Balancing Diagnostic Precision and Renal Safety

RSSA-SAR Abdominal Congress: Key Takeaways for Radiologists

Dr Paul Scholtz on focused protocols, AI accountability, and the future of abdominal imaging This episode is a debrief from the 2026 RSSA-SAR Abdominal Imaging Congress held in Cape Town, delivered by a radiologist who both attended and presented there. It is aimed squarely at radiologists - especially those with an interest in abdominal imaging who could not make it to the Congress - and covers the debates, advances, and clinical tensions that defined the meeting. Dr Paul Scholtz, specialist radiologist at Morton and Partners and the first radiologist in Africa to receive the ESGAR diploma in gastrointestinal and abdominal radiology, unpacks what is actually shifting in abdominal imaging practice versus what is still aspirational. Topics include: why focused (not abbreviated) MRI protocols matter for pancreatic cyst follow-up; the closing gap between 1.5 Tesla and 3 Tesla magnets for tissue characterisation; how faster MRI acquisition is changing patient throughput; and when CT remains the more pragmatic choice over MRI in the South African context. The episode tackles the real resource gap between evidence-based guidelines and what is achievable in South African public and private settings. Dr Scholtz discusses the LI-RADS classification system for hepatocellular carcinoma screening, the absence of ultrasound surveillance programmes for chronic liver disease and cirrhosis, and the clinical and ethical tension between underscanning and overscanning. The PI-RADS lexicon debate in prostate MRI, the management of incidental findings and incidentalomas, and liver fat quantification and stiffness assessment using ultrasound and MRI are all addressed directly. On AI in radiology, Dr Scholtz cuts through the hype with a clear position: AI should function as an adjunct to the radiologist's report, not replace clinical judgement - and the radiologist retains full medico-legal accountability for every signed report. The episode closes with practical guidance for trainees on incidental finding management, and a note to referring clinicians on how better clinical information produces better imaging outcomes. Contrast agent trends - including lower-dose gadolinium-based agents and reducing iodinated contrast volume alongside CT radiation dose - round out a comprehensive and clinically grounded conversation. ESGAR - European Society of Gastrointestinal and Abdominal Radiology [https://www.esgar.org/] · Radiology Society of South Africa (RSSA) [https://www.rssa.co.za/] · Society of Abdominal Radiology (SAR) [https://www.abdominalradiology.org/]

Contrast Media Safety: What Radiologists and Radiographers Need to Know

With Dr. Ranchod, diagnostic and interventional radiologist. This episode is for radiologists, radiographers, and anyone involved in requesting or performing imaging studies who want to replace outdated clinical dogma with evidence-based practice. Dr. Ranchod, a South African diagnostic and interventional radiologist with over 25 years of experience, systematically dismantles the most persistent misconceptions in contrast media safety, including the widely held but scientifically unfounded belief that iodine allergy is a real clinical entity. Dr. Ranchod explains why there is no such thing as iodine allergy: iodine is a trace element essential for thyroid function and encountered daily in iodized salt, not an allergen. Adverse reactions to contrast media are caused by the artificial chemical compounds added to the tri-iodinated benzene ring, not iodine itself. The episode unpacks the difference between allergic-like (anaphylactoid) reactions and physiological reactions, and classifies them as mild, moderate, and severe with clear management pathways including antihistamines, bronchodilators, epinephrine, and full resuscitation protocols. The discussion covers CT radiation dose safety and the use of iterative reconstruction algorithms and weight-based protocols to keep dose as low as reasonably achievable (ALARA), including paediatric-specific safeguards. MRI safety is addressed in depth: metallic projectile hazards, pacemaker and aneurysm clip contraindications, MRI-conditional devices, and the critical recommendation to perform a chest X-ray before emergency MRI in stroke patients who cannot provide a history. Gadolinium-based contrast agents are examined through the lens of nephrogenic systemic fibrosis (NSF): why it only emerged when double and triple doses were given to patients with peripheral vascular disease and low GFR, why linear agents carry the association, and what gadolinium retention in brain, bone, and heart currently means clinically (no proven harm, but caution in paediatrics). The episode also addresses iodinated contrast in pregnancy, porphyria, and asthma, the fish and shellfish allergy myth, and when premedication with steroids is genuinely warranted versus defensive medicine. A national cumulative radiation dose registry for South Africa is proposed as a key patient safety reform.

Balancing Diagnostic Precision and Renal Safety

Radiology & nephrology: evolving partnership in contrast decisions. In this episode of Radiology with a Dose of Insight, we explore one of the most nuanced and often debated areas in modern imaging: the use of contrast agents in patients at risk of kidney injury. Joined by Dr Ashesh Ranchod and Dr Muhammed Hassen, we unpack the evolving relationship between radiologists and nephrologists — from historical caution and “contrast hysteria” to a more collaborative, evidence-based approach. Through real-world scenarios, including high-stakes emergency decisions, we examine the balance between diagnostic urgency and renal safety. The conversation dives into the shift from Contrast-Induced Nephropathy (CIN) to Post-Contrast Acute Kidney Injury (PC-AKI), the true mechanisms of kidney injury, and how often contrast is wrongly blamed. We also tackle the clinical “gray zone” — patients with borderline renal function — where decision-making becomes less about guidelines and more about judgment, communication, and shared responsibility. Read more on the PRESERVE trial [https://pubmed.ncbi.nlm.nih.gov/23660180/]

The Invisible Revealed: Iodine and the Birth of Clearer Medicine

Why Radiology's most powerful tool isn't the scanner - it's the element inside it. In this episode, we journey through one of medicine’s most dramatic transformations: how a single element turned blurry shadows into lifesaving clarity. From Röntgen’s eerie glowing screen in 1895 to the high-stakes, trial-and-error era of early contrast experiments, we trace the desperate quest to make the invisible visible. Enter iodine — small, mighty, and scientifically elegant. We’re joined again by Dr Ashesh Ranchod, who brings his trademark clarity to the chemistry, physics, and sheer audacity behind iodine’s rise in imaging. Together, we unpack the early toxic formulations, the breakthrough of tri-iodinated benzene rings, the 1950s game-changer Hypaque, and the evolution toward modern non-ionic contrast that revolutionised both CT and vascular imaging. If you’ve ever wondered how radiology moved from murky guesses to precise, targeted diagnosis — this is the story. Bold science. Brave pioneers. And one element that changed everything.

125 Years of Radiology

Paying Homage to the Pioneers. Step inside the story of how radiology taught the world to see the unseen. Host Dr. Mantha Makume chats with Dr. Ashesh Ranchod, one of South Africa’s leading radiologists, to trace the fascinating evolution of medical imaging — from Wilhelm Röntgen’s mysterious “X-rays” to modern AI-powered scans. This episode explores the science, the pioneers, and the daring discoveries that revolutionised how we diagnose and treat disease.