• ACR contrast administration guidelines apply. To provide guidelines for the use of intravenous or oral, iodinated and gadolinium based contrast media, as well as the proper response of Radiology staff in the event of a contrast media event. July 12, 2016 — The updated American College of Radiology (ACR) Manual on Contrast Media contains a statement addressing the U.S. Food and Drug Administration (FDA) safety communication on use of gadolinium-based contrast agents for magnetic resonance imaging (MRI).. Gadolinium-based contrast agents are administered to approximately 30 … Editor in Chief: Evan Appelbaum, MD . 12 This recommendation is based on numerous studies that have shown the safety of gadolinium-based contrast in the breastfeeding patient. • Order With contrast Administration of Contrast Media to Pregnant or Potentially Pregnant Patients define terms commonly associated with both MRI and CT contrast agents and safety. American College of Radiology . 2. • Order WO/W contrast for osteomyelitis. MRI Contrast Administration Guideline The purpose of this guideline is to define MRG’s recommendations for screening patients prior to any gadolinium ‐based contrast agent (GBCA) administration and recommended use of GBCAs based on eGFR results. �����%�t�=�H��|�CL��|5����>~�a!l�d�ckܦ��c��+���_��ǿd�ʦ��d�)o��І��" MRI of the spine is to be scanned WO/W if: • Patient has a history of surgery to the area of the spine to be imaged. MRI abdomen without IV contrast . Patients on dialysis or with GFR less than 30 will not receive contrast. Recommended definitions pertaining to intravenous contrast media administration for acute kidney injury (AKI), chronic kidney disease (CKD), contrast-induced acute kidney injury, and contrast-associated acute kidney injury are provided in a previously published ACR-NKF consensus document on intravenous iodinated contrast media . MRI … • If a MR Shoulder arthrogram is ordered fluoroscopy must be scheduled also to guide the joint injection of GBCA. In: Practice guidelines and technical standards 2000. All MR scans are evaluated independently prior and/or during scanning by technologists and on duty radiologist to determine if contrast may or may not be necessary to acquire optimum exam results. (see guidelines above) MRI of the Shoulder • Order WO contrast for shoulder pain or possible rotator cuff tear or tendonitis. • Routinely order WO/W contrast. �#�!�4Hݢ�~�B>c�N� Treatment of Contrast Reactions 95 18. Created: February 1, 2007 Current revision: May, 2017 (VJ, FA , KS) POLICY ON: Radiologic Intravascular Contrast The following document will provide guidelines for the administration of intravascular contrast for both CT and MR examinations. Contrast flow is manually tested to ensure patency. describe current practices, according to the ACR, regarding contrast screening (s) and safety. Radiology… ACR Manual on Contrast Media, Version 7; 2010. • In certain cases involving Multiple Sclerosis contrast may be used in the cervical and thoracic spines. • Exceptions requiring prep are MR Enterography and MRCPs. See DR Policy 1.17: Medication . Reston, VA: American College of Radiology, 2000:429 –433 [Google Scholar] (see guidelines above) MRI poses no known risk to the fetus in the second and third trimester. The ACR states in its published manual on contrast media that it is safe for the mother to continue breastfeeding after the administration of intravenous gadolinium-based contrast. Some Cardiac MRI exams, Gamma-Knife Met protocol brain MRI) require renal function screening as a larger dose of Gadolinium is being used. Comprehensive Contrast Policy; Administration of Contrast via Indwelling CVC in the Adult or Pediatric Patient; Administration of Enteric and IV Contrast on Inpatient Unit Both terms imply correlative diagnosis.      • patient age 60 or greater endstream endobj 217 0 obj <>>>/Filter/Standard/Length 128/O(�W�>�u*�[�V��/���=8���k7M��)/P -1340/R 4/StmF/StdCF/StrF/StdCF/U(�$ۃ��!��#\n-�\\ )/V 4>> endobj 218 0 obj <>>> endobj 219 0 obj <> endobj 220 0 obj <. MRI of the Lower Extremity (femur, tib / fib). Patients receiving GBCAs for spinal imaging are subject to contrast guidelines as stated above. Scope This guideline applies to all MRI exams where patients are scheduled to receive GBCAs. Gadolinium-based contrast agents (GBCAs). Administration of intravenous contrast: 1. ie: toes, mid foot, heel. Adult patients with non-power injectable central line, may undergo contrast injection for a CT/MRI by hand injection into the CVC, except into dialysis catheters. • ACR Guidelines are followed when patients are to receive Gadolinium based contrast agents(GBCA). (see guidelines above) • Call OneCall (452-6234) to schedule MRI exams. MRI contraindicated: CT with contrast Lumbosacral plexus abnormality MRI lumbosacral plexus (pelvis) without contrast musculOskeleTal ORdeRiNG GuideliNes shOuldeR Indication Preferred Study Trauma, surgical hardware X-ray first. • ACR contrast administration guidelines apply. Same policy for group III agents for in-patients and out-patients as above would apply in this setting. Discuss common applications for various options in oral contrast agents Administration of intravenous contrast: 1. MRI of the spine is routinely ordered WO unless certain conditions apply. Some studies may use Feraheme (ferumoxytol injection) as part of an NU approved IRB. • Pediatric patients may require anesthesia sedation which is scheduled by OneCall(452-6234). MRI Contrast Administration Guideline The purpose of this guideline is to define MRG’s recommendations for screening patients prior to any gadolinium‐based contrast agent (GBCA) administration and recommended use of GBCAs based on eGFR results. These are evaluated on a case by case basis when necessary by the on duty radiologist. discuss common applications for Intravenous contrasts in both MRI and CT exams. • Order WO contrast routinely for hip pain. • Not all MR scans can be performed on the open MRI. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness ... hemodialysis may undergo contrast-enhanced MRI with group II agents if safety guidelines are followed. • routinely ordered on patients between the ages of 12-45 to decrease radiation exposure. • Order WO contrast for foot pain. 236 0 obj <>stream �H��-�{/� CȭJ�������7r���+�u`������8���G����|�#��=>���tꂡP���d��2wS�,�h����fo�[�r�;����-X��� k0w��\x�x`S!hD��w���!�x%��W�8rȦ�c�s'�����tA�����+�f�"��'�����t����y���E>�s��"\q�:Z}v��0X(^~c�C�o�2�8 ��� 1Ys�|� Clarification: MRI Technologists & MRI Contrast Injections From the ACR Practice Guidelines: D. Technologist (Page 3) Technologists performing injections of contrast media should be in compliance with existing operating policies and procedures at the imaging facility in which they are working. 2. • order WO if evaluating for adrenal adenoma vs. malignancy ACR standard for performing and interpreting magnetic resonance imaging (MRI). (see guidelines above). These patients require a Serum Creatinine level no older than seven(7)days. Intravenous (IV) contrast material is used extensively for CT and MRI scans done in emergency departments (ED). O MRI area of interest without IV contrast 7 This procedure is an alternative to MRI without and with contrast if contrast Ois contraindicated. New Contrast Study Guidelines (Eovist Liver for MRI and CT contrast studies only) From ACR Contrast Manual for high risk assessment: The following is a suggested list of risk factors that may warrant renal function assessment (e.g., serum creatinine, eGFR) prior to the administration of intravascular iodinated contrast medium. • ACR contrast administration guidelines apply. 1 Since then there has been a huge increase in the use of • Patient must arrive 1.5 hrs prior to exam to register and drink Volumen. 2010 ACR Committees* Joint Consensus Recommendations • ACR contrast administration guidelines apply. • Patient is being evaluated for discitis or osteomylitis. • MRI questions can be answered by a technologist by calling 452-7676 or 452-7504. Scope This guideline applies to all MRI exams where patients are scheduled to receive GBCAs. • Emergency contrast reaction drug box located in the radiology department areas utilizing contrast media. In 2001, the American College of Radiology (ACR) formed a Blue-Ribbon Panel on Magnetic Resonance (MR) Safety in response to various reports in the medical literature and print media detailing MR imaging (MRI) adverse events and incidents involving patients, equipment, and personnel. 1 For eGFR 30-59, the ACR advises “No special precautions are necessary in this group.” For eGFR 60-119, “Any GBCA can be administered safely to these patients.” MRI of the Elbow • Order WO contrast . No other representation of this material is authorized without express, written per mission from the American College of Radiology. AKI occurring within 48 hours after the administration of contrast media. Direct supervision for contrast studies. Iodinated and gadolinium-based contrast media are used on a daily basis in most radiology practices. Contrast-associated acute kidney injury (CA-AKI): Any AKI occurring within 48 hours after the administration of contrast media. MRI in the first trimester should only be performed after consultation with radiology faculty. • Patient has a recent history of cancer and primary or metastatic disease is suspected. Adapted from the American College of Radiology's Practice Guideline for the Performance and Interpretation of Cardiac Magnetic Resonance Imaging (MRI), 2006, Effective 10/01/06acrcmr Breast feeding can be continued without interruption after administration of iodinated contrast or gadolinium to a lactating patient These included 299 examinations (242 patients) with eGFR of 30–44 mL/min/1.73 m 2 and 183 examinations (157 patients) with eGFR less than 30 mL/min/1.73 m 2. Allergic Type Contrast Reaction Prevention A. Patients with GFRs between 30-60 will be evaluated on a case by case basis by the radiologist on duty to determine efficacy of GBCA administration. Overall, 7820 GA MRI examinations were identified, performed in 5351 patients (3022 women and 2329 men). Many times these scans are able to be performed without NPO status but proper prep is preferred for optimum quality. 2010 ACR Committees* Joint Consensus Recommendations Reprinted with permission of the American College of Radiology. Gastrointestinal (GI) Contrast Media in Adults: Indications and Guidelines: ACR–ASNR Position Statement on the Use of Gadolinium Contrast Agents: Adverse Reactions to Gadolinium-Based Contrast Media: Nephrogenic Systemic Fibrosis: Treatment of Contrast Reactions: Administration of Contrast Media to Pregnant or Potentially Pregnant Patients Administration by Technologists in Diagnostic Radiology. MRI of the Cervical / Thoracic / Lumbar Spine. The American College of Radiology (ACR) has published a new manual for using contrast media in imaging. PRACTICE PARAMETER IV Contrast Media Vascular access should be established or confirmed using the facility’s protocol. Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. CT area of interest with IV contrast 6 Contrast is preferred to help with soft- The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Its use is essential to make many critical diagnoses in ED patients. CT for pre-operative planning of fractures. endstream endobj startxref • order WO contrast for pain or fx Intravenous Contrast Media Guidelines- Adult 4 III.      • patient has history of diabetes American College of Radiology; Park S, Kang D, Sohn K et al. For all non-contrast exams, excluding Nuclear Medicine exams, routine imaging proceeds. • If a MR Shoulder arthrogram is ordered fluoroscopy must be scheduled also to guide the joint injection of GBCA. 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