BACKGROUND: This study was conducted to determine the degree to which the clinical practice concerning computed tomographies (CTs) with iodinated contrast media in patients with lung cancer was in accordance with ESUR international guidelines. Lung cancer is treatable with platinum-based cytostatic drugs, which can be nephrotoxic. According to the ESUR s guidelines this adds to the risk of developing contrast-induced nephropathy.
METHODS: A retrospective study of lung cancer patients at Hillerød Hospital.
METHODS: Patients in current treatment with platinum-based cytostatic drugs up to and including 20 Sept. 06 who had undergone an elective CT with iodinated contrast media. A total of 51 patients where included. P-creatinine and other potential risk factors for development of contrast-induced nephropathy were collected.
RESULTS: In 31.4% of the patients included, P-creatinine was measured no earlier than seven days prior to their CT. 43.1% of the patients included had received a platinum-based cytostatic drug after the latest measurement of their P-creatinine prior to their CT scan. 45.1% of the patients received a platinum-based cytostatic 14 days or less before CT scan. 66.7% had additional risk factors. None needed nephrologic assistance.
CONCLUSIONS: Significant deviations were found between the clinical practice and ESUR international guidelines covering prevention of contrast-induced nephropathy. This study has led to changes in the guidelines and clinical practice regarding contrast-induced nephropathy at Hillerød Hosipital. Now all elective patients have P-creatinine measured no more than seven days prior to CT with iodinated contrast media.

Cervical myelography may be performed with non-ionic contrast media either by direct cervical puncture or by lumbar puncture with run-up of the contrast medium. In this prospective study of 300 cervical myelograms using iopamidol (130 by direct puncture and 170 by lumbar puncture), we have shown that the run-up technique causes no more side effects than direct puncture technique and films of equivalent diagnostic quality are obtained. A sub-group of 80 patients had EEG examinations before and after myelography, plus a lateral skull film taken at the end of the myelogram to assess the amount of contrast medium that had entered the skull. More EEG abnormalities were found in those patients examined by direct puncture and significantly more contrast medium had entered the skull in this group. Run-up myelography therefore results in less intracranial spill and so less potential for cortical irritation. In view of the EEG abnormalities, anticonvulsant premedication is discussed, and we now give phenytoin to all patients having cervical myelography with iopamidol. We consider that cervical myelography can be adequately and more safely performed by lumbar puncture technique but, to optimise patient safety, should be performed by a radiologist experienced in neuroradiology.