When it comes to iodinated contrast reactions in children, it's important to have a policy in place before the need arises, as well as appropriate training, equipment, and physiologic ranges, according to a presentation by Dr. Donald P. Frush at the International Symposium on Multidetector-Row CT May 19.

A policy should be in place beforehand regarding contrast reactions because the reactions in children are rare, unpredictable, happen quickly, and are often unheralded, according to Dr. Frush, a professor of pediatric medicine at Duke University.

Frush has been involved as a consultant in several lawsuits over children's contrast reactions that had bad outcomes.

"The problem is not so much whether the outcome is bad or good," he said. "The problem is when you don't have a policy and people just did whatever they thought was OK."

At Duke, the radiologists conducted a simulation protocol involving mannequins, and the researchers found that early intervention was critical (Radiology 2007;245:236-244). The radiologists and trainees were deficient in their ability to manage contrast reactions in children, according to Frush.

A decision-based algorithm, a sort of flow chart to help a radiologist determine the appropriate next step based on the patient's weight, age, and other factors, would aid radiologists significantly, Frush said.

Another possibility is the creation of a rapid response team. When something goes wrong, the rapid response team is activated.

"Radiologists are not the right people to be managing a kid who is starting to turn bad, and you don't want to wait until it's too late. Anybody's worried about anything -- you can call this team, and they're not punitive. They prefer to be called and told, ‘Hey everything's OK,' rather than the other way around," he said.

The rarity of contrast reactions makes it all the more important to establish a policy and to understand the nuances of the reactions, Frush said.