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Quality Practice
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Inside News
The decision-making process around
contrast administration is one of
the most challenging aspects for all
members of the medical imaging team.
It is a topic that the College continually
receives queries about.
The previous Iodinated Contrast
Guidelines, published in 2009,
required revision to reflect the
changing landscape regarding contrast
administration. A working group
was formed in late 2014 following
expressions of interest received from
eight Fellows to an advertisement on
the College website. A further Fellow,
a nephrologist and a radiographer also
joined the group.
The relevant contrast guidelines from
the European Society of Urogenital
Radiology, The Royal College of
Radiology, the American College of
Radiology and the Canadian Association
of Radiologists were reviewed.
The working group aimed to create
guidelines that would provide our fellow
health care professionals in Australia
and New Zealand with contemporary
information and practice guidance
regarding the safe and appropriate
use of iodinated contrast agents. The
information and recommendations in
the guidelines have been laid out in
a clear and straightforward manner
as we could achieve and point-of-
care tools for use by practitioners and
patients have been included to facilitate
implementation of the guidelines into
clinical practice.
The draft guidelines were published for
consultation in late November 2015.
Direct feedback from related medical
colleges and organisations was also
sought.
I would like to take the opportunity to
thank everyone who provided feedback.
Each comment was reviewed by the
group and the guidelines amended
accordingly.
“The decision-making
process around contrast
administration is one of
the most challenging
aspects for the medical
imaging team”
Although the entire contents of the new
guidelines lie outside the scope of this
article, major changes from the previous
guidelines include:
1. A marked reduction in the
recommended patient screening
questions to assess risk of contrast
induced acute kidney injury (CI-AKI)
to:
a) known kidney disease (including
kidney transplant)
b) diabetes, and
c) use of medication containing
metformin.
2. Removal of the previously
recommended measurement of
an eGFR within three months for
stable outpatients prior to contrast
administration in favour of a more
tailored approach to determine what
a suitable interval between an eGFR
and contrast administration should be
in any individual patient.
3. Inclusion of an overview of the current
controversy regarding the decreasing
strength of the association between
iodinated contrast and AKI. The
recommended management and
suggested precautions for patients
with impaired renal function who may
benefit from contrast administration
have also been expanded and
changed accordingly.
4. A change to the recommended
management of patients taking
metformin receiving iodinated
contrast. Cessation of metformin
for at least 48 hours is now
recommended following IV contrast
in patients with an eGFR < 30mL/
min/1.72m2 or who have deteriorating
renal function with an eGFR to
be performed prior to restarting
metformin.
5. Expanded information regarding
treatment of anaphylactic reactions to
contrast including an emphasis on the
prompt use of IM adrenaline (0.5mg
for adults) into the vastus lateralis
for moderate and severe reactions.
The use of IV glucagon in patients,
especially those taking B-blockers,
who do not respond to repeated IM
adrenaline injections has also been
included.
Iodinated Contrast Media Guideline, 2016 Version
Revision of the contrast guidelines published
in 2009 was necessary to reflect changes in
the contrast administration landscape.