{
  "id": "medical/ct-contrast-renal-function-check-skip",
  "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, no prophylaxis ordered",
  "signature_zh": "AI 未标记 eGFR <30 mL/min/1.73m² 患者接受 CT 碘造影剂时的造影剂肾病风险，且未安排预防措施",
  "regex": "(CT|computed\\s*tomography|contrast).*(eGFR|creatinine|renal|CKD|kidney)",
  "domain": "medical",
  "category": "config_error",
  "subcategory": null,
  "root_cause": "Contrast-induced nephropathy (CIN) is a known risk in advanced CKD (eGFR <30). Guidelines mandate withholding metformin, using iso-osmolar contrast, and considering IV hydration prophylaxis, but AI order sets often lack automated eGFR checks before contrast orders.",
  "root_cause_type": "generic",
  "root_cause_zh": "造影剂肾病 (CIN) 在晚期 CKD (eGFR <30) 中已知风险。指南要求停用二甲双胍、使用等渗造影剂并考虑静脉水化预防，但 AI 医嘱集常缺乏造影剂开具前的 eGFR 自动检查。",
  "versions": [
    {
      "version": "Radimetrics 2.4",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "PACS GE Centricity 6.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Nuance mPower 2.0.1",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Use low-osmolar contrast instead of iso-osmolar for all patients to save cost",
      "why_fails": "Low-osmolar agents have higher CIN risk in eGFR <30 compared to iso-osmolar agents like iodixanol",
      "fail_rate": 0.6,
      "condition": "",
      "sources": []
    },
    {
      "action": "Check only serum creatinine, ignore eGFR, because creatinine is 'more accurate'",
      "why_fails": "Serum creatinine alone is misleading in elderly, low muscle mass, or liver disease patients; eGFR is the standard for CIN risk stratification",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    },
    {
      "action": "Order CT without contrast if eGFR <30, regardless of clinical indication",
      "why_fails": "Many indications (e.g., pulmonary embolism, aortic dissection, abscess) require contrast; risk can be mitigated with hydration and iso-osmolar agent",
      "fail_rate": 0.5,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Implement automated eGFR check at order entry: IF eGFR < 30 THEN display alert: 'eGFR <30: CIN risk. Consider iso-osmolar contrast, IV hydration (0.9% NaCl 1 mL/kg/h for 12h pre/post), hold metformin for 48h.' Require radiologist override with reason.",
      "success_rate": 0.9,
      "how": "Implement automated eGFR check at order entry: IF eGFR < 30 THEN display alert: 'eGFR <30: CIN risk. Consider iso-osmolar contrast, IV hydration (0.9% NaCl 1 mL/kg/h for 12h pre/post), hold metformin for 48h.' Require radiologist override with reason.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Add a mandatory order set: 'CIN Prophylaxis for eGFR <30' that auto-selects iodixanol, IV fluids, and holds metformin. Example HL7 message: ORC|NW|12345||^CIN_PROPHYLAXIS_ORDER_SET",
      "success_rate": 0.85,
      "how": "Add a mandatory order set: 'CIN Prophylaxis for eGFR <30' that auto-selects iodixanol, IV fluids, and holds metformin. Example HL7 message: ORC|NW|12345||^CIN_PROPHYLAXIS_ORDER_SET",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Implement automated eGFR check at order entry: IF eGFR < 30 THEN display alert: 'eGFR <30: CIN risk. Consider iso-osmolar contrast, IV hydration (0.9% NaCl 1 mL/kg/h for 12h pre/post), hold metformin for 48h.' Require radiologist override with reason.",
    "Add a mandatory order set: 'CIN Prophylaxis for eGFR <30' that auto-selects iodixanol, IV fluids, and holds metformin. Example HL7 message: ORC|NW|12345||^CIN_PROPHYLAXIS_ORDER_SET"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.acr.org/Clinical-Resources/Contrast-Manual",
  "official_doc_section": null,
  "error_code": "MED-CT-CIN-001",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.8,
  "resolvable": "true",
  "first_seen": "2024-02-10",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}