What screening criteria do you use to give patients IV contrast for the CT sim?

This is an extremely frustrating and commonly encountered scenario in radiation oncology clinic (and the diagnostic CT suite).

What is most frustrating is how stubbornly the dogma of contrast-induced nephropathy has persisted, and the vast amount of needlessly wasted resources spent worrying about it.

There is not good evidence that modern iodinated contrast media causes acute or chronic renal injury in normally functioning kidneys. Past studies purporting to demonstrate this phenomenon are taint...

This is something that comes up all the time, and is frustrating because each radiologist that you ask has their own personal threshold. My resident recently found this on the 2020 ACR appropriateness criteria for IV contrast, and it is very useful as a standard. My own personal threshold now is a GFR around 50-60 ml/min, and I tell them to drink a lot that night. Hope this is helpful.

"At the current time, there is very little evidence that IV iodinated contrast material is an independent risk ...

For an actual screening process, if you're setting up a new department, a good place to start would be to go borrow the process and check list from your diagnostic imaging department.

You need a system in place so that you don't inadvertently give contrast to somebody on metformin without stopping the metformin.

Then there are various disease states that might make you more conservative about what actual creatinine and GFR is OK to give contrast.

A good screening process will deal with all of th...

Our CT sim techs require a creatinine within the last 30 days (which can be flexible with physician approval) to be below 1.5, our usual cut-off to give contrast. If between 1.3 and 1.5, the techs and physician generally try to coordinate some amount of IV hydration if we feel that it's due to dehydration, but generally prefer to avoid contrast in this situation as well.

Creatinines between 1.0 and 1.3 is a discussion between techs and physician to either be aborted or be recommended to undergo ...

An important point is to notify medical malpractice carrier of the decision to administer IV contrast within the department; when I checked this box on an annual update form, my rates doubled and I promptly decided that I would offload that work back to the radiology department, which is already paying the increased premium to oversee IV contrast. Then I use a fusion product such as mim or velocity for the contrast information.

We use GFR, not Cr, based on current radiology recommendations.