Communicating Risks of Contrast Agents to Patients

One of the most commonly used imaging tools in a radiologist’s arsenal is the contrast agent. It enhances the appearance of structures and fluids, but it isn’t without risks and challenges. And, it’s up to radiologists, industry experts say, to make sure your patients and staff understand how to use it and why.

While less than 1 percent of patients experience a negative response to a contrast agent, according to a Mayo Clinic study, everyone involved with a scan using contrast should be aware of all possible outcomes and know how to handle them. The American College of Radiology offers guidance in how to best administer these agents, but creating the optimal experience for the patient involves more than selecting the right agent and using the correct measurement.

“You’re giving someone a drug, and there’s a risk to that. Patients have to understand that risk,” said Lawrence Marks, MD, chair of radiation oncology at the University of North Carolina at Chapel Hill School of Medicine. “They have to understand the value of the test, but like everything else in medicine, your actions should be based on a discussion with the patient before you do it.”

Educating the Patient

Although the risks can be minor, you should always consider if using contrast is even necessary, said Jeffrey Kanne, MD, associate professor of thoracic imaging and quality and safety vice chair at the University of Wisconsin School of Medicine and Public Health. If you can obtain the same information with the same level of specificity without using an agent, then do so, he said. That is always the safest option.

However, if contrast media is necessary, make it as easy to understand as possible. Like many procedures in radiology, the use of contrast media includes complex terminology that is potentially unfamiliar to patients. Always explain what the contrast media is and what it does in basic terminology - then, employ the teach-back method.

“Make sure you have patients explain back to you what you said. It’s a very valid way of ensuring patients truly understand,” Kanne said. “If they can recount back, you know they understand. If not, it’s clear you haven’t communicated effectively, and you need to try a different approach.”

One such strategy is a patient education website that addresses the risks associated with contrast media and tells patients what information you will need to ensure not only their safety, but also the best imaging results. For example, the University of Washington Medical Center maintains a patient education page that answers questions about need and risk in easy-to-understand language.

In addition, be willing to sit with patients and give them the opportunity to voice their questions and concerns. The most common worry patients have, Kanne said, is the misconception that contrast agents are radioactive. Others - many of whom experienced previous-generation contrast agents - fear the procedure will be painful and cause a burning sensation.

Training Your Staff

To ensure your providers and technologists have a full understanding of contrast media and the associated challenges, consider partnering with a pharmacy either within your facility or nearby. According to the American Society of Health-System Pharmacists (ASHP), working more closely with the individuals who prepare the contrast media could help you better educate your colleagues.

For instance, said Niesha Griffith, MS, RPh, the pharmacy and infusion services director at Ohio State University Medical Center, change these terms you use to describe contrast media.

“Our biggest challenge was in changing the culture,” Griffith said during a previous ASHP clinical meeting presentation. “We encouraged the radiologists and the technologists to refer to the contrast agents as medications, and not just within the department, but also when talking to patients. Accomplishing that required a lot of education and reinforcement.”

One of the most effective education and safety tools Ohio implemented, she said, was pocket cards for technologists. A pocket card exists for each contrast agent, and it includes all the generic and brand names of medications that interact negatively with the agent. This strategy enables technologists to double-check the procedure one last time and contact the radiologist if there are any red flags.

It’s also imperative that any technologist in your practice or department who is charged with administering contrast agents has received the proper training, Kanne said. Each type of scan should have an individual protocol, developed by a radiologist and the medical physicist team, that specifies which contrast, the dosage, and the route given, all adjusted for weight and size. Have a standard for IV placement, and keep this information where technologists can readily access it.

Ultimately, Kanne said, it’s your responsibility to ensure an imaging study using contrast goes as smoothly as possible for the patient.

“You should make the patient feel that when they come in for a test, you’re available to talk with them,” he said. “We don’t have a lot of patient contact as radiologists, but if patients understand that a physician trained in medical imaging is immediately available to speak with them, it can have a very beneficial impact on their experience.”