The annual per-capita radiation exposure due to diagnostic imaging increased six-fold from 0.5 to 3.

0
millisieverts (mS) from the 1980s to mid-2000s, carrying with it not only the risk of cancer but also the risks
of intravenous (IV) contrast in patients susceptible to radiographic contrast-induced neprothpathy (RCIN)
(1). Emergency physicians routinely obtain CT scans to evaluate many types of patients in daily practice,
such as those who present with abdominal pain, neurological symptoms, or chest pain. This chapter focuses
on some of the special populations commonly seen in every- day practice. We start by reviewing the renal
effects of radi- ological contrast media and pretreatment options in the patient with underlying renal
insufficiency. We then review the systematic approach to the patient who has a history of a contrast reaction.
Finally, we review guidelines regarding diagnostic image ordering and acquisition in pregnant and pediatric
patients.
Radiographic contrast-induced nephropathy
RCIN is a significant complication in at-risk patients who receive IV contrast. It is the third most common
cause of hospital-acquired renal failure, after surgery and hypoten- sion (2), and is associated with
prolonged hospitalizations, worsened renal function at discharge, and increased mortality. One study
found that patients with RCIN were 2.7 times more likely to die before the 28-day follow- up (3–6).
Because serial creatinine clearance measurements (glo- merular filtration rates) are not practical or
cost-effective in an acute care setting, isolated serum creatinine levels are used to measure renal function
for most ED patients receiving CT scans. In general, the literature defines RCIN as an increase in
total serum creatinine by 25%, or