The AMACING race.

As oncologists, we all image patients like crazy. So it’s not uncommon to have a patient, especially a sick one, who needs a contrasted CT scan but just doesn’t have the nephron power you’d hope for. The American College of Radiology currently recommends preventative measures such as intravenous fluids (IVF) with administration of iodinated contrast--typically at least 6 hours before and at least 4 hours after scanning. Turns out this is based more (all?) on intuition with little to no data to back it up. Never to lose a cost-saving opportunity, the Dutch decided to put this time-consuming practice to the test in the AMACING trial: 660 patients with creatinine values of 30-59 were randomized to +/- IVF surrounding a contrasted scan. So how did the fluid-filled fare? There were exactly 8 contrast-induced nephropathies in each the IVF and no IVF arms…and 18 IVF complications.  With bundled payment models on the horizon, clinics will have to go Dutch with a set amount of funds for each patient. So in a race to cut costs, cutting the hours of IVF for every patient with an creatinine <60 getting a contrasted scan seems like a good place to start.