patient tolerance of milk and VoLumen, a 0.1% barium suspension, in patients undergoing abdominal and pelvic CT with oral and i.v. contrast media.

Subjects and methods: Two hundred fifteen consecutive outpatients were randomly assigned to receive either whole milk (n = 115) or VoLumen (n = 100). Results were independently reviewed by two radiologists who were blinded to the oral contrast agent used. Degree of bowel distention was qualitatively scored on a 4-point scale, and bowel wall visibility was graded qualitatively on a yes-or-no basis. A questionnaire regarding oral contrast tolerability was provided to each patient. Cost comparison of the two agents was performed.

Results: No statistically significant differences were seen between whole milk and VoLumen with respect to degree of bowel distention and mural visualization for all segments of bowel studied (p > 0.05 for both reviewers). Significantly more patients ranked milk as pleasant in taste compared with VoLumen (p < 0.0001). More patients preferred milk compared with VoLumen (p < 0.0001). Milk was better tolerated than VoLumen, with fewer abdominal side effects, including abdominal discomfort (p = 0.019), cramping (p = 0.019), nausea (p = 0.016), and diarrhea (p = 0.0002). The cost per patient for VoLumen is $18 compared with $1.48 for milk.

Conclusion: Whole milk is comparable to VoLumen with respect to bowel distention and bowel wall visualization and has a lower cost, better patient acceptance, and fewer adverse symptoms. Milk is a cost-effective alternative to VoLumen as a low-attenuation oral contrast agent.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Barium Sulfate / administration & dosage
  • Barium Sulfate / adverse effects*
  • Barium Sulfate / economics*
  • Contrast Media / administration & dosage
  • Contrast Media / adverse effects
  • Contrast Media / economics*
  • Cost-Benefit Analysis
  • Drug Costs
  • Female
  • Humans
  • Iohexol / analogs & derivatives
  • Male
  • Middle Aged
  • Milk / adverse effects*
  • Milk / economics*
  • Prospective Studies
  • Single-Blind Method
  • Suspensions
  • Tomography, X-Ray Computed*


  • Contrast Media
  • Suspensions
  • Barium Sulfate
  • Iohexol
  • iopromide