In recent literature, the frequency of Contrast Associated Acute Kidney Injury (CA-AKI) after primary percutaneous coronary intervention (PCI) is reported to range from 10.4% to 23.2%. CA-AKI after primary PCI can lead to 4 to 8 fold increased risk of in-hospital mortality. Intravenous iodinated contrast media (ICM) are commonly used with CT to evaluate disease & to determine treatment response. Although patients have benefited from their use, CM historically have been denied or delayed in pts with ↓ kidney function due to the perceived risks of AKI. This is important because denying patients diagnostic testing that is indicated in a timely fashion creates potential for indirect harm related to delayed diagnosis & misdiagnosis. Because of the critical role CM play in modern medical imaging, clinicians & radiologists are routinely charged with balancing the potential risks of CM with diagnostic benefits. Clinical decision making in pts potentially at risk for AKI is often fraught with confusion, uncertainty, & heterogeneity. The data will be mentioned in this presentation should be considered in the context of the entire clinical scenario.