Transcript Document
Gadolinium-Based Contrast Agents (GBCA) in MRI at BIDMC: Improved safety Background Currently there are 9 FDA-approved GBCA in the United States with differing approved usages for MRI, though many are administered off-label widely. Each differs in chemical structure and characteristics, which effect stability and can effect clinical use and safety. Safety profiles of GBCA had been superb until in the mid 2000’s when it was discovered that a new disease, nephrogenic systemic fibrosis (NSF), was associated with GBCA administration in patients with renal dysfunction. After collection of data on NSF cases, results of research studies, and guidance from the FDA and American College of Radiology (ACR), the importance of chemical structure and stability of a GBCA is more clear. Policy revisions have improved safety with GBCA administration. Though safer policies have been in place for several years, many in healthcare are not aware. Problem • • • • • Primary GBCA used had many associated cases of NSF GBCA administration policies needed updating for safety and clarity Mis-information in non-MRI radiology and wider medical community about GBCA safety Patient anxiety about GBCA from what they hear from others and read on the internet Belief that allergy to one GBCA means allergic to all GBCA Goals • • • • Switch to safer GBCA for most MRI at BIDMC based on risk categories and study results Review and update types of GBCA at BIDMC and clarify uses Review and update policies on GBCA administration and create workflow guidance Clear the confusion on GBCA safety with providers and patients through education Team • MRI Operations Committee • MRI Safety Committee Results - Changes • • • • Changed GBCA for most MRI at BIDMC from Magnevist to Gadavist Established updated GBCA administration policy (RAD-57) Established updated Outpatient & Inpatient GBCA administration workflow Reinforced use of GBCA Prohance in patients with severe renal dysfunction; Prohance can be given safely above eGFR = 15 mL/min/1.73m2 in patients with stable chronic renal dysfunction linear macrocyclic Next Steps • Survey providers about what they would like to know about GBCA administration • Inform providers directly and through email about GBCA safety in renal dysfunction and that an allergic reaction to 1 GBCA is usually isolated and such patients can receive other GBCA • Try to have GBCA administration pop-ups on OMR at time of ordering MRI with information For More Information Contact Martin P. Smith, MD Radiologist (MRI/Abdominal Imaging) [email protected]