James A. Brink MD, Presenter: Nothing to Disclose

Richard H. Cohan MD, Presenter: Consultant, General Electric Company Consultant, Medscape, LLC

1) Understand the background and current status of best practice clinical and workflow management and its imperitive for improving patient outcomes. 2) To review indications for premedication prior to contrast material administration. To summarize the current understanding of iodinated contrast media nephrotoxicity. To describe common errors made in treating contrast reactions. 3) To understand the requirement to match radiation dose according to the individual patient, clinical question and modality used. To outline meaningful radiation metrics including organ dosages and the overall radiation absorbed to estimate patient risk.

BEST PRACTICES: Increasingly medicine is being defined and evaluated based on patient outcomes rather than procedural events. While best practices are evolving and sometimes incomplete, many do exist, yet there is marked departmental variation from one organization to another. This session will outline why and how best practice implementation, particularly as it relates to IV contrast use and radiation dose, is essential to achieve better patient outcomes. This will require evaluation of current practices and comparison to  nationally driven guidelines, with subsequent compliance to guidelines where they exist.    CONTRAST SAFETY: Some patients have contrast reactions despite premedication. Patients who have repeated reactions in this setting tend to have reactions of similar severity.  Studies performed with control groups suggest that there is minimal to no increased risk of contrast-induced renal failure in patients who receive iodinated contrast material; however, the control groups likely included patients at increased risk of acute kidney injury.  Some errors treating contrast reactions relate to failure to administer epinephrine or using the wrong dose / wrong route. The act of administering this drug can also be problematic.   RADIATION DOSE: In all radiological examinations that utilize x-rays, there are always three important issues that must be taken into consideration. The first relates to the appropriate amount of radiation to be used, which must always explicitly take into account the imaging task at hand as well as the physical characteristics of the patient undergoing the CT examination. The second issue is how to transform the radiation incident on the patient into the organ doses received which are essential to understanding (any) patient risks. The final consideration is to understand the radiological significance of the radiation absorbed by the patient, and to estimate (any) radiological risks, as well as the corresponding uncertainties.

Brink, J, Cohan, R, Quality and Safety 2014: Best Practices, Radiation and Contrast Media.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/13010780.html