Gadolinium and or Pregnancy Flashcards
Linear structure gadolinium based contrast agents (GBCA’s):
should not ever be used
are the only GBCA’s associated with gadolinium retention
have one bond between the gadolinium and ligand molecules
are named this way because the gadolinium molecules line up in a straight line
have one bond between the gadolinium and ligand molecules
The physician providing “direct supervision” does not need to be in the MRI room during contrast administration. True or False?
True
False
True
Gadolinium is considered to be:
magnetic
ferromagnetic
paramagnetic
unmagnetic
paramagnetic
All extracellular GBCA’s have the same concentration of Gadolinium except _____. This agent has twice the concentration of Gadolinium and can be administered at half the volume as the others.
Magnevist
Omniscan
Ablavar
Gadavist
Gadavist
Which of the following suggests a high likelihood of a reaction to gadolinium?:
Prior gadolinium-based contrast reactions
Prior iodine-based contrast reactions
Asthma
Anxiety
Prior gadolinium-based contrast reactions
All of these are non-allergic reactions to gadolinium based contrast agents (GBCA’s) except:
Nausea
Emesis
Hives
Headache
Hives
Allergic reactions to GBCA are common. True or False?
True
False
False
Gadolinium deposition has been reported to happen within what structures within the human body?
bone marrow, internal capsule, dentate nucleus
dentate nucleus, putamen, internal capsule
bone marrow, dentate nucleus, globus pallidus, and orbital globes
putamen, internal capsule, globus pallidus
bone marrow, dentate nucleus, globus pallidus, and orbital globes
According to the ACR, pregnant healthcare workers in the MR environment:
Must not work in MRI for the duration of the pregnancy
Are able to work in and around the MR environment, with the exception of Zone IV during scanning
Are OK to work in MRI after the first trimester
Have no restrictions because there is no ionizing radiation
Are able to work in and around the MR environment, with the exception of Zone IV during scanning
NSF has occurred most frequently with:
Group 1 agents, patients with decreased renal function
Group 1 agents, patients with normal renal function
Group 2 agents, patients with decreased renal function
Group 2 agents, patients with acute renal function deficits
Group 1 agents, patients with decreased renal function
Macrocyclic GBCA’s have four bonds between the gadolinium ion and the ligand molecule. Disassociation can occur if just one of these bonds break before the contrast is excreted by the patient. True or False?
True
False
False
Guidelines suggest that MRI during pregnancy:
Should wait until after the first trimester
Should be avoided
Can be performed at any stage of the pregnancy after risk benefit assessment
Is entirely up to what the patient wants
Can be performed at any stage of the pregnancy after risk benefit assessment
Concentrations of anthropogenic (caused by human activity) gadolinium in ground and drinking water are greater in developed, urban areas when compared to less populated, rural areas. True or False?
True
False
True
The occurrence of anthropogenic (originating from human activity) gadolinium is increasing and has been reported in:
waste water
reservoirs
tap (drinking) water
internationally and in the U.S.
all of the above
waste water
reservoirs
tap (drinking) water
internationally and in the U.S.
Macrocyclic structure gadolinium based contrast agents (GBCA’s):
are always a better choice than linear structure
are safe for all patients regardless of renal function
have four bonds between the gadolinium and ligand molecule
can be administered in any dose regardless of patient weight
have four bonds between the gadolinium and ligand molecule
Which gadolinium agent sub classification is thought to be more stable than the other?
Non-Ionic
Ionic
Ionic
According to the Centers for Medicare and Medicaid Services (CMS), _________ supervision is required when injecting gadolinium based contrast agents.
General
Direct
Personal
Indirect
Direct
What differentiates one gadolinium based contrast agent from another?
Cost
Type of gadolinium
Ligand molecule as well as ionic and non-ionic sub classifications.
Nothing, they’re all the same
Ligand molecule as well as ionic and non-ionic sub classifications.
Gadolinium is considered paramagnetic because it:
becomes permanently magnetic when exposed to the magnetic field
repels the magnetic field
becomes temporarily magnetized when exposed to the magnetic field
becomes temporarily magnetized when exposed to the magnetic field
Direct supervision during contrast administration means:
another level 1 MR staff member must be in Zone 3 while contrast is being administered
a radiologist must be in the MRI suite while contrast is being administered
a physician must be available and interruptible to provide assistance if needed
another staff member must watch the contrast injection
a physician must be available and interruptible to provide assistance if needed
All the following are examples of Group 1 GBCA agents (and therefore, have a known relationship to nephrogenic systemic fibrosis) EXCEPT:
Magnevist
Omniscan
Optimark
Prohance
Prohance
Anxiety can have an effect on allergic-type reactions to GBCA. True or False?
True
False
True
The decision to scan a pregnant patient should be made by the ____________ after performing a risk vs benefit assessment.
Technologist
Supervising radiologist
MRSO
Referring physician
Department manager
Supervising radiologist
Which bond is more stable in regards to GBCA’s?
Ionic
Nonionic
Neither
It doesn’t matter, the only concern is linear or macrocyclic
Ionic
All of the following gadolinium agents are examples of Group 2 agents (and therefore are associated with few, if any unconfounded cases of nephrogenic systemic fibrosis) EXCEPT:
Dotarem
Gadovist
Multihance
Optimark
Optimark
Which is NOT an example of an acute gadolinium reaction?
anaphylaxis
hives (urticaria)
nausea/vomiting
deposition
deposition
The ligand molecule is what differentiates one GBCA from another.
True
False
True
GBCAs are different than other prescription medications in terms of dose and delivery. True or False?
True
False
False
Since 2007, GBCA practice world-wide has been modified by three major changes. These include all of the following EXCEPT:
Pre-screening (at the minimum higher risk) patients for renal disease
Not administering GBCA or administering a lower dose of GBCA if renal disease is present
Talking patients out of GBCA when we feel it is not indicated
Selecting specific agents to be used or specifically not to be used in patients with renal disease
Talking patients out of GBCA when we feel it is not indicated
The ACR has determined that pregnant patients can be accepted to undergo MR scans at any stage of pregnancy if the risk–benefit assessment of the patient warrants that the study be performed. True or False?
True
False
True
Magnevist is associated with noncounfounded reports of gadolinium retention. What does that mean?
It means that these reports have not been verified
It means that Magnevist is a linear structure contrast agent
It means that the FDA does not agree with the reports
It means that Magnevist was the only gadolinium based contrast agent these patients received
It means that Magnevist was the only gadolinium based contrast agent these patients received
Which is NOT an example of a chronic gadolinium reaction?
urticaria
nephrogenic systemic fibrosis
bone marrow retention
dentate nucleus retention
urticaria
All linear structure GBCA’s behave similarly and are similar in their number of reported cases of NSF. True or False?
True
False
False
Patients with unrelated allergies may be at an increased risk to have an allergic-like reaction to intravenous contrast, so they should be premedicated. True or False?
True
False
False
According to the ACR, giving GBCA to a breastfeeding mother is _________ because the of the _______ amount of __________ contrast in the breast milk.
unsafe / high / non-chelated
safe / low / non-chelated
unsafe / low / chelated
safe / low / chelated
safe / low / chelated
Your radiologist has approved a contrast enhanced MR study for a patient who is 22 weeks pregnant and comes to you, the MRSO, for advice on the type of GBCA to be used. You have access to all contrast agents on the market. Which would you suggest based on stability/least likely to disassociate?
linear ionic agents like Magnevist, MultiHance
linear non-ionic agents like Omniscan, Optimark
macrocyclic ionic agents like Dotarem
macrocyclic non-ionic agents like Gadavist, ProHance
macrocyclic ionic agents like Dotarem
Gadolinium is not directly seen on post contrast imaging. True or False?
True
False
True
There is no known cure for NSF. True or False?
True
False
True
Define “Direct Supervision.”
The physician or NPP must be immediately available and interruptible to furnish assistance and direction throughout the performance of the procedure.
The physician or NPP must be in the magnet room during the examination.
The physician or NPP must be in the building throughout the performance of the procedure.
The physician or NPP must be reachable to give emergency instructions in an emergency situation
The physician or NPP must be immediately available and interruptible to furnish assistance and direction throughout the performance of the procedure.
Macrocyclic structure GBCA’s are more stable than linear structure because:
Macrocyclic are more expensive than linear
Macrocyclic GBCA’s have four bonds with their ligand which must be broken simultaneously for disassociation to occur
They aren’t. Linear structure GBCA’s are more stable.
Macrocyclic structure GBCA’s use larger gadolinium molecules.
Macrocyclic GBCA’s have four bonds with their ligand which must be broken simultaneously for disassociation to occur
Confounded reports of gadolinium retention means:
The reports are more believable
The gadolinium retention is not observable
Patients reporting gadolinium retention received different brands of GBCA over time
Nothing. Gadolinium retention does not happen.
Patients reporting gadolinium retention received different brands of GBCA over time
Anthropogenic (caused by human activity) gadolinium is removed by municipal waste water treatment facilities. True or False?
True
False
False
