The Risk to Radiologists from Monitoring Contrast Agent Administration

Whitney J. Palmer

Allergic reactions to contrast agents are rare – having a radiologist on-hand to keep an eye on patients can raise the providers risk of being involved in a car accident.

It is currently standard procedure for radiologists to keep an eye on patients who receive contrast agents during a procedure. But, maintaining the practice might not offer much benefit – in fact, it could present risks to the radiologist, specifically, that you might not have considered.

Allergic reactions to contrast agents are rare, occurring in 0.0004 percent-to-0.04 percent of patients. Requiring a radiologist to be at the bedside to handle these adverse outcomes on the off-chance they occur, though, could put the provider at risk for something far more common – a car wreck, said industry experts in an opinion article.

In their piece, published on March 16 in the Journal of the American College of Radiology, Andrew Wilmot, M.D., of Brighton Radiology Associates, and Saurabh Jha, M.D., associate professor of radiology and co-program director of the cardiothoracic imaging fellowship at the Hospital of the University of Pennsylvania, pointed out that radiologists can identify allergic reactions, but they are largely too inexperienced to step in if something goes wrong. One study, they said, found only 11 percent knew the tools used to administer epinephrine during an allergic response.

“Practice makes perfect,” they said, “and radiologists, thankfully, don’t get to practice many emergencies, given that contrast is exquisitely safe.”

Given this shortcoming, they said, it is time for the industry to consider the risk-reward associated with asking a radiologist to drive to an outpatient center for a procedure they are not the best equipped to handle. More time on the road, they said, equates to a higher likelihood of a car accident resulting in injury or death.

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They offered up this scenario: the 33 percent of more than 48,000 American radiologists could drive an average of 50 miles roundtrip each week to oversee contrast administration. That adds up to roughly 30 million additional miles on the road annually. The AAA Foundation for Traffic Safety reports that, per 100 million miles driven, there are 1.13 deaths and more than 100 injuries. That could result in an additional fatal car accident every two-to-three years for the radiology industry, said Wilmot and Jha.

It is also important to point out, they said, that – unlike with adverse contrast agent reactions – hospitals and healthcare facilities bear no actual financial or legal risk if a radiologist is injured in a car wreck. This leaves the provider to shoulder the financial burden of time missed from work alone.

“It seems the policy of requiring radiologists at outpatient facilities is overkill, or at best a competition between two small risks,” Wilmot and Jha said, “risk that a radiologist will be killed in a fatal car crash versus the risk for death from a contrast reaction.”

Removing radiologists from the situation does not put patient in danger, they added. Radiologic technologist are actually the providers responsible for administering the contrast agent, so they should be equally equipped to handle any adverse reactions that do occur. Given that, there is very little reward to having a radiologist involved.

“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?”