In patients with no evidence of AKI and with eGFR ≥30 mL / min/1.73m2 , there is no need to discontinue metformin either prior to or following the intravenous administration of iodinated contrast media, nor is there an obligatory need to reassess the patient’s renal function following the test or procedure.

**Cetirizine (Zyrtec®) is a selective antagonist of the histamine H1 receptor. Previous protocols for premedication in pediatric patients with a history of allergic-type reactions to iodinated contrast have recommended the use of diphenhydramine (Benadryl®) instead of cetirizine. The advantage of cetirizine is that it is not associated with the side effect of drowsiness that accompanies the use of diphenhydramine (Benadryl®).  For families or referring providers who have a preference for the use of diphenhydramine (Benadryl®), pediatric dosing is as follows: Diphenhydramine 1 mg/kg by mouth 1 hour prior to imaging study.

Patients with extravasation should be assessed and reassured by a radiologist, and referred to the Emergency Department if there is skin blistering, altered tissue perfusion, increasing pain, or change in sensation distal to the site of extravasation. In all cases, it is critical that the responsible radiologist communicates directly with the patient, referring physician, and Emergency Department as appropriate and documents these communications in the report or medical record.

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The list in brief 1. Best Overall 2. Content Creators 3. Budget 4. 4K/60fps 5. Image Quality 6. 2K 7. Other Webcams We Tested 8. How We Test 9. Shopping Tips 10. Discounts

A prior allergic-like reaction to intravascular iodinated contrast is the most substantial risk factor for a recurrent reaction upon future contrast administration. Up to 35% of patient will experience a recurrence if no premedication prophylaxis is given. Importantly, patients with a mild index reaction have a very low risk (< 1%) of developing a moderate or severe reaction in the future (2).

In patients with a history of prior moderate or severe prior allergic-type reaction to iodinated contrast or in patients in whom the severity of a prior allergic-type contrast reaction is unknown, oral premedication prophylaxis with a corticosteroid and an antihistamine beginning 12 hours prior to expected contrast administration as outlined below should be strongly considered. In patients in whom more rapid imaging must be obtained, the accelerated premedication protocol outlined below showed non-inferiority to a more traditional longer protocol in a recent retrospective single institution series (5). For several reasons, it is preferable for referring physicians to prescribe the premedication regimen, although other arrangements may be possible depending on individual circumstances.

The Razer Kiyo Pro is a good 1080p/60fps option for those who don't need (or want) the 4K resolution of the Kiyo Pro Ultra. It drops the built-in ring light we saw in its predecessor (the Razer Kiyo), and has a design that looks a lot like its 4K successor (the Kiyo Pro Ultra), minus the convenient built-in privacy shutter (it does come with a lens cover, though).

The Dell Pro Webcam is a good plug-and-play webcam — it performed well in all of our lighting scenarios right out of the box. It was especially impressive in our low-light test scenario, as it’s one of the only webcams we’ve reviewed that has managed to adequately light both the foreground and the background in a near-dark setting. It also features Digital Overlap HDR.

Acute adverse reactions to the intravascular administration of iodinated contrast material occur in < 1% of patients. The majority of reactions are mild non-life-threatening events that usually only require observation, reassurance, and/or supportive measures. Severe and potentially life-threatening adverse events do occur rarely (~0.04%) and unpredictably however. Nearly all life-threatening reactions occur within the first 20 minutes after contrast medium injection.

Safe intravenous access, for the injection of intravenous contrast, is vital in obtaining high quality contrast enhanced or angiographic studies. Proper technique is used to avoid the potentially serious complications of contrast media extravasation, air embolism, and damage to the catheter. When the proper technique is used, contrast medium can safely be administered intravenously by power injector, at high-flow rates of up to 2 mls/second (depending on size of patient). A short peripheral IV catheter in the antecubital or forearm area is the preferred route for intravenous contrast administration. However other routes may need to be used and each is considered separately.   Learn more

Best Budget Webcam The Modern Webcam is a budget-friendly 1080p/30fps webcam with a simple plug-and-play design and a built-in stand. It's not perfect, but it can usually be found for under $50.

The use of premedication to prevent recurrent allergic reactions to intravascular iodinated contrast remains controversial. One randomized controlled trial showed that premedication decreased the rate of allergic-like reactions in average-risk (with or without prior history of allergic-like reaction) patients exposed to older high-osmolar iodinated contrast (3). This trial is not directly applicable to modern practice since the contrast medium (high osmolar contrast) is no longer in clinical use and because the patients studied included all patients rather than the patients with a history of prior allergic-type reaction who are targeted for premedication in modern practice. A second smaller randomized controlled trial did investigate prevention of allergic-type reactions in patients exposed to modern low-osmolar iodinated contrast, however this trial again enrolled average risk patients rather than only patients with a history of prior allergic-type reaction (4). This trial showed that in average risk patients premedication prophylaxis did decrease the overall rate of allergic-type reaction (4.7% vs. 1.7%) and of mild reactions (1.9% vs 0.2%) but did not show statistically significant reductions in moderate or severe reactions. It remains an open question whether this trial failed to show a reduction in moderate or severe reactions because premedication prophylaxis is not effective in this regard or whether the trial was underpowered to capture a difference in these uncommon events. Finally, it is important to note that at least 2% of patients with a history of prior allergic-type reaction will still experience a recurrent reaction (“breakthrough reaction”) despite receiving premedication prophylaxis. In most cases the severity of the breakthrough reaction will be similar to that of the index reaction.

*Estimated glomerular filtration rate (eGFR) is estimated from serum creatinine levels and is considered the best overall index of kidney function. In adults, the CKD-EPI equation is used to estimate GFR. In pediatric patients, the Bedside Schwartz equation is considered the best equation for estimating glomerular filtration rates. This equation requires knowledge of the patient’s height in addition to serum creatinine.

The Microsoft Modern Webcam comes with an intuitive, if not particularly powerful app that's designed to look like a Windows menu. You can use the app to turn on and customize this webcam's special features, which include flicker reduction and HDR mode.

Pallav Kolli, Brett Elicker, Fergus Coakley, Kerry Cho, Charlene Fong, Tina Hampton, Roy Gordon, John Mackenzie, and Ron Zagoria (Updated 7/20/18)

***Prior UCSF recommendations for corticosteroid prophylaxis recommended the use of EITHER methylprednisolone (Solu-Medrol®) OR prednisone to be given 12 and 2 hours prior to imaging studies. We have simplified this recommendation to only include methylprednisolone for two reasons: 1) To simplify the recommended premedication protocol by only including one medication, and 2) the relevant randomized control trial utilizing prednisone did so with dosing at 13, 7, and 1 hours prior to contrast administration (not 12 and 2 hours as per prior and current UCSF protocols). In situations where a patient or referring clinician strongly prefers to use prednisone instead of methylprednisolone for corticosteroid prophylaxis, this should ideally be given as prednisone 50 mg orally 13, 7, and 1 hour prior to imaging study.

The UCSF Department of Radiology routinely screens patients undergoing CT examinations to identify those individuals with chronic kidney disease and thus at potential risk of acute kidney injury and recommends volume expansion therapy to mitigate the risk in this subgroup.

+In order to standardize understanding of the effects of nephrotoxic events on kidney function, the diagnosis of acute kidney injury (AKI) should be used according to the Acute Kidney Injury Network criteria. These criteria define specific changes in serum creatinine or urine output within 48 hours of a nephrotoxic event necessary to make the diagnosis of acute kidney injury.

The Facecam MK.2 is a nice upgrade to the original Facecam, but it's just... not that different. It's got the same basic specs as its predecessor — 1080p/60fps video, a f/2.4 aperture fixed-focus lens, and an 82-degree field of view.

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Razer’s first 4K webcam, the Kiyo Pro Ultra, has the largest sensor ever put in a webcam — a 1/1.2-inch Sony Starvis 2, with a wide f1.7 aperture — as well as 4x digital zoom, an adjustable field of view (72 - 82 degrees), and a nicely-integrated physical privacy shutter. It’s a large but relatively lightweight webcam, and it has the same detached-DSLR lens aesthetic as its predecessors.

The Dell Pro Webcam looks similar to its pricier sibling (but... cheaper). It has a plastic chassis, a magnetic lens cap, a non-detachable USB-A cable, and a built-in monitor clamp — it’s definitely less “premium” than the Dell Ultrasharp, but it’s well built and still looks relatively sleek sitting on top of your monitor.

Nvidia introduces a new merged CPU and GPU AI processor — GB200 Grace Blackwell NVL4 Superchip has four B200 GPUs, two Grace CPUs

Contrast medium dose: There is no clear dose-toxicity relationship for contrast medium injected INTRAVENOUSLY. Therefore, there is no defined threshold of contrast administration above which additional intravenous iodinated contrast should be withheld. The decision to administer closely spaced contrast-enhanced studies is thus considered by the American College of Radiology to be clinical and subjective, where high-risk patients are treated with greater caution than the general population.

Most web conferencing apps limit your streaming resolution to 1080p or 720p, but that doesn’t mean a webcam with a higher resolution is completely wasted. If you plan on zooming in to crop out your background, the 2K WB5023 Dell Pro Webcam is similarly priced to the Brio 500, offers impressive out-of-the-box performance, and outputs a 2K resolution, which will give you a touch more detail in closer shots.

It's impossible to recommend a universally perfect webcam, because there are so many different ways to use webcams these days. And there are so many different types of webcams these days — from standard HD (1080p) to 4K resolution, with different lenses and sensors and AI-powered tech. You shouldn't just grab an ultra high-res 4K and call it a day — most of the common video conferencing platforms (e.g. Zoom, Google Meet, Microsoft Teams) don't even support resolutions higher than 1080p (if that).

Performance-wise, it displays good auto-exposure and white balancing in well-lit and low-light scenarios, but the HDR was underwhelming. It's a good webcam, but the Logitech Brio 500 has better out-of-the-box image quality, a better built-in shutter design, and is cheaper.

First, the patient’s electronic medical record is searched to determine whether a serum creatinine and an estimated glomerular filtration rate (eGFR) acquired within the past 6 weeks are available for outpatients and within the last 7 days for inpatients.

Best 4K Webcam The Facecam Pro is a 4K/60fps webcam — that's right, 60fps — with a 90-degree field of view and an excellent autofocus lens. It comes with some pretty robust software and is a good option for content creators who need those 60fps.

Our first round of shooting uses the camera's default, out-of-the-box settings. We then manually adjust the camera's settings using the camera's companion software, if applicable. If the camera doesn't come with software, we use a third-party application (YouCam 9) to adjust its settings. We take our photos using the Windows Camera app for consistency.

The incidence and risk factors for contrast-induced nephropathy have not been well-studied in pediatric patients. The effect of intravascular iodinated contrast on kidney function is generally assumed to be similar between children and adults.

Pulmonary edema is a rare severe reaction that can occur in patients with tenuous cardiac reserve (cardiogenic pulmonary edema) or in patients with normal cardiac function (noncardiogenic pulmonary edema).  Noncardiogenic pulmonary edema can be allergic-like or physiologic; if the etiology is unclear, it may be judicious to assume that the reaction is/was an allergic-like one.

Safe intravenous access, for the injection of intravenous contrast, is vital in obtaining high quality contrast enhanced or angiographic studies. Proper technique is used to avoid the potentially serious complications of contrast media extravasation and/or air embolism. When the proper technique is used, contrast medium can safely be administered intravenously by power injector, at high-flow rates of up to 5 mls/second. A short peripheral IV catheter in the antecubital or forearm area is the preferred route for contrast administration. However other routes may need to be used and each is considered separately.  Learn more

It adds onboard storage, HDR, and 4x digital zoom, and has been redesigned with a built-in privacy shutter and a lower-profile chassis. It's also cheaper at $150 (the original Facecam debuted at $200).

Acute contrast reactions can be categorized as allergic-like (e.g. urticaria, bronchospasm, erythema, facial edema, laryngeal edema, anaphylactic shock) or physiologic (e.g. nausea/vomiting, hypertension, vasovagal reactions, arrhythmia). Reactions are further classified as mild, moderate, or severe in nature (Table 1).

Multiple subsequent studies have since used propensity score adjustment and propensity score matching to correct for selection bias that may have limited prior studies [9-13]. Taken collectively, we can conclude from these studies that intravenous iodinated contrast administration is only rarely associated with acute kidney injury in patients with stable eGFR >30mL/min/1.73m2. These studies have come to conflicting conclusions as to whether intravenous administration of iodinated contrast is associated with acute kidney injury in patients with eGFR < 30 mL/min/1.73m2.

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Higher risk. This cohort of patients appears to be at greatest risk for post-contrast acute kidney injury after administration of intravenous iodinated contrast. Contrast should not be administered unless the patient is on dialysis and anuric, or if contrast is considered diagnostically imperative and the benefits of contrast outweigh the risk of post-contrast acute kidney injury. If the patient meets these criteria, the referring attending physician should document the need for contrast and that the benefit of contrast outweighs the risk of post-contrast acute kidney injury in the patient’s medical record.  Pre-procedural prophylaxis again post-contrast acute kidney injury with intravenous volume expansion therapy should be utilized. The optimal IV volume expansion protocol is unknown and ideally should be tailored to the patient’s volume status and medical conditions, which may necessitate discussion between the referring physician and the radiology team. Suggested protocols:

Many other interventions have previously been proposed to reduce the incidence in patients and are deserving of further mention:

The decision to administer contrast in patients undergoing CT should always be a matter of clinical judgment based on the individual circumstances of the patient and following consultation between the radiologist and requesting provider when necessary. Patients with chronic kidney disease (CKD) whose estimated glomerular filtration rates* are < 30 mL/min/1.73m2 may be at risk for developing post-contrast acute kidney injury, an uncommon but potentially serious form of acute kidney injury (AKI). The method of contrast delivery is also important; the incidence of post-contrast acute kidney injury is higher after intra-arterial contrast administration than after intravenous contrast administration.

Like most (all) ultra-high-res 4K webcams, the Elgato Facecam Pro isn’t for everyone — remember, web conferencing apps such as Zoom, Microsoft Teams, and Google Meet, limit your outgoing stream to 720p or 1080p at most. The Facecam Pro is not only capable of producing a high-res 4K image, it’s able to output a 4K stream at 60fps. For context, other 4K webcams max out at 4K/30fps; the Facecam Pro is the first and only webcam capable of 4K/60fps streaming.

Most video conferencing apps cap streaming video quality at 1080p, so a 2K webcam might not seem any more usable than a 4K webcam in that regard. However, a higher resolution webcam can still make a difference if you plan on zooming in (perhaps to crop out your background), so it’s not just content creators who can benefit.

The Microsoft Modern Webcam is cheaper and more readily available than everyone's favorite old standby, the Logitech C920. Plus, the Modern Webcam has more features and offers better color reproduction than its 12-year-old competitor.

Best Image Quality The Kiyo Pro Ultra is a 4K/30fps webcam with an extra-large sensor and a wide aperture with a shallow depth-of-field — meaning it will give your images that blurred background effect without software.

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The Link offers unparalleled image quality, thanks to its 1/2-inch sensor and 4K resolution. But — more importantly — the Link has some of the best auto-exposure, color reproduction, and auto-focus we’ve ever seen in a webcam. Most webcams have difficulty adjusting between different lighting scenarios (especially quickly), and while the Link isn’t perfect, it’s very good at adjusting on the fly. This, combined with the webcam’s 3-axis gimbal and AI-powered movement tracking, makes the Link a very powerful contender for content creators who move a lot, or for professional or educational presentations.

The Insta360 Link is an AI-powered 4K webcam perched on a 3-axis gimbal, packed with a variety of capture modes and features that will appeal to content creators such as AI movement tracking, and offers incredibly impressive color reproduction and auto-exposure. This doesn’t come cheap — the Link is one of the pricier webcams on this list with a retail price of $300 — but it's inline with other 4K options.

Best Webcam for Most People The Brio 500 is a 1080p/30fps webcam with a flexible, 90-degree field of view and impressive auto-white balance and auto-exposure right out of the box. It performs well in a variety of lighting conditions and is a great choice for chatting with family, friends, and coworkers.

We then shoot test photos in three lighting conditions: (1) well-lit, with bright lighting both in front of and behind the subject; (2) backlit/overexposed, with bright light behind the subject and one 27-inch monitor in front of the subject; and (3) low-light, with no lighting aside from one 27-inch monitor in front of the subject. Our home office lighting is completely controlled.

The Link is a very impressive webcam — maybe a little too impressive. Realistically, the Link is probably overkill for all but a very small user demographic. 4K resolution isn’t even possible in most web conferencing apps, and capture modes such as “portrait mode,” “top-down mode,” and “desktop mode” are fun to play with but aren’t terribly beneficial unless you already know how you’re going to use them. Remember, this is still a webcam — it needs to be connected to a computer to work, so it's not as versatile as a standalone action cam, like a GoPro.

For use in patient with prior moderate, severe, or unknown contrast reaction when clinical situation warrants imaging sooner than allowed (12 hrs) with standard protocol

It doesn't matter if you're video conferencing with coworkers, chatting with family members, or live streaming to an audience of thousands — you want to look good! Or, at least, like you're not using a laptop from 2004.

However several studies have shown that in patients who receive intravascular iodinated contrast, those that develop post-contrast acute kidney injury (PC-AKI) tend to have longer hospital stays, higher mortality, and higher incidence of cardiac and neurologic events than patients who do not develop acute kidney injury. These results must be interpreted with caution however: these studies did not include cohorts of patients who did not receive iodinated contrast. It is therefore not possible to conclude if patients who developed acute kidney injury did so as a result of receiving contrast versus alternative causes of acute kidney injury. It also impossible to conclude whether the increased morbidity and mortality seen in patients with PC-AKI is associated with intravascular iodinated contrast exposure or due to some other factor such as the underlying comorbid diseases present in these patients.

A Radiology nurse or a Radiology technologist may administer intravenous contrast media under the general supervision of a physician. This policy applies for all areas in the Department of Radiology and Biomedical Imaging where intravenous iodinated contrast media is given. In order to provide for the safe administration of contrast media, those persons administering contrast media and those performing the imaging procedures must have an understanding of indications for use of contrast media as well as the potential side effects (contrast reactions) and their management.

While this may not be too much of a problem for the casual user, professional streamers and content creators who are looking for precise control over their streaming output will probably be better off with the Insta360 Link or the Elgato Facecam Pro — both similarly-priced 4K webcams with very usable software.

There are two primary strategies to reduce the incidence of post-contrast acute kidney injury in at-risk patients. The first strategy is to avoid contrast entirely when it is not required to establish the diagnosis or when another imaging modality may be used to answer a clinical question. The second strategy is to utilize peri-exposure volume expansion therapy. The use of volume expansion therapy is based upon studies that have shown decreased rates of post-contrast acute kidney injury in patients receiving volume expansion therapy. But it should be noted that these studies are heterogeneous, with many performed in patients undergoing intra-arterial administration of iodinated contrast.

After managing an acute adverse event to intravascular contrast exposure, it is critical to analyze the event and determine whether the patient experienced an allergic-like reaction. Allergic-type reactions should be further classified by severity. The most substantial risk factor for the development of an acute allergic-like reaction to intravascular iodinated contrast is a prior allergic-like reaction to intravascular iodinated contrast. Thus, any allergic-like reaction should be documented as an allergy in the patient’s electronic medical record so that appropriate prophylaxis (reviewed in the next section) can be considered prior to future administration of intravascular iodinated contrast material.

Whether you're shopping for one of the best webcams or one that didn't quite make our list, you may find savings by checking out the latest Logitech promo codes, Newegg promo codes, Amazon promo codes, Razer promo codes or Micro Center coupons.

Patients on dialysis can receive IV contrast, and early post-procedural dialysis is NOT routinely required. However, the fact that a patient is on dialysis should NOT be regarded as automatically allowing the administration IV contrast. The Nephrology Service is readily available for consultation in problematic cases.

Historically, the greatest concern over the use of intravascular iodinated contrast for imaging studies has been the possibility that contrast could have an adverse effect on kidney function. This possible adverse effect has been termed contrast-induced nephropathy (CIN). Concern for CIN is rooted in early literature suggesting a correlation between intravascular iodinated contrast administration and subsequent decreases in kidney function (as measured by serum creatinine tests). However these early studies were limited in several ways: 1) they did not include control groups of patients who did not receive intravascular iodinated contrast, 2) many studies were performed in the era of older high-osmolar contrast media whereas contrast media in current use are universally low- or iso-osmolar, 3) the definition of CIN varied between studies, and 4) many studies evaluated the effects of intra-arterial administration of iodinated contrast rather than intravenous administration, as is commonly performed for non-invasive imaging studies. Given the confounding factors present in these previous studies, the American College of Radiology has adopted the term post-contrast acute kidney injury (PC-AKI) for any sudden deterioration in renal function that occurs within 48 hours following intravascular administration of iodinated contrast and reserves the term contrast-induced nephropathy (CIN) for PC-AKI that is caused by intravascular administration of iodinated contrast.

This is, hands-down, one of the best webcams we’ve tested when it comes to image quality — it has excellent auto-exposure and color balancing and a shallow depth of field that gives you a nice blurred-background effect without using software. Its impressive image quality was most apparent in our well-lit test setting, but it also did pretty well in our low-light and overexposed scenarios (once we tweaked some settings). The crispness and clarity of the picture is shockingly good, even compared to other 4K webcams — and while the average person probably doesn’t need (and can’t even use) such ultra-HD streaming, this does mean a better picture for lower-resolution streams, especially if you’re zooming and cropping.

The Logitech Brio 500 is the first new Logitech webcam (for non-creators) in over a decade, and while its 1080p/30fps resolution may sound underwhelming, its performance is not. Armed with a flexible 90-degree field of view and Logitech’s "RightLight 4" image adjustment technology, the Brio 500 produces an impressive, exposure-balanced image right out of the box and is a great choice for most people.

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In patients with a history of prior mild reaction (limited hives/itching, limited cutaneous edema, limited “itchy/scratchy” throat, nasal congestion, or sneezing/conjunctivitis/rhinorrhea), either no premedication prophylaxis or premedication consisting of only an antihistamine prior to the planned imaging study is recommended (protocol below). This recommendation is based on the following rationale: 1) mild allergic-type reactions do not typically require medical treatment, 2) patients with a mild allergic-type reaction have a very low risk (< 1%) of developing moderate or severe reactions in the future, 3) the effectiveness of corticosteroid prophylaxis for preventing this type of reaction is uncertain. In fact, in one retrospective study, patients with a history of prior mild allergic-type contrast reaction had lower rates of breakthrough reactions when they had received an antihistamine alone as opposed to either a corticosteroid alone or a corticosteroid and antihistamine (2).

It should also be noted that the common belief that dialysis patients require early post-procedural dialysis is unsupported by clinical studies and expert guidelines. Dialysis pre-procedure may be desirable, particularly if a large dose of contrast is anticipated or in patients with heart failure.

The MX Brio produces balanced, evenly-lit images that work especially well in a professional setting, and this webcam is aimed at business users (rather than gamers/streamers/creators). It's not quite as dramatic or as detailed as the creator-focused 4K webcams we've tested (but it's also cheaper, at $200).

Contrast extravasation is the accidental extravascular injection of intravascular contrast media caused by dislodgment of the cannula, contrast leakage from the vessel puncture site, or rupture of the vessel wall. Contrast extravasation is a well-recognized complication, with reported frequencies of 0.25% (56/22,254), 0.7% (475/69,657) and 0.9% (48/5,106) in three large CT series where power injectors were used [1-3]. Extravasation usually causes some combination of immediate pain, erythema, and swelling, but fortunately these are usually self-limiting and long-term major morbidity is rare [4]. However, severe skin and subcutaneous ulceration can occur, and subfascial extravasation may cause compartment syndrome (neurovascular signs and symptoms due to increased volume in the confined spaces formed by the deep fascia). These major complications may occur even with small volume (< 10cc) extravasations and non-ionic contrast media [4, 5]. Only 1 patient required fasciotomy for compartment syndrome in a series of 475 extravasations [2].

The Kiyo Pro features a large, impressive light sensor that boosts the image in low-light conditions, as well as HDR, an adjustable field of view (80/90/103-degrees), and records uncompressed 1080p/60fps video.

Sarah Jacobsson Purewal is a senior editor at Tom's Hardware covering peripherals, software, and custom builds. You can find more of her work in PCWorld, Macworld, TechHive, CNET, Gizmodo, Tom's Guide, PC Gamer, Men's Health, Men's Fitness, SHAPE, Cosmopolitan, and just about everywhere else.

Best Webcam for Content Creators The Link is a 4K/30fps webcam that comes on its own AI-powered 3-axis gimbal. It's definitely overkill for most users, but it's got the best auto-exposure and color reproduction we've seen on a webcam.

The Facecam Pro’s design isn’t particularly impressive — it’s bulky, boxy, and large — but the webcam is relatively lightweight and easy to maneuver, whether you place it on the included monitor mount or attach it to a tripod. It does lack a physical privacy cover, which seems like a pretty big oversight given how incredibly detailed and high-def the webcam’s picture is (plus, the Elgato Facecam came with a privacy cover).

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Cardiopulmonary arrest is a nonspecific end-stage result that can be caused by a variety of the following severe reactions, both allergic-like and physiologic.  If it is unclear what etiology caused the cardiopulmonary arrest, it may be judicious to assume that the reaction is/was an allergic-like one.

Nurses, technologists, and/or radiologists administering intravascular iodinated contrast media must first assess the patient for risk factors predisposing them to an adverse reaction to iodine contrast. This is achieved by completion of the Patient Screening Form For Iodinated Contrast (pdf). Patients also receive the Patient Information Leaflet for CT (Appendix B) at this time. The patient (or their parent/guardian) indicates:

eGFR Caluclators:  GFR Calculator for Adults (for patients 18 and older) and GFR Calculator for Children, from the National Kidney Disease Education Program website.

Caring for patients with acute contrast reactions requires a prepared team, adequate resources available for immediate management, and knowledge of how to activate additional resources to assist in caring for severely ill patients. Initial assessment of a patient experiencing an acute contrast reaction should include an assessment of how the patient looks, whether the patient can speak and how his or her voice sounds, an assessment of the patient’s breathing, and measurement of vital signs. Treatment should then proceed as indicated based on the nature and severity of the acute contrast reaction.

Finally, it is important to consider the morbidity and mortality resulting from post-contrast acute kidney injury. The usual course of post-contrast acute kidney injury consists of a transient asymptomatic elevation in serum creatinine. Serum creatinine usually begins to rise within 24 hours of intravascular iodinated contrast medium administration, peaks within 4 days, and often returns to baseline within 7 to 10 days. It is unusual for patients to develop permanent renal dysfunction.

We were especially impressed with the Brio 500’s auto-white balance, which is something almost all webcams struggle with: it wasn’t perfect, but it was almost as impressive as the auto-white balance seen on much pricier webcams, such as the Insta360 Link. Logitech’s "RightLight 4" technology, which is designed to compensate for less-than-ideal lighting situations, did an excellent job of producing flattering, evenly-lit images in both low and overexposed lighting.

In patients taking metformin who are known to have acute kidney injury or severe chronic kidney disease (stage IV or stage V; i.e., eGFR< 30), or are undergoing arterial catheter studies that might result in emboli (atheromatous or other) to the renal arteries, metformin should be temporarily discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been re-evaluated and found to be normal.

The webcam's built-in stand is convenient (and impossible to lose), but it doesn't allow the camera to swivel or rotate for better shooting angles. Logitech's C920 shares this limitation, but there are cheaper options that offer more flexibility. If you're looking for a webcam that costs and performs in the C920's space, the Microsoft Modern Webcam does a better job of reproducing colors more vividly and accurately, and has advanced options such as HDR. It's an easy choice, so long as your monitor isn't too curvy on the back.

Metformin (Glucophage®) is an oral hypoglycemic agent that is eliminated by renal excretion. The most significant potential adverse effect of metformin therapy is the development of metformin-associated lactic acidosis, a rare but serious condition that can be fatal. Any factors that decrease metformin excretion from the kidney or increase blood lactate levels may theoretically increase the risks for patients to develop metformin-associated lactic acidosis.

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For several reasons, it is preferable for referring physicians to prescribe the premedication regimen, although other arrangements may be possible depending on individual circumstances. An APEX smartset has been created to facilitate prescribing of recommended premedication regimens and can be accessed by searching for “contrast premedication".  Patients with a history of prior severe reaction will be imaged at a facility where rapid access to a higher level of care is available (Moffitt-Long Hospital, Mount Zion Hospital, Mission Bay Hospital).

We test each of our webcams by inspecting its specs, design, and build quality, as well as how easily its lens can be covered for privacy. We also test the stability and flexibility of any built-in or included monitor stands.

As soon as an extravasation is detected, the contrast infusion should be stopped immediately, the catheter removed, and the local overseeing radiologist notified. The affected extremity should be elevated above the heart and cold compresses applied topically. The radiologist evaluating the patient will decide whether the patient can be managed by observation in Radiology for 1-2 hours or requires transfer to the Emergency Department for possible review by Plastic Surgery. Indications for transfer to Emergency Department include skin blistering, altered tissue perfusion, increasing pain, or change in sensation distal to the site of extravasation. Given that there is only a limited relationship between the volume extravasated and the severity of complications, it has been suggested that “only signs and symptoms should be used as criteria for plastic surgery consultation and additional treatment”, and ED referral based purely on the volume extravasated is probably unjustified [2]. Similarly, performing a CT or radiograph of the extremity for large extravasation is of doubtful utility, other than in cases where the extravasation may be subfascial and may cause a compartment syndrome. If the patient is transferred to the Emergency Department, the patient must be escorted. Irrespective of the treatment plan, it is CRITICAL that the radiologist communicates appropriately with the referring physician and the Emergency department. In addition a radiologist at Moffitt from the responsible imaging section should be notified so that the patient can be visited as soon as possible in the Emergency Department. All evaluations and communications must be documented, either in the dictated report or medical record. Patients who are sent home after observation should be given discharge instructions that include the phone number for the patient to call a nurse in Radiology, 353-1564, or go to the nearest Emergency Department if severe problems develop. The technologist or nurse must complete an incident report on-line. The Radiology safety nurse will follow up on all cases of extravasation.

The MX Brio is Logitech's update to the Brio 4K — the first 4K webcam... ever. The MX Brio sports the same resolution (4K/30fps, 1080p/60fps) as its predecessor but has an upgraded sensor and improved software for an image that's twice as detailed as the Brio 4K. It's also got a nice new look — a sleek aluminum chassis with a convenient integrated privacy shutter.

Small children, the elderly, and unconscious patients are at higher risk for extravasation, partially because of reduced reporting of injection site pain [4]. Other risk factors are use of an injection site other than the antecubital fossa, use of an indwelling venous cannula that has been in place for over 24 hours, and multiple attempts at venous access [4, 6]. When extravasation does occur, complications are more severe in extremities with poor vascular or lymphatic circulation (e.g., on the side of a prior mastectomy with radiation or lymph node dissection) or when extravasation occurs on the dorsum of the hand of foot [4]. Based on these considerations, and realizing that prevention is the key to avoiding contrast extravasation, the following practice guidelines are suggested:

Signs and symtoms are often life-threatening and can result in permanent morbidity or death if not managed appropriately.

The UCSF Department of Radiology employs a practical but conservative approach to managing patients with a prior history of allergic-type reaction to intravascular iodinated contrast, stratified by severity of prior reaction.

Patients on dialysis can receive IV contrast, but the fact that a patient is on dialysis should NOT be regarded as automatically allowing the administration IV contrast, because of several potential hazards, including:

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Based on existing evidence, the UCSF Department of Radiology employs a practical but conservative approach to screening and volume expansion for the prevention of post-contrast acute kidney injury:

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While these hazards of giving IV contrast to dialysis patients may be relatively small, these risks should be weighed against the likely diagnostic benefit of contrast administration. The Nephrology Service is readily available for consultation in cases where the risk/benefit assessment is complicated, and closely follows all hospitalized dialysis patients.

Many patient-specific factors have been proposed as placing patients at risk for CIN. At present the most studied and accepted risk factor for CIN is pre-existing severe renal insufficiency, as described above. Other proposed risk factors in the literature (but with weaker support) include a history of diabetes mellitus, dehydration, cardiovascular disease, diuretic use, advanced age, multiple myeloma, hypertension, hyperuricemia, and multiple iodinated contrast medium doses in a short time interval. Therefore, screening of patients at risk for CIN is targeted to identify patients with pre-existing severe renal insufficiency.

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If this information is not available, the information from the patient’s screening form is reviewed, focusing on four key questions to identify patients who are most likely to have underlying chronic kidney disease:

Recent studies [2-8] suggest that historical concern for CIN after administration of intravenous iodinated contrast was likely overstated. Studies utilizing unmatched control groups published in the last two decades have found no correlation between intravascular contrast administration and subsequent abnormal kidney function. The common limitation of these studies is that patients were not randomized to either receive or not receive iodinated contrast and that the control groups were not matched by patient-specific factors to patients receiving iodinated contrast. These studies are thus limited by selection bias.

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The ideal route, rate, and volume for volume expansion therapy are unknown. The intravenous route is preferred to the oral route for patients at risk for post-contrast acute kidney injury as this route has been more well-studied. Isotonic intravenous fluids (0.9% normal saline, lactated Ringers solution) are preferred. There is no clear superiority of 0.9% normal saline or sodium bicarbonate solutions for prophylaxis in this setting.

* Cetirizine is a selective antagonist of the histamine H1 receptor. The use of cetirizine (Zyrtec®) instead of the previously recommended antihistamine diphenhydramine (Benadryl®) is preferred in adults due to the side effects associated with diphenhydramine (drowsiness). Substituting diphenhydramine (50 mg PO or IV 1 hour prior to imaging study) for cetirizine is acceptable in situations where a patient or referring clinician has a strong preference for this antihistamine.

Choice of contrast medium: Iodinated contrast agents in modern use are universally low-osmolar solutions. There is no clear advantage of iso-osmolar contrast agents compared with modern low-osmolar contrast agents for the prevention of post-contrast acute kidney injury.

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Signs and symtoms are more pronounced and commonly require medical management.  Some of these reactions have the potiential to become severe if not treated.  Moderate reactions include:

Prior guidelines from the American College of Radiology recommended withholding metformin when a patient was planned to receive intravascular iodinated contrast based on the theoretical risk of patients developing contrast-induced nephropathy and therefore retaining metformin within the body. However further examinations of the rare cases of metformin-associated lactic acidosis have revealed that almost all cases occurred when patients were receiving metformin despite having one or more patient-associated contraindications to receiving this drug. There have been no reports of lactic acidosis in patients properly selected for metformin therapy. As a result, recent guidelines from the American College of Radiology are more measured in the management of this medication around the time of intravascular iodinated contrast administration:

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N-acetylcysteine: The American College of Radiology and the European Society of Urogential Radiology concur that there is insufficient evidence of the efficacy of this medication for reducing the incidence of post-contrast acute kidney injury to recommend its use.