Safe Use of Contrast Media: What the Radiologist Needs to Know.

Iodinated and gadolinium-based contrast media are used on a daily basis in most radiology practices. These agents often are essential to providing accurate diagnoses, and are nearly always safe and effective when administered correctly. However, reactions to contrast media do occur and can be life threatening. Therefore, it is critical for faculty and staff to know how reactions to contrast agents manifest and how to treat them promptly. The decline in renal function seen occasionally after intravenous administration of iodinated contrast agents is poorly understood and likely multifactorial, and its association with the contrast medium may be overemphasized. However, it is important that radiologists be aware of current understanding and strategies to decrease the incidence of renal dysfunction. Nephrogenic systemic fibrosis, a skin disease, is an adverse reaction related to use of some gadolinium-based contrast agents in patients with chronic renal failure. The types of gadolinium most often associated with this condition and the indications for withholding gadolinium are important and are discussed in this article. The use of enteric contrast agents and contrast agents during pregnancy and nursing are reviewed briefly. Current knowledge for safe use of contrast media and key concepts that all radiologists should know are summarized in this review.

Meaningful Peer Review in Radiology: A Review of Current Practices and Potential Future Directions.

The current practice of peer review within radiology is well developed and widely implemented compared with other medical specialties. However, there are many factors that limit current peer review practices from reducing diagnostic errors and improving patient care. The development of "meaningful peer review" requires a transition away from compliance toward quality improvement, whereby the information and insights gained facilitate education and drive systematic improvements that reduce the frequency and impact of diagnostic error. The next generation of peer review requires significant improvements in IT functionality and integration, enabling features such as anonymization, adjudication by multiple specialists, categorization and analysis of errors, tracking, feedback, and easy export into teaching files and other media that require strong partnerships with vendors. In this article, the authors assess various peer review practices, with focused discussion on current limitations and future needs for meaningful peer review in radiology.

The effect of clinical decision support for advanced inpatient imaging.

PURPOSE: To examine the effect of integrating point-of-care clinical decision support (CDS) using the ACR Appropriateness Criteria (AC) into an inpatient computerized provider order entry (CPOE) system for advanced imaging requests. METHODS: Over 12 months, inpatient CPOE requests for nuclear medicine, CT, and MRI were processed by CDS to generate an AC score using provider-selected data from pull-down menus. During the second 6-month period, AC scores were displayed to ordering providers, and acknowledgement was required to finalize a request. Request AC scores and percentages of requests not scored by CDS were compared among primary care providers (PCPs) and specialists, and by years in practice of the responsible physician of record. RESULTS: CDS prospectively generated a score for 26.0% and 30.3% of baseline and intervention requests, respectively. The average AC score increased slightly for all requests (7.2 ± 1.6 versus 7.4 ± 1.5; P < .001), for PCPs (6.9 ± 1.9 versus 7.4 ± 1.6; P < .001), and minimally for specialists (7.3 ± 1.6 versus 7.4 ± 1.5; P < .001). The percentage of requests lacking sufficient structured clinical information to generate an AC score decreased for all requests (73.1% versus 68.9%; P < .001), for PCPs (78.0% versus 71.7%; P < .001), and for specialists (72.9% versus 69.1%; P < .001). CONCLUSIONS: Integrating CDS into inpatient CPOE slightly increased the overall AC score of advanced imaging requests as well as the provision of sufficient structured data to automatically generate AC scores. Both effects were more pronounced in PCPs compared with specialists.