Maintaining a rigorous log of patient gadolinium dosage should be a priority for radiology departments and imaging centers, according to Hans-Klaus Goischke, Dr. med.

Contrast agents are a common way to enhance detail in organs and soft tissues during an MRI exam, and no contrast agent is as widespread or as useful as gadolinium. Concern over gadolinium deposition has been brewing since a 2014 study showed significant deposits in several regions of the brain, but there is no evidence suggesting that gadolinium deposits alter brain function.

Goischke, however, challenges the assumption that a lack of results equals safety.

“Even though no clinical implications can be drawn from the reported hyper-intensities in the brain, the findings are worrisome,” he wrote.

He argued that it is essential to maintain a log that tracks each gadolinium injection with a risk assessment and relevant info, including date, dose, type of formulation and magnetic field strength. Detailed documentation should be required because neural tissue deposition can occur with as little as four doses over a patients’ lifetime.

Goischke pointed to a case study of a 39-year old multiple sclerosis patient who underwent 21 gadolinium injections at various locations over 12 years. Records of how much gadolinium she was exposed to were not kept. Current American College of Radiology (ACR) guidelines simply advise that “the identity and dose of gadolinium-based contrast agents (GBCA) used should be recorded after each intravenous administration,” but they don’t provide any outline for inter-institution dose tracking. Products like GE Healthcare’s DoseWatch and Bayer’s Radimetrics offer contrast tracking, but they have varying levels of integration with general EMR systems, so a permanent solution is still needed. 

“Gadolinium deposition is occurring, and exact documentation of gadolinium use can improve care for our patients,” wrote Goischke.

Read the full article at the Journal of the American College of Radiology.