{
  "id": "medical/contrast-induced-nephropathy-missed",
  "signature": "AI fails to flag contrast-induced nephropathy risk for a patient with eGFR <30 mL/min/1.73m² scheduled for CT with IV iodinated contrast",
  "signature_zh": "人工智能未能提醒接受CT碘对比剂检查且eGFR<30 mL/min/1.73m²患者的对比剂肾病风险",
  "regex": "contrast.*(?:CT|angiography|nephropathy|eGFR|creatinine).*administer",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "The AI model omitted a mandatory renal function check before contrast administration, ignoring the KDIGO guideline that requires eGFR assessment within 7 days and alternative imaging or prophylaxis for patients with eGFR <30.",
  "root_cause_type": "generic",
  "root_cause_zh": "AI模型在对比剂给药前遗漏了强制性肾功能检查，忽略了KDIGO指南要求在7天内评估eGFR，并对eGFR<30的患者采用替代影像学或预防措施。",
  "versions": [
    {
      "version": "Radiology Information System v5.2.1",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Epic Radiant 2024",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "DICOM Conformance Statement 3.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "In patients with severe renal impairment (eGFR <30), standard saline hydration is insufficient to prevent CIN without withholding contrast entirely or using iso-osmolar contrast agents.",
      "fail_rate": 0.65,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Multiple large RCTs (e.g., ACT trial) have shown N-acetylcysteine provides no benefit over placebo for preventing CIN in high-risk patients.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Even low-volume contrast can cause nephropathy in eGFR <30 patients; the only safe approach is alternative imaging (MRI, ultrasound) or hemodialysis planning.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Check eGFR within 7 days prior to contrast; if eGFR <30, order non-contrast MRI or ultrasound instead of CT. Document in EHR: 'CIN risk - alternative imaging selected.'",
      "success_rate": 0.95,
      "how": "Check eGFR within 7 days prior to contrast; if eGFR <30, order non-contrast MRI or ultrasound instead of CT. Document in EHR: 'CIN risk - alternative imaging selected.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "If contrast is unavoidable (e.g., for acute pulmonary embolism), pre-administer 0.9% saline 1 mL/kg/h for 12 hours, use iso-osmolar contrast (iodixanol), and schedule post-procedure hemodialysis if eGFR <15. Implement in order set: 'CONTRAST-CIN-PROTOCOL'.",
      "success_rate": 0.8,
      "how": "If contrast is unavoidable (e.g., for acute pulmonary embolism), pre-administer 0.9% saline 1 mL/kg/h for 12 hours, use iso-osmolar contrast (iodixanol), and schedule post-procedure hemodialysis if eGFR <15. Implement in order set: 'CONTRAST-CIN-PROTOCOL'.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Integrate a CDS (Clinical Decision Support) rule into the CPOE system: if contrast order AND eGFR <30, block order and display: 'eGFR <30: CIN risk. Alternative imaging required. Contact radiology.'",
      "success_rate": 0.9,
      "how": "Integrate a CDS (Clinical Decision Support) rule into the CPOE system: if contrast order AND eGFR <30, block order and display: 'eGFR <30: CIN risk. Alternative imaging required. Contact radiology.'",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Check eGFR within 7 days prior to contrast; if eGFR <30, order non-contrast MRI or ultrasound instead of CT. Document in EHR: 'CIN risk - alternative imaging selected.'",
    "If contrast is unavoidable (e.g., for acute pulmonary embolism), pre-administer 0.9% saline 1 mL/kg/h for 12 hours, use iso-osmolar contrast (iodixanol), and schedule post-procedure hemodialysis if eGFR <15. Implement in order set: 'CONTRAST-CIN-PROTOCOL'.",
    "Integrate a CDS (Clinical Decision Support) rule into the CPOE system: if contrast order AND eGFR <30, block order and display: 'eGFR <30: CIN risk. Alternative imaging required. Contact radiology.'"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.kdigo.org/guidelines/ckd-evaluation-and-management/",
  "official_doc_section": null,
  "error_code": "CIN-RISK-01",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.82,
  "resolvable": "partial",
  "first_seen": "2024-03-15",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}