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On May 5, 2015, Health Imaging published “Q&A: Gadolinium update with leading MRI safety expert Emanuel Kanal, MD”. That same day, an editorial authored by Emanuel Kanal, MD, Director of MR Services at the University of Pittsburgh Medical Center, and Michael F. Tweedle, PhD, Professor and Stefanie Spielman Chair in Cancer Imaging at The Ohio State University Medical School, was published online in Radiology. Their editorial, “Residual or Retained Gadolinium: Practical Implications for Radiologists and Our Patients”, addresses the issue of gadolinium retention in patients with normal renal function. The Q&A is a follow-up to that editorial.
For those who may not be familiar with Dr. ‘Manny’ Kanal, he is a nationally recognized radiologist and a leader in the area of MRI safety. He is the Chair of the founding Board of Directors of the American Board of Magnetic Resonance Safety (ABMRS). Dr. Kanal spoke with Health Imaging for an exclusive interview regarding the new evidence of gadolinium retention and its potential impact on diagnostic imaging and patient safety.
I will not go into all the details of the Q&A here, but there are several interesting comments that Dr. Kanal made that I want to mention.
Regarding the effects of retained gadolinium, Dr. Kanal questioned a comment in an article on Mayo Clinic News Network that was made by one of the authors of the recently published Mayo Clinic study. He said something to the effect of ‘Well, no one has ever shown that this is harmful.’ Dr. Kanal, acknowledged that is true, but, he said, “At the same time, no one has ever studied it to date, so how could they show whether it’s harmful or not?”
When asked how many of the patients who received one or more of the estimated 10 million contrast injections in the U.S. each year could have retained gadolinium in their bodies, Dr. Kanal said, “There is the potential for some level of gadolinium retention for essentially 100 percent of those patients who receive contrast for an MR examination”. (more…)
On May 5, 2015, an editorial by Emanuel Kanal, MD, Director of Magnetic Resonance Services and Professor of Radiology and Neuroradiology at the University of Pittsburgh Medical Center, and Michael F. Tweedle, PhD, Professor and Stefanie Spielman Chair in Cancer Imaging at The Ohio State University Medical School, was published online ahead of print. The editorial, “Residual or Retained Gadolinium: Practical Implications for Radiologists and Our Patients”, is in the June 2015 issue of Radiology. It addresses the issue of gadolinium retention in patients with normal renal function, as evidenced by published findings by Kanda et al, Errante et al, Quattrocchi et al, McDonald et al, and Radbruch et al.
In December of 2013, a study by Kanda et al first brought attention to what appeared to be evidence of residual gadolinium within the brain tissues of patients without severe renal disease. The evidence of gadolinium in the brain started with reports of abnormal signals in the globus pallidus and the dentate nuclei on unenhanced T1-weighted MR images after repeated prior administration of certain gadolinium-based contrast agents or GBCAs. Other studies found measureable concentrations of gadolinium in normal brain tissues from patients with normal renal (kidney) function. In their editorial, Kanal and Tweedle said, “These provocative findings cause us to reconsider what we know and what we need to learn to better care for our patients”.
The authors said, “We now have clear evidence that the administration of various GBCAs results in notably varied levels of accumulation of residual gadolinium in the brain and bones of patients, even those with normal renal function. What we still do not know is the clinical significance, if any, of this observation.” (more…)
MRI safety recently took a step forward with the formation of the American Board of Magnetic Resonance Safety (ABMRS). According to its website, the not-for-profit corporation’s purpose is to improve the safety of medical and research magnetic resonance (MR) environments. That includes the safety of MR facilities and the certification and qualification of the professionals who oversee the physical and operational safety of the MR equipment, environment, and processes.
The leadership of the founding Board of Directors includes the following:
- Chair: Emanuel Kanal, MD, Director of MR Services at the University of Pittsburgh Medical Center
- Vice Chair: Max Amurao, Phd, Director of Radiation Safety for Clinical Programs at Columbia University/New York Presbyterian Hospitals
- Secretary/Treasure: Tobias Gilk, MArch, Sr. Vice President of Radiology-Planning and Founder of Gilk Radiology Consulting
After years of trying to get the FDA and medical community’s attention about the issue of Gadolinium retention in patients with normal kidney function, it looks like our efforts have begun to pay off.
I want to share some news about Dr. Emanuel (Manny) Kanal. If you aren’t familiar with his name, Dr. Kanal is a leading radiologist and someone the FDA looks to for advice on matters related to MRI Safety. Duke and I have been in communication with him since October of 2013.
As you might imagine, MRI Safety is an important issue that requires medical professionals to stay well-informed about safety issues directly related to MR devices as well as the Gadolinium-based Contrast Agents administered for contrast-enhanced MRI and MRA. Since June of this year, Dr. Kanal has been conducting MRI Safety Officer (MRSO) and MRI Medical Director (MRMD) Seminars.
During a seminar on September 9, 2014, Dr. Kanal provided a “Gadolinium Contrast Overview”. According to the MRI Patient Safety blog, besides describing the state of NSF, he described “new and growing concerns about non-NSF bio-retention”. (more…)