RD6.1 | Procedure-specific Written and Verbal Patient Instructions — Summary & Reflection

KEY TAKEAWAYS

Procedure-specific Patient Preparation — Key Points

• Preparation is a clinician responsibility at the point of referral, delivered in BOTH written and verbal form (RD6.1); each channel covers the other's weakness, and a teach-back check confirms understanding.
• Every instruction protects either image quality (fasting, bladder filling, bowel prep) or patient safety (contrast and device screening). Name the goal to reason from principles, not memory.
• Ultrasound abdomen: fast 4–6 hours (gallbladder distension). Pelvic/obstetric transabdominal: full bladder (drink, do not void); transvaginal: empty bladder.
• Barium meal/swallow: ~6-hour fast. Barium enema: low-residue diet + laxative + cleansing enema.
• Iodinated contrast (CT/IVU): confirm eGFR (CA-AKI risk at eGFR <30); hydrate; withhold metformin from time of contrast for 48 h if eGFR <60, resume after renal review; check allergy/prior reaction.
• Gadolinium (MRI): avoid at eGFR <30 (NSF risk).
• MRI environment: remove all metal; screen for pacemaker/ICD, cochlear implant, aneurysm clip, intra-ocular metal (orbital X-ray for metal workers). The magnet is always on.
• Exclude pregnancy before any ionising study. Verify preparation and screening AT THE DOOR — an unknown eGFR is a red flag, not a normal value.

REFLECT

Think back to the last imaging request you saw made on a ward round or in clinic. Ask yourself: (1) Was the patient given preparation instructions in BOTH written and verbal form, tailored to the specific procedure — or just told 'go for a scan'? (2) For any contrast study, was the eGFR checked and the metformin question addressed before the patient left? (3) For any MRI, was device and metal screening done, and for any ionising study in a woman of reproductive age, was pregnancy excluded? Now imagine you are the ordering clinician next time: rehearse, in one or two sentences, exactly what you would write and what you would say to that patient. Building this habit — never ordering a scan without simultaneously planning its preparation — is what turns RD6.1 from an examination topic into a reflex that protects every patient you refer.