Patient Assessment and Preparation for Radiologic Procedures
Targeted, not total
Radiology assessment is procedure-driven. Before any study, screen four systems: allergy/contrast history (prior reaction and its severity and treatment, asthma, atopy), renal function (most recent creatinine/eGFR and the date drawn, dialysis status, metformin), cardiopulmonary status (heart failure, pulmonary hypertension, beta-blocker use that can blunt reaction signs), and pregnancy status (LMP, documented test, breastfeeding). Add a medication review for anticoagulants, insulin, and sedatives, plus baseline vital signs and an accurate weight, since weight drives pediatric and contrast dosing.
Then judge the patient's ability to participate: NPO status and airway assessment (Mallampati, ASA class) if sedation is planned, IV gauge and site patency relative to the planned injection rate, hearing and vision, language, anxiety and claustrophobia, and whether a responsible adult will escort the patient home.
Traps the exam loves: accepting a charted no-allergies entry without asking; assuming a prior contrast reaction was mild because the patient calls it mild; treating a signed consent as proof of understanding; missing that a 22-gauge hand IV cannot support a power injection at 5 mL/s; forgetting the pregnancy question in a patient whose negative test is months old.
Worked example: an outpatient scheduled for contrast-enhanced CT has an eGFR of 28. The right move is neither silent cancellation nor silent proceeding, but to hold, notify the ordering provider, and document. An eGFR near 30 is the accepted decision point where contrast-associated kidney injury risk is weighed against diagnostic benefit.
Rule of thumb: assess for the study you are about to do, and reassess when the study changes.