Figure 1
Iodinated contrast media
utilised in a dual-bolus
CT urogram to provide
optimal enhancement
of the abdominal viscera
as vasculature as well as
delayed visualisation of
the left upper renal tract
in a case of haematuria.
Figure 2A
Iodinated contrast media
being used to guide an
interventional angiography
stenting procedure of
the proximal external
iliac artery.
Figure 2B
Confirmation of good
angiographic result
post-stent placement.
Table 1
Risk factors and prophylaxis for intravenous
iodinated contrast 1,3
eGFR level
Risk
Prophylaxis
≥45ml/min/1.73m 2 Nil None
30–44ml/min/1.73m 2 Oral or intravenous hydration
Low
<30ml/min/1.73m 2
High*
Alternative imaging or likely withhold
contrast
eGFR - estimated glomerular filtration rate
*Will depend on patient history and known chronic kidney disease or dialysis
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community settings, PoC blood testing is not
used widely within imaging, 7 with limited
evaluation of its clinical utility in this
environment. Research has shown variation
between device performance, 8,9 although there
is strong concordance with laboratory testing
and assurance of the performance standards
of many different devices.
What has not yet been realised is the
opportunity to streamline the imaging pathway
and only undertake testing on patients with
risk factors. This would remove a significant
administrative burden from clinicians and
imaging departments as well as reduce
inappropriate testing. For many departments,
this is a fundamental change in procedures and
it will take some convincing of the validity of
such a change. Research is ongoing to evaluate
the implementation of a screening enabled
pathway utilising PoC and this will hopefully
provide evidence of the challenges and benefits
of the innovation.
Case studies
A 75-year-old patient was referred for a CT
scan of the abdomen. The referring clinician
had arranged a kidney function test, which
confirmed a normal level of 70ml/min/1.73m 2 .
On the scan day, the patient indicated that she
had been unwell in the previous week; therefore
a PoC creatinine test was performed. This
identified a marked reduction in kidney function
to 28ml/min/1.73m 2 , confirmed on laboratory
testing. The early indication enabled appropriate
action to be taken, including advice regarding
proactive oral hydration. On follow up testing
three days later, this had improved to
58ml/min/1.73m 2 .
Another 87-year-old patient with chronic
kidney disease whose eGFR over the
preceding four months varied between
39 and 44ml/min/1.73m 2 had a PoC test on
the day of her CT urogram. This