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Introduction

Contrast agents are essential in several diagnostic imaging techniques, especially in Computed Tomography (CT) scans, since they improve the visibility of interior structures, blood arteries, tissues, and organs, aiding in accurate diagnosis [1]. Even though contrast agents are necessary for imaging, there is a possibility that they might cause harm to the kidneys, especially for those who are already at risk [2]. The term “contrast-induced nephropathy” (CIN) has been revised to “contrast-associated nephropathy” (CAN) or “contrast-associated acute kidney injury” or “post-contrast acute kidney injury” (PC-AKI) [3]. Contrast-induced nephropathy (CIN), now more commonly referred to as Post Contrast-Acute Kidney Injury (PC-AKI), may occur after the injection of contrast agents [4]. The CMSC recommends using the terminology suggested by the ACR Committee on Drugs and Contrast Media and indicates that the earlier term of CIN be replaced with PC-AKI [5].

PC-AKI refers to a sudden and frequently reversible decline in renal function, assessed through measurements of estimated glomerular filtration rate(eGFR) [6]. This type of injury can occur shortly following the use of contrast agents. Typically, the initial stage of AKI occurs between 48 and 72 hours after an infusion of contrast medium. This condition is referred to as acute renal injury [7]. This condition is characterized by an abrupt elevation in serum creatinine (SCr) above 25%, corresponding to an increase of 0.5 mg/dL (44 μmol/L). It may also include a decrease in urine output, signifying renal dysfunction [8]. The vast majority of cases of PC-AKI may be reversed with early identification and appropriate therapy. However, some cases can lead to more severe and irreversible kidney damage, particularly in individuals who are at a higher risk [9]. The development of post-contrast acute renal injury is more likely to occur in those who already have comorbidities such as kidney disease, diabetes, dehydration, or other conditions [10].

Medical professionals must understand the procedures, risk factors, and preventive strategies associated with PC-AKI induced by contrast-enhanced imaging. Essential measures, including early detection, hydration, and limiting contrast exposure, are vital to optimizing patient outcomes. Radiologists and radiographers are instrumental in identifying at-risk patients and mitigating harmful responses to contrast substances. However, knowledge inadequacies persist in clinical settings.

This research intends to evaluate the knowledge, perception, and practice of radiologists and radiographers about PC-AKI. It will concentrate on the following topics: the definition of PC-AKI, its risk factors, alternative imaging techniques, emergencies, concerns for paediatric and pregnant patients, preventative strategies, and post-contrast care.

 

Materials and methods

Survey research was conducted in South India among radiologists and radiographers to evaluate their knowledge, perceptions, and PC-AKI practice over two months (November-December 2024). We directly approached six nearby tertiary hospitals, where we explained the topic and requested their participation in completing the survey. Some of the individuals associated with other tertiary centres were contacted via telephone. We contacted around 700 individuals, comprising 200 radiologists and 500 radiographers. A total of 304 individuals completed the survey, comprising 224 radiographers and 80 radiologists.

Before the survey began, participants were provided comprehensive and detailed information on the study’s objectives and safety concerns. They were informed that all replies would be kept confidential. This transparency was provided via various channels, including phone calls, text messaging, and email notifications. This approach ensured participants understood the survey’s purpose, the voluntary nature of their participation, and the measures taken to ensure anonymity. Furthermore, it was stated that only aggregated data would be used in any reports or publications, implying that no personally identifiable information would be disclosed or made public in any way.

Based on documented PC-AKI literature (Annexure A), a well-structured and thorough 30-item multiple-choice questionnaire in 6 sections was created to collect the most relevant data. We incorporated the term CIN in the questionnaire to improve clarity and understanding.

Participants were informed that CIN would be referred to as PC-AKI. All participants were given a clear explanation of this new terminology to ensure their understanding. The questionnaire sought to investigate a broad range of subjects, including participants’ knowledge of the PC-AKI definition, common risk factors for developing PC-AKI after contrast, and knowledge of alternative imaging that might reduce or eliminate the use of contrast medium. In addition, the survey examined participants’ understanding of PC-AKI emergency care procedures and comprehension of particular concerns in vulnerable patient groups such as pregnant women and children. The questionnaire also addressed preventative methods, patient care procedures, and the overall treatment of contrast-induced kidney injury.

The questionnaire was also designed to gather comprehensive demographic data, including participants’ age, gender, years of professional experience, and specific professional roles within radiology. The demographic information offered context for analyzing responses. It enabled the identification of trends and correlations among various groups, including differences in awareness or practice related to years of experience or specific job functions. This approach facilitated a comprehensive understanding of the factors influencing knowledge and clinical behaviour regarding PC-AKI.

The questionnaire was distributed through Google Forms to facilitate participation and data collection. This platform was selected due to its accessibility and user-friendly interface. It allows participants to complete the survey at their convenience, enabling efficient data collection and analysis. The questionnaire details and structure are presented in Annexure A.

 

Statistical analysis 

The collected data were entered into Microsoft Excel 2016 and analysed with IBM SPSS Statistics for Windows, Version 29.0 (Armonk, NY: IBM Corp). To describe the data, descriptive statistics, frequency analysis, and percentage analysis were used for categorical variables. The Chi-Square test was used to find the significance of qualitative categorical data.

Validity and Reliability: Content validation was performed to ascertain the suitability and relevance of the questionnaire items. The Content Validity Index (CVI) was calculated using expert evaluations, yielding a score of 0.71 and a statistically significant p-value of 0.0005, indicating acceptable content validity. The reliability of internal consistency was evaluated using Cronbach’s alpha. The overall reliability value was 0.80 (p = 0.0005), suggesting substantial consistency across the questionnaire items.

 

Result

Participant demographics

Most radiologists and radiographers are aged between 26 and 35 years, comprising 82.5% and 90.1% respectively, reflecting a predominantly young workforce. The proportion of males was slightly higher in both groups, comprising 52.5% of radiologists and 57.6% of radiographers. All radiologists possessed doctoral degrees, while radiographers exhibited diverse educational qualifications: 74.1% held bachelor’s degrees, 17.9% obtained master’s degrees, and 8.0% had a high school diploma. Most professionals possessed 1 to 10 years of work experience, with 68.8% of radiologists and 69.6% of radiographers falling within this range. Radiographers had a higher workload, with 24.6% performing more than 40 CT scans daily, compared to 2.5% of radiologists. See Table 1.

Demographics statistics	Profession	Radiologists N = 80 (%)	Radiographers N = 224 (%)
Age range	26-35 years	66 (82.5%)	202 (90.1%)
	36-45 years	12 (15.0%)	17 (7.6%)
	Above 46 years	2 (2.5%)	5 (2.3%)
Sex	Male %	42 (52.5%)	129 (57.6%)
	Female %	38 (47.5%)	95 (42.4%)
Education	Doctoral Degree (e.g., MD, PhD)	80 (100%)	–
	Master’s Degree	–	80 (17.9%)
	Bachelor’s Degree	–	166 (74.1%)
	High School Diploma	–	18 (8.0%)
Experience	1-10 years	55 (68.8%)	156 (69.6%)
	10-20 years	13 (16.2%)	37 (16.5%)
	20-30 years	12 (15%)	28 (12.5%)
	Above 30 years	–	3 (1.3%)
Avg. CT scans Performed/Day	10-20 patients/day	22 (27.5%)	107 (47.7%)
	21-30 patients/day	36 (45.0%)	41 (18.3%)
	31-40 patients/day	12 (15.0%)	21 (9.4%)
	More than 40 patients/day	10 (2.5%)	55 (24.6%)

Table 1. Participant demographics.

The Opinions of Radiologists and Radiographers on the Definition of PC-AKI

A substantial majority of radiologists (70, 87.5%) and a considerable number of radiographers (119, 53.1%) accurately recognized PC-AKI as a rapid deterioration in renal function after the injection of contrast material. However, a notable proportion of radiographers (56, 25%) mistakenly associated PC-AKI with allergic reactions.

75 (93.8%) radiologists correctly defined it as a 25% increase in SCr or a rise of 0.5 mg/dL within 48 to 72 hours after contrast administration. 143 (63.8%) radiographers also recognized these criteria. However, some radiographers mistakenly reported increases in HbA1c (28, 12.5%) or temporary reductions in renal function as indicators of PC-AKI (26, 11.6%).

A substantial number of radiologists (76, 95%) and radiographers (162, 72.3%) agreed that PC-AKI-induced kidney damage is reversible and generally appears between 48 and 72 hours after the infusion of contrast media.

Radiologists (78, 97.5%) and radiographers (177, 79%) agree that SCr and eGFR are important kidney function markers. Most radiologists understood kidney function tests, although some radiographers indicated a kidney biopsy (19, 8.5%). Notably, 20 (8.9%) radiographers mistakenly recommended renal ultrasonography (Figure 1). The Chi-Square value (χ² = 16.449, p = 0.002) shows a substantial difference in knowledge, perception, and practice regarding renal function evaluation between radiologists and radiographers.

We questioned the normal range of creatinine, resulting in a consensus among radiologists and radiographers of 0.5 to 1.2 mg/dL, with agreement rates of 76 (95%) radiologists and 196 (87.5%) radiographers. 4 (5.1%) radiologists and 28 (12.5%) radiographers were unaware of the normal creatinine range.

Most respondents understood the Cockcroft-Gault formula for eGFR, with 49 (61.3%) radiologists and 54 (25.4%) radiographers demonstrating comprehension. Notably, 6 (28.1%) radiographers employed a serum creatinine-adjusted algorithm, indicating variability in eGFR calculations.

Among the radiologists surveyed, 58 (72.5%) indicated that an eGFR value below

30 mL/min/1.73m² categorizes patients as being at high risk for renal impairment. However, 8 (10%) of the radiologists highlighted an eGFR higher than 90 mL/min/1.73m², and 10 (12.5%) mentioned a range of 30 to 59 mL/min/1.73m², which was inaccurate. The distribution of eGFR answers was more varied among radiographers, 72 (32.1%) identified the high-risk category as eGFR below 30ml/min/1.73m² (Figure 2). The Chi-Square value of (χ² = 46.436, p = 0.0005) indicates a statistically significant difference in knowledge, perception, and practice about eGFR risk levels between radiologists and radiographers.

Radiologists (76, 95%) and radiographers (149, 66.5%) identified reduced urine production and elevated serum creatinine as PC-AKI’s most common clinical symptoms.

Among radiologists, 68 (85.0%) indicated that PC-AKI typically begins within 48-72 hours after contrast injection. A smaller percentage (9, 11.3%) reported that symptoms start within the first 12-24 hours. In the radiographer group, the majority (123, 54.9%) recognized accurately that PC-AKI develops within 48-72 hours. 71 (31.7%) reported it to occur within the first 12-24 hours. Fewer radiographers reported that PC-AKI starts within the first week (21, 9.4%) or after 1-2 weeks (9, 4%) (Figure 3). The observed difference was statistically significant (χ² = 22.972, p = 0.0005).

Insights from Radiographers and Radiologists on Risk Factors

The majority of radiologists (78, 97.5%) radiographers (166, 74.1%) identified older patients with diabetes or chronic renal disease as the most at risk for PC-AKI. This aligns with established risk factors for the condition.

79 (98.8%) radiologists and 162 (72.3%) radiographers identified dehydration or hypovolemia as factors significantly increasing PC-AKI risk, recognizing its significance in renal function and fluid balance.

112 (50.0%) radiographers and 57 (71.3%) radiologists concurred that poorly regulated blood sugar levels in patients with diabetes mellitus are linked to an increased risk of PC-AKI.

Evaluating comorbidities related to an increased risk of PC-AKI demonstrated a statistically significant difference between radiologists and radiographers (χ² = 9.744, p = 0.045). These conditions were identified accurately as the most critical risk factors by 172 (76.8%) radiographers and 73 (91.3%) radiologists, respectively. Less than 10% of respondents listed secondary comorbidities as significant risk factors, including hyperthyroidism, peptic ulcer disease, chronic liver disease, and chronic obstructive pulmonary disease (COPD) (Figure 4).

Regarding contrast volume and PC-AKI risk, most radiologists (57, 71.3%) and radiographers (144, 64.3%) agreed that a greater contrast volume raises the risk of PC-AKI.

Both groups identified nonsteroidal anti-inflammatory drugs (NSAIDs) as a notable risk factor linked to a highlighted risk of PC-AKI when used alongside iodinated contrast agents. 78 (34.8%) radiographers and 66 (82.5%) radiologists selected this option.

The Views of Radiologists and Radiographers Regarding Alternative Imaging for PC-AKI

A notable correlation exists between profession and modality choice (χ² = 13.129, p = 0.011). Among imaging professionals, 38 (47.5%) radiologists and 78 (34.8%) radiographers primarily utilize ultrasound to evaluate these high-risk patients. Meanwhile, 31(38.8%) radiologists and 71 (31.7%) radiographers identified MRI as a suitable option for this group of patients (Figure 5).

Patients with CKD at high risk for PC-AKI require caution when utilizing imaging techniques that may lead to nephrotoxicity. In this context, 68 (85%) radiologists and 72 (35.3%) radiographers recognized Magnetic Resonance Angiography (MRA) with gadolinium contrast as an imaging technique necessitating careful consideration due to its potential nephrotoxic effects. Most radiologists (79, 98.8%) and radiographers (153, 68.3%) stated that MRI without contrast provides high-resolution kidney imaging without nephrotoxicity, making it a safer option for PC-AKI patients.

The Chi-Square value of (χ² = 17.990, p = 0.001) indicates a statistically significant result, showing that non-ionic, low-osmolar contrast agents are the suggested choice for patients highly susceptible to PC-AKI. 69 (86.3%) radiologists and 141 (62.9%) radiographers, respectively, strongly recommended non-ionic, low-osmolar contrast agents (Figure 6).

Regarding the low osmolar contrast media knowledge, 69 (88.8%) radiologists identified Iohexol and 154 (68.8%) radiographers did the same. Diatrizoate was chosen by 7 (8.8%) radiologists and 24 (10.7%) radiographers, whereas metrizoate was recognized by 2 (2.5%) radiologists and 18 (8.0%) radiographers. Although barium sulphate is not a low-osmolar contrast agent, 15 (6.7%) radiographers mentioned it (Figure 7). The Chi-Square value of (χ² = 16.155, p = 0.003) indicates a statistically significant difference between professions.

Due to its safety in patients with impaired kidney function, radiologists 51 (63.8%) and radiographers 86 (38.4%) preferred Iodixanol (Visipaque) for high-volume CT angiography in patients with compromised eGFR (30-50 ml/min).

Perspectives of Radiographers and Radiologists Regarding PC-AKI in Emergency Cases, Pregnant and Paediatric PatientsThe results (χ² = 35.958, p = 0.0005) showed that the majority agreed on the importance of hydration. Specifically, 62 (77.5%) radiologists and 98 (43.8%) radiographers believed that administering intravenous fluids before exposure to contrast agents is the most effective method for minimizing PC-AKI risk. However, 18 (22.5%) radiologists and 63 (28.1%) radiographers thought using low-osmolar contrast agents would sufficiently mitigate this risk. Other answers from radiographers consisted of performing a kidney biopsy to evaluate renal function (16, 7.1%) and altogether avoiding contrast imaging (29, 12.9%) (Figure 8).

The main issues with contrast agents in pregnant individuals were teratogenic consequences and fetal damage. The majority of radiologists (50, 62.5%) and radiographers (71, 31.7%) chose this, emphasizing the necessity of avoiding contrast agents.

74 (92.5%) radiologists and 139 (62.1%) radiographers chose ultrasonography or MRI over contrast imaging unless necessary.

Since children are more susceptible to larger contrast media doses, radiologists 67 (83.8%) and radiographers 78 (34.8%) advised monitoring contrast media volume in paediatric patients.

Paediatric patients have an increased risk of PC-AKI owing to smaller kidneys and undeveloped renal function. 55 (68.8%) radiologists and 96 (42.9%) radiographers agreed.

The finding revealed a statistically significant difference between radiologists and radiographers (χ² = 40.520, p = 0.0005). Most radiologists, 55 (68.8%), believe that contrast-enhanced CT should be performed promptly, while only 3 (3.8%) feel waiting for renal function testing is necessary. Among radiographers, 71 (31.7%) recommended administering contrast-enhanced CT quickly (Figure 9).

Perspective of Radiographers and Radiologists on preventive measures for PC-AKI

75 (93.8%) radiologists and 110 (49.1%) radiographers emphasized the importance of maintaining excellent glycaemic control and ensuring adequate hydration before the procedure.

The result (χ² = 53.593, p = 0.0005) demonstrated a statistically significant difference between radiologists and radiographers. 66 (82.5%) radiologists and 80 (35.7%) radiographers agreed that using high-osmolar contrast agents to decrease the volume of contrast is not an appropriate choice (Figure 10).

Regarding dialysis, 43 (53.8%) radiologists and 73 (32.6%) radiographers correctly stated that it is not recommended as a preventive strategy but may be necessary if acute renal injury occurs.

 

Discussion

The research presents a new survey conducted among South Indian radiologists and radiographers, focusing on their knowledge, perception, and practice assessment regarding PC-AKI in CT imaging. PC-AKI signifies a reduction in renal function following the administration of contrast medium (CM) during diagnostic imaging, particularly in CT scans.

Definition of PC-AKI

The most prevalent definition of contrast-induced nephropathy is abrupt renal failure that occurs within 48 hours following intravascular contrast material exposure that cannot be attributed to any other cause [11]. A widely accepted definition of PC-AKI does not exist. The European Society of Radiology (ESUR) describes contrast-induced nephropathy (PC-AKI) as a decline in the renal system, indicated by a rise in SCr of over 25% or 44 µmol/L (0.5 mg/dL), which takes place within 3 days following the intravenous use of contrast media, provided there is no other identifiable cause [12]. Certain specialists describe PC-AKI as a rise in Scr that surpasses 25% or is equal to or greater than 0.5 mg/dl (44 μmol/l) from the mean within 48 hours [13]. Another study defined PC-AKI as a significant rise of 44.2-μ mol/L or a relative increase of 25% in SCr over 48, 72, or 96 hours [14]. The Kidney Disease Improving Global Outcomes (KDIGO) guidelines stipulate that SCr levels have to increase by at least 0.3 mg/dL beyond the initial level within 48 hours following CM administration, or they must rise by 1.5 times or more over the initial level within seven days [15]. Another research study has stated that in practice, SCr levels frequently rise until GFR has decreased by at least 50%, at which stage a patient is at a higher risk of experiencing severe PC-AKI [16].

PC-AKI is mainly caused by pre-existing renal disease and increased serum creatinine levels. According to the ESUR Guidelines on contrast media usage, individuals who already have renal failure (SCr more than 132 mmol/L or 1.5 mg/dL), especially if it results from diabetic nephropathy, are at the highest risk of getting PC-AKI [17]. The prevalence of PC-AKI in individuals with chronic renal disease is significantly elevated, ranging from 14.8% and 55% [18]. Numerous studies have shown that older age independently predicts PC-AKI [19]. The incidence of PC-AKI in those with diabetes varies between 5.7% and 29.4% [20]. PC-AKI rates are often comparable to those of the non-diabetic population in people with diabetes with preserved renal function and no other risk factors. However, a small percentage of people with diabetes with underlying renal insufficiency acquire clinically severe PC-AKI [21]. Diabetes linked to renal insufficiency is a reliable indicator of PC-AKI, even though diabetes by itself is not typically regarded as an independent risk factor [22]. In one research, 81% of diabetic individuals with blood creatinine 4.0 mg/dl and 27% of the patients with baseline SCr 2.0-4.0 mg/dl had PC-AKI [23]. The dosage of contrast media (CM) plays a significant role in developing PC-AKI [24]. Several studies have identified CM volume as a key modifiable risk factor, with a well-documented correlation between higher CM levels and increased PC-AKI risk [25].

Our study revealed that while radiologists and radiographers have a broad comprehension of PC-AKI, radiologists demonstrated more accuracy in their expertise. Radiographers exhibited deficiencies, especially in recognizing diagnostic criteria, risk thresholds, and appropriate evaluations of renal function.

Alternative Imaging for PC-AKI

To reduce PC-AKI risk, avoid employing contrast agents and investigate other imaging methods such as MRI, Ultrasound, Nuclear Medicine, or non-contrast CT [26]. Although dosages of gadolinium-based contrast agents up to 0.3 mmol/kg are typically regarded as non-nephrotoxic, they may still result in renal dysfunction, particularly in patients with pre-existing renal impairment or diabetic nephropathy [27]. Previously, gadolinium drugs were used to mitigate the reliance on iodinated contrast in patients with a higher risk of developing PC-AKI [28]. Although it has been suggested and used as a substitute for iodinated substances in radiographic contrast studies, it is now only permitted for MRI contrast testing. Nevertheless, after examining the available evidence, the European Society of Urogenital Radiology’s Contrast Media Safety Committee and the PC-AKI Consensus Working Panel cannot recommend using this class of medications to avoid nephrotoxicity [29]. In individuals with preexisting renal impairment, Low Osmolar Contrast Media (LOCM) significantly lower PC-AKI than High Osmolar Contrast Media (HOCM), according to extensive clinical studies and meta-analyses [30]. Numerous studies have demonstrated that the IOCM iodixanol and other LOCMs (such as Iopamidol, Iopramide, and Ioversol) have a lower risk of PC-AKI than do the two LOCMs, Iohexol and ioxaglate [31].

This research assessed the comprehension of risk variables related to PC-AKI among radiologists and radiographers using specific questions. Both groups knew about age, diabetes, chronic renal disease, and dehydration or hypovolemia. Radiologists were more aware of poorly regulated blood glucose levels, increased contrast volume, and nephrotoxic agents such as NSAIDs. Most responders correctly recognized PC-AKI’s key comorbidities. However, radiographers often cited less critical illnesses. These data show that radiographers require ongoing training to guarantee safe risk assessment and contrast media use.

PC-AKI in Emergency Situations, Pregnant, and Paediatric Patients

The fundamental component of treatment for preventing PC-AKI is intravenous fluid hydration with regular saline, which has been shown in randomized studies to be consistently beneficial in preventing PC-AKI. Those in all risk groups often get fluid hydration, particularly those with an estimated GFR of less than 60 mL/min/1.73m² are thought to need it [32]. PC-AKI is a prevalent comorbidity observed in hospitalized children with exposure to nephrotoxic agents [34]. The development of PC-AKI may be independently predicted by contrast volume [35]. When determining the contrast volume, it is essential to consider the child’s size, the ongoing research, and the anticipated GFR [36]. Children are particularly susceptible to receiving excessive doses of contrast media, so professionals advise careful oversight of the contrast media volume used. When it comes to polytrauma, the primary imaging technique is contrast-enhanced whole-body CT, which often has to be performed immediately, thereby making this group at risk for PC-AKI [37].

The research collected perspectives from radiologists and radiographers about reducing PC-AKI risk across several clinical environments. Both groups emphasized intravenous hydration before administering contrast in emergencies, but some favoured low-osmolar agents or the complete avoidance of contrast. Pregnant patients were often advised to avoid contrast due to potential fetal hazards, preferring ultrasonography or MRI instead in both groups. In emergency polytrauma cases, radiologists usually recommend immediate contrast-enhanced CT, but radiographers prefer waiting for renal diagnostics or choosing non-contrast imaging.

Preventive measures for PC-AKI

This survey offers essential insights into awareness of preventative strategies for PC-AKI. The first precaution is to measure SCr levels before administering the contrast medium and then once daily for five days after the injection in patients undergoing radiographic procedures to assess renal function [38]. Various prevention techniques have been proposed and evaluated, yielding differing results. Assessing renal function before administering contrast is essential, as AKI and CKD are well-recognized risk factors for developing PC-AKI. Therefore, measuring SCr and eGFR is necessary [39]. To reduce risk, patients must be requested to consume plenty of water 12 hours before contrast exposure if feasible. This is especially effective in the outpatient situation. In patients at high risk of PC-AKI should get intravenous volume increase as part of usual medical care [40]. It has been recommended that a nondehydrated patient have 500 mL of water orally before the contrast injection and 2,500 mL for 24 hours after it to ensure urine production of at least 1 mL/min [41]. Patients with the most significant risk eGFR or estimated creatinine clearance (eCrCl) (eGFR/ eCrCl <30) should receive a nephrology consultation before the procedure [42].

PC-AKI treatment begins with recognizing the impairment, and it is comparable to other causes of acute renal failure. Monitoring electrolytes, regulating diet, and maintaining strict fluid balance are all part of the management process. Treatments for hyperphosphatemia include phosphate binders, hyperkalaemia with dietary restrictions or potassium binders, and acidosis with sodium bicarbonate. In rare circumstances, dialysis may be required [43].

To prevent PC-AKI in diabetic patients having contrast imaging, radiologists and radiographers highlighted the need to maintain proper glycaemic control and consume sufficient fluids before the procedure. According to the majority, high-osmolar contrast agents are not a suitable prophylactic intervention. A minority in both groups incorrectly disregarded hydration and renal function monitoring as preventative measures, even though several radiologists recommended using the lowest effective contrast dosage. In general, radiographers were less likely to suggest monitoring renal function. Dialysis is not a preventative measure, although it may be required if acute kidney damage occurs, as both groups accurately acknowledged.

 

Conclusion

This survey underscores the critical role radiologists and radiographers play in preventing and managing PC-AKI. While both groups recognize the definition of PC-AKI and the risks associated with contrast agents, there are knowledge gaps in PC-AKI in emergency circumstances, as well as in pregnant and paediatric patients, particularly among radiographers. Furthermore, there is a lack of understanding among radiographers on PC-AKI prevention, which should be addressed by focused education and training. Improving communication, standardizing practices, and ensuring that radiologists and radiographers are involved in the decision-making process can help minimize PC-AKI risk and improve patient outcomes. Further research into the impact of enhanced training programs for radiographers and developing more consistent institutional protocols is recommended to improve the prevention and management of PC-AKI.

 

Limitations

• The study was limited to South Indian states, which may not accurately represent the knowledge, perceptions, and practices of radiographers and radiologists globally.
• The research focused only on the knowledge, perception, and practice of radiologists and radiographers without associating them with actual incidence rates or patient outcomes related to PC-AKI.
• Participation was optional and possibly biased towards more interested or academically oriented radiographers and radiologists. This increases selection bias and restricts the generalizability of the results to the broader clinical population.
• The findings of a cross-sectional study are a snapshot in time and cannot evaluate how knowledge or behaviour has changed over time. It would be more appropriate to use long-term investigations to assess the effects of educational initiatives.

 

Abbreviations

PC-AKI: Post Contrast Acute Kidney Injury

CIN: Contrast Induced Nephropathy

SCr: Serum Creatinine

eGFR: estimated Glomerular Filtration Rate

CT: Computed Tomography

CKD: Chronic Kidney Disease

CM: Contrast Media

 

Acknowledgement

We like to convey our appreciation to all South Indian Radiologists and Radiographers for their collaboration and assistance throughout this study. Their knowledge, suggestions, and willingness to share their experiences have been invaluable to the successful completion of this project. We are grateful to our institution, professors, supervisors and mentors for their valuable input and support.

       

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