Implementation plan

Recommendation	Time frame for implementation: <1 year, 1 to 3 years or >3 years	Expected effect on costs	Limitations for implementation	Barriers to implementation¹	Actions needed for implementation²	Parties responsible for actions³	Other remarks
Use the lowest dose GBCA needed to achieve a diagnostic MRI examination.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
Do not use prophylactic measures to avoid the development of PC-AKI in high risk patients (eGFR<30ml/min/1.73m²) receiving GBCA intravenously at the appropriate dose.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR
Do not substitute ICM with GBCA in order to avoid PC-AKI in computed tomography and/or digital subtraction angiography.	1 to 3 years	None	Lack of knowledge of guideline	Lack of knowledge of guideline	Dissemination of guideline	NVvR

¹ Barriers can be found at multiple levels. They can exist at the level of the consultant, the hospital organisation, and the health care system.

² Actions needed for implementation, but also actions to promote implementation. Think about checks during quality visits, guideline publication, information of hospital management, et cetera.

³ Who is responsible for implementation of recommendations will largely be determined by the level where the barriers are expected to be.