Expert brings insights, history, strong opinions to NSF controversy

December 1, 2008

John C. Hayes is editor of Diagnostic Imaging.

Sometimes we get to explore a controversy with a bit of historical perspective. That opportunity usually involves someone who has spent considerable time in radiology and has developed strong opinions about what the history shows. We have just such an example in a commentary from Prof. Dr. Peter Rinck that appears on page 23 of this edition.

Rinck, an expert in MR contrast, looks at the association of nephrogenic systemic fibrois and gadolinium. Probably better than anyone else, Rinck has the clinical and scientific knowledge, along with the business perspective, that allows him to reach some interesting conclusions about how this problem came about.

Some of what he reports those of us who have followed the NSF controversy know already: for example, that cyclic agents are less likely to be associated with NSF than linear agents. But there is much here that is new and reflects Rinck's considerable experience in the field, including inside knowledge gained as an instructor who taught physicians and vendor representatives about the mechanisms of gadolinium contrast.

As is appropriate in this setting, Rinck also imparts lessons learned. Coming in for criticism is an industry that failed to heed some of the warning signs and, especially, radiologists who pursued off-label gadolinium uses without fully understanding the mechanisms at work.

Rinck's column is a provocative article and worth your attention.

John C. Hayes is editor of Diagnostic Imaging.