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I read the study by Zanardo et al. entitled “Abdominal CT: a radiologist-driven adjustment of the dose of iodinated contrast agent approaches a calculation per lean body weight” [1] with interest. This study found that radiologist-derived, non-standard adjustments in contrast dosing were effective in reducing total contrast media dosing without significant impact on image quality. Our group shares a similar interest in optimizing contrast media dose, but found dissimilar results; patients randomized to a lean body weight dosing regimen in our study did not have significant reduction in the variability of mean hepatic enhancement [2]. We have several comments. First, I agree that lean body weight may more accurately predict the volume of contrast needed; lean tissue can be expected to have a different metabolic activity and contrast uptake than adipose tissue. Previous studies in Japanese populations have demonstrated differences in enhancement per gram of contrast enhancement program of iodine [2–7] but conclusions that lean body weight dosing strategies will reduce interpatient variability have relied on inferences. A recent randomized controlled trial by our group in a North American population did not demonstrate any significant differences in contrast enhancement per gram of iodine or the variance of the mean hepatic enhancement between

Response to: Abdominal CT: a radiologist-driven adjustment of the dose of iodinated contrast agent approaches a calculation per lean body weight