RD6.1 | Patient Preparation for Imaging — Assignment

CLINICAL SCENARIO

Mrs R, a 64-year-old woman, attends your primary-care clinic with painless visible haematuria. You decide to refer her for a contrast-enhanced CT urogram (an iodinated-contrast, ionising-radiation study) to investigate the urinary tract. On review of her records: she has type 2 diabetes treated with metformin 1 g twice daily, hypertension on an ACE inhibitor, and her most recent eGFR is 52 mL/min/1.73m². She is post-menopausal. She has no known iodine/contrast allergy and no metallic implants. She lives alone, speaks limited English, and is anxious about 'the dye'.

Your task is to construct the complete, tailored written-and-verbal preparation that you would give Mrs R for this specific procedure, justifying each instruction by the safety or image-quality goal it serves.

Section 1: Renal Safety and Medication Adjustment (250–300 words)

Analyse the renal-safety implications of giving iodinated contrast to Mrs R and state the exact medication instruction you would give.

Guidance: Interpret her eGFR of 52 against the relevant thresholds. State and justify the metformin instruction (withhold at the time of contrast and for 48 hours, resume only after renal function is rechecked and confirmed stable — because eGFR <60). Comment on contrast-associated AKI caution and hydration. Distinguish the metformin threshold (eGFR <60) from the CA-AKI caution threshold (eGFR <30) and explain why they differ. Note the relevance of her ACE inhibitor to renal function.

Section 2: Procedure-specific Preparation for Image Quality (150–200 words)

Specify the fasting/hydration and any procedure-specific instructions that optimise the CT urogram itself.

Guidance: State the fasting/clear-fluid and hydration advice appropriate for an iodinated-contrast CT and explain the image-quality and safety rationale. Make clear which essential regular medicines she may still take. Avoid importing instructions from other modalities (e.g. full bladder for ultrasound, bowel cleansing for barium) and explain why they do not apply here.

Section 3: Pre-procedure Safety Screening and Red Flags (150–200 words)

List the safety screening you (or the department) must complete and confirm before Mrs R receives contrast, and the red flags that would make you pause.

Guidance: Cover allergy/previous contrast-reaction screening, confirmation of recent renal function, and — because she is a woman, though post-menopausal — how you would handle pregnancy status for an ionising study (and why it can be reasonably excluded here). Identify the door-step checks that confirm preparation actually succeeded (metformin withheld, fasting state, consent/understanding). State at least two red flags that should stop the study pending review.

Section 4: Delivering Instructions in Both Channels (200–300 words)

Show how you would deliver this preparation in BOTH written and verbal form, tailored to Mrs R as a person.

Guidance: Draft the key points of the written information sheet AND describe the verbal counselling, including teach-back to confirm understanding. Address her limited English (interpreter / translated sheet), the fact she lives alone (who manages her medication holds, transport, post-contrast hydration), and her anxiety about contrast. Explain why each channel covers the other's weakness.

PEER REVIEW

Review one peer's preparation plan as if you were the radiology department receiving the referral. Confirm: (1) Is the metformin instruction correct and unambiguous (hold at contrast + 48 h, resume after renal review)? (2) Are the two eGFR thresholds correctly distinguished? (3) Has pregnancy status for this ionising study been handled appropriately? (4) Could the patient actually follow the written-and-verbal instructions given her limited English and living alone? Give one specific strength and one specific, actionable improvement.