title: Survey of gadolinium-based contrast agent utilization among the members of the Society for Pediatric Radiology: a Quality and Safety Committee report.
abstract: BACKGROUND
  Gadolinium-based contrast agents (GBCAs) have been used for magnetic resonance (MR) imaging over the last three decades. Recent reports demonstrated gadolinium retention in patients' brains following intravenous administration. Since gadolinium is a highly toxic heavy metal, there is a potential for adverse effects from prolonged retention or deposition, particularly in children. For this reason, the Society (SPR) for Pediatric Radiology Quality and Safety committee conducted a survey to evaluate the current status of GBCAs usage among pediatric radiologists.
  
  
  OBJECTIVE
  To assess the usage of GBCAs among SPR members.
  
  
  METHODS
  An online 15-question survey was distributed to SPR members. Survey questions pertained to the type of GBCAs used, protocoling workflow, requirement of renal function or pregnancy tests, and various clinical indications for contrast-enhanced MRI examinations.
  
  
  RESULTS
  A total of 163 survey responses were compiled (11.1% of survey invitations), the majority of these from academic institutions in the United States. Ninety-four percent reported that MR studies are always or usually protocoled by pediatric radiologists. The most common GBCA utilized by survey respondents were Eovist (60.7%), Ablavar (45.4%), Gadovist (38.7%), Magnevist (34.4%) and Dotarem (32.5%). For several clinical indications, survey responses regarding GBCA administration were concordant with American College of Radiology (ACR) Appropriateness Criteria, including seizures, headache and osteomyelitis. For other indications, including growth hormone deficiency and suspected vascular ring, survey responses revealed potential overutilization of GBCAs when compared to ACR recommendations.
  
  
  CONCLUSIONS
  Survey results demonstrate that GBCAs are administered judiciously in children, yet there is an opportunity to improve their utilization with the goal of reducing potential future adverse effects.
authors.affiliation: Department of Radiology, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway, South Bronx, NY, 10461, USA. einat.blumfield@nbhn.net.
authors.forename: Einat
authors.identifier: http://orcid.org/0000-0002-9089-572X
authors.initials: E
authors.lastname: Blumfield
authors.affiliation: Department of Radiology, Penn State Hershey Children's Hospital, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Moore
authors.affiliation: Department of Radiology, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Drake
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Goodman
authors.affiliation: Department of Radiology, Children's Hospital of Georgia, Augusta University, Augusta, GA, USA.
authors.forename: Kristopher N
authors.initials: KN
authors.lastname: Lewis
authors.affiliation: Wake Radiology, Raleigh, NC, USA.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Meyer
authors.affiliation: Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL, USA.
authors.forename: Thang D
authors.initials: TD
authors.lastname: Ngo
authors.affiliation: Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Sammet
authors.affiliation: Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Arta Luana
authors.initials: AL
authors.lastname: Stanescu
authors.affiliation: Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Swenson
authors.affiliation: Department of Radiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Slovis
authors.affiliation: Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Iyer
mesh_terms: D001921:Brain / Q000378:metabolism; D002648:Child; D003287:Contrast Media / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005682:Gadolinium / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D038622:Internationality; D008279:Magnetic Resonance Imaging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D057188:Workflow
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Children; Contrast; Gadolinium-based contrast agent; Magnetic resonance imaging; Survey