Estimated GFR should be calculated as close to the day of the procedure as possible and should be documented in the medical record, ideally as part of the preprocedural checklist. The writing committee also recommends that the total amount of contrast volume administered to a patient should be documented clearly in the procedure report. The risk of contrast-induced renal injury increases with increasing volume of contrast administered, and physicians should follow a principal of as low as reasonably pos- sible, especially in patients who have preexisting renal dysfunction (35). Although recent studies suggested an as- sociation between high total contrast dose (or GFR-based Nallamothu et al. JACC Vol. 63, No. 7, 2014 ACC/AHA/SCAI/AMA-PCPI/NCQA February 25, 2014:722 45 contrast dose) and contrast-induced acute kidney injury, we do not believe that the current evidence is robust enough to support a speci c contrast threshold that should not be exceeded under any circumstance (4,32). In addition, no evidence indicates that simply documenting the dose is linked to improved patient outcomes. For these reasons, the writing committee designated this measure only for internal quality improvement at the present time. Of course, indi- vidual circumstances during a case often will dictate whether the use of additional contrast is worthwhile for the safety of the procedure. Nevertheless, recording the total volume of contrast used for each case, as required by the measure, should serve as the rst step toward understanding and modifying patterns of contrast use in cardiac catheterization laboratories. 5.6. Radiation Dose Documentation Current guidelines recommend that procedural radiation dose should be recorded for all patients and should be limited to as low as reasonably achievable, according to clinical circumstances. Measures of radiation dose include total air kerma at the interventional reference point, air kerma area product, uoroscopy time, and number of cine images (4). 