Why it’s time to reconsider radiologists' role in monitoring adverse contrast reactions
Radiologists are required to monitor contrast administrations at outpatient imaging facilities in case of an adverse reaction. But some providers say it may be time to rethink this practice.
Severe reactions occur in .04% to .0004% of patients, with the risk of death about 1 in 170,000, authors wrote in an opinion piece published Tuesday in JACR. And even during such events, rads have the knowledge but lack the experience to adequately intervene.
One study found only 11% know what equipment would be needed to administer epinephrine during anaphylactic shock.
“Practice makes perfect, and radiologists, thankfully, don’t get to practice many emergencies, given that contrast is exquisitely safe,” Andrew Wilmot, MD, of Brighton Radiology Associates, and Saurabh Jha, MD, with Hospital of the University of Pennsylvania, argued March 16.
Is the added risk to radiologists worth it?
In their piece, the Pennsylvania editorialists also argued that radiologists’ added time driving to outpatient centers each week increases their chance of getting in a car accident. A risk that may not outweigh the odds they properly handle a contrast reaction, in the rare case one occurs.
For example, if 33% of the more than 48,000 rads in the U.S. drives to imaging centers in a given week and that each goes an extra 50 miles per week for contrast monitoring, that would total more than 30 million excess miles driven per year, the authors explained.
And given there are 1.13 deaths and more than 100 injuries per 100 million miles driven, according to the AAA Foundation for Traffic Safety, this would lead to an average of one excess fatal car accident every 2 to 3 years.
“It seems the policy of requiring radiologists at outpatient facilities is overkill, or at best a competition between two small risks: risk that a radiologist will be killed in a fatal car crash versus the risk for death from a contrast reaction,” Wilmot and Jha added.
Furthermore, while contrast reactions have legal and financial consequences for health systems, there is no such precedent protecting rads from excess driving. If a provider is injured due to a work-related car accident, systems have no legal risk. The writers urge radiologists to challenge this.
Radiologic technologists are already required to perform exams, and the editorialists suggest they are more than capable to do the job.
“The trade-off would be worthwhile if we were indispensable at the bedside in an emergency,” the authors wrote. “As we’re arguably no better than technologists in managing contrast reactions, doesn’t it make sense for health systems to train and compensate technologists for this role and have radiologists focus on reading films?”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.