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11. Contrast agents and other drugs

A variety of contrast agents and other drugs are used in the MR environment.  Examples include gadolinium based contrast agents (GBCA), liver specific contrast agents, iron oxides, diazepam, antispasmodic agents such as buscopan and glucagon and diuretics such as furosemide.

11.1

Contrast agent injections should only be undertaken if clinically indicated and at the request of the supervising MRI radiologist or radiographer who is appropriately trained and is authorised by the Clinical Director or Lead Radiologist.  This authorisation should be documented in the local rules.  Radiographers are permitted, under law, to supply and administer prescription only medicines (including contrast media) under patient group directions (PGDs) and, therefore, MRI departments should have PGDs in place.  If the drugs being administered are not prescription-only medicines, then PGDs are not required in law although they are considered good practice.  If an intravenous (IV) injection is to be given by a radiographer, that radiographer should be trained and competent in IV administration.18  A register of contrast administration should be kept.

11.2

Patient consent should be sought in line with departmental protocols and all staff should be conversant with local emergency procedures.

11.3

Up-to-date information on supply, administration and prescribing of medicines, including example PGDs, can be accessed from the members section of the website: https://www.sor.org/practice/other-groups/prescribing    (accessed February 28th 2013)

11.4

Gadolinium containing agents are the most common contrast agents used in MR imaging.  They are linked in varying degrees to a risk of nephrogenic systemic fibrosis (NSF).  The European Medicines Agency and its Committee for Medicinal Products for Human Use (CHMP) reviewed the risk of nephrogenic systemic fibrosis (NSF) with gadolinium containing contrast agents19 and classified them according to risk as follows:

High risk - Omniscan (gadodiamide), OptiMARK (gadoversetamide), Magnevist (gadopentetic acid)

Medium risk - MultiHance (gadobenic acid), Primovist (gadoxetic acid), Vasovist (gadofosveset)

Low risk - Gadovist (gadobutrol), ProHance (gadoteridol), Dotarem (gadotericacid)

11.5   Risk minimisation methods

The MHRA15 has issued guidance regarding minimising the risk of NSF: this can be viewed on their website: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON087741
(accessed 28th February 2013)

13695342-exclamation-point.jpg Departments should have within the local rules clear written procedures in place regarding the use of GBCAs in order to minimise the risk of NSF.

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