Dangers of gadolinium in medical imaging

NSF/NFD (nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy) is very dangerous because it is a painful, debilitating, and sometimes deadly condition, with no cure, and no consistently successful treatment. "Once you have NSF/NFD it is almost impossible to get rid of, but it can be prevented. NSF/NFD is caused by gadolinium-based contrast agents used in MRI's (magnetic resonance imaging), and so far, has only been confirmed in people with kidney disease. The bottom line - if you have kidney disease or impaired renal function, avoid tests using gadolinium-based contrast agents if at all possible" (the Little-Known Debilitating and Deadly Danger of MRIs 2007). Therefore, people are becoming afflicted with an incurable, man-made disease that is related to a common medical procedure performed daily (Some Kidney Patients Suffer MRI Poisoning 2007).

Nephrogenic systemic fibrosis (NSF) is an emerging systemic disorder characterized by widespread tissue fibrosis. It is known to occur only in patients with renal disease. Unfortunately, NSF may develop rapidly and can sometimes result in patients becoming confined to a wheelchair. Furthermore, the skin thickening can be confused clinically with peripheral edema.

Pathophysiologically, NSF results in increased tissue deposition of collagen, commonly resulting in thickening and hardening of the skin of the extremities and often culminating in immobility and contractures of the joints. In some patients, there is clinical involvement of other tissues (lung, skeletal muscle, heart, diaphragm, esophagus, etc.), although the patient may not be clinically symptomatic (3). While NSF sometimes stabilizes, it rarely spontaneously remits. No consistently effective therapy exists, although rapid correction in renal function (by medical or surgical means) generally results in a cessation of progression and often in a reversal of symptoms (Kuo, P., Kanal, E., Abu-Alfa, a., Cowper, S.). (Therefore, the symptoms are as follow, which could lead to death from a practice that is performed daily the Little-Known Debilitating and Deadly Danger of MRIs 2007).

Tightening and swelling of the skin, typically starting with the legs, moving to the arms, and sometimes the trunk

Thickening of the skin around the joints, restricting movement

Skin which feels "woody" and has a texture similar to that of an orange peel

Red or dark patches of skin

Burning, itching, and/or sharp pains in affected areas

Fluctuating hypertension preceding the appearance of skin lesions

Symmetrical skin lesions, commonly on the ankles and thighs and between the wrists and upper arms

Muscle weakness

Deep bone pain in the hips and ribs

Calcification of soft tissues

Yellow plaques near the eyes

Seventy-eight thousand three hundred fifty-three (65,009 adult and 13,344 pediatric) IV administrations of gadolinium-containing contrast material were performed during the study period. Acute allergic-like reactions were documented after 54 injections (reaction frequency, 0.07%). Forty-eight reactions involved adult patients (adult reaction frequency, 0.07%), and six reactions occurred in pediatric patients (pediatric reaction frequency, 0.04%). Forty (74%) acute allergic-like reactions were mild, 10 (19%) were moderate, and four (7%) were severe. No gadolinium-containing contrast material-related death occurred during the study period. Twenty-six (50%) of 52 patients had one or more presumed risk factors for contrast material reaction (Dillman, J., Ellis, J., Cohan, R., Strouse, P., Jan, S. 2007).

Patients with kidney disease have prolonged exposure to gadolinium in their tissues. Certain forms of gadolinium are bound by a linear chelate and have the potential to dissociate more readily, releasing the toxic ion. From there, all forms of gadolinium should be viewed with concern. NSF occurs only in patients with advanced kidney disease. Even though the cause-and-effect link is not proven, the association of NSF with gadolinium exposure is strong enough for the FDA to issue a warning. If an MR study with contrast is absolutely required, a nongadodiamide contrast using the lowest possible dose is preferable." It would also seem prudent to perform hemodialysis to enhance gadolinium elimination and to identify other potential cofactors (Busko, M.2007).

There are many issues that impact MR safety that should be considered during site planning for a given MR installation. These have historically not been dealt with in the prior versions of the ACR MR Safe Practice Guidelines. For the first time, we include in this article, as separate appendices, sections that address such issues as well, including cryogen emergency vent locations and pathways, 5-gauss lines, siting considerations, patient access pathways, etc. Yet despite their appearance herein, these issues, and many others, should be reviewed with those experienced in MR site planning and familiar with the patient safety and patient flow considerations prior to committing to construction of a specific site design. In this regard, enlisting the assistance of an architectural firm experienced in this area, and doing so early in the design stages of the planning process, may prove most valuable (Kanal, E., 2007).

From there, in order to decrease the health risk, there are some safety procedures that they need to take care of (Kanal, E., 2007).

All clinical and research MR sites should maintain MR safety policies (Kanal, E., 2007)

These policies and procedures should also be reviewed concurrently with the introduction of any significant changes in safety parameters of the MR environment of the site (e.g., adding faster or stronger gradient capabilities or higher RF duty cycle studies) and updated as needed. In this review process, national and international standards and recommendations should be taken into consideration prior to establishing local guidelines, policies, and procedures (Kanal, E., 2007)

Each site will name an MR medical director whose responsibilities will include ensuring that MR safe practice guidelines are established and maintained as current and appropriate for the site. It is the responsibility of the site's administration to ensure that the policies and procedures that result from these MR safe practice guidelines are implemented and adhered to at all times by all of the site's personnel (Kanal, E., 2007)