Safety warning: Nephrogenic Systemic Fibrosis (NSF)and gadolinium

Advice from the MHRA:

Nephrogenic Systemic Fibrosis (NSF) is a debilitating and sometimes fatal condition. It has been associated with some intravenous gadolinium-containing magnetic resonance imaging (MRI) contrast agents in patients with severe renal impairment. On the basis of the available evidence, the UK Commission on Human Medicines (CHM) together with the European Pharmacovigilance Working Party (PhVWP) of the Committee for Medicinal Products for Human Use (CHMP) recommended:

• Do not use Omniscan (gadodiamide) in patients with severe renal impairment (ie, GFR [glomerular filtration rate] <30ml/min/1·73m2)>
• Careful consideration should be given to the use of other gadolinium-containing MRI contrast agents in patients with severe renal impairment (ie, GFR <30ml/min/1·73m2).

MHRA Safety Warning

Online GFR calculator

More info
European Society of Urogenital Radiology
RSNA News Feb '07
The International Center for Nephrogenic Fibrosing Dermopathy Research (ICNFDR)

Recent articles in Radiology here and here.

New Radiology Educational Resource

Thereportingroom.com is a new, free educational site developed by Simon Morley of UCH. The team includes Gerald de Lacey and Lol Berman.

The aim of this website is to allow you to test yourself at interpreting radiology cases using software similar to normal day to day practice. We have developed viewing software which runs on your web browser allowing you to scroll through stacks of CT and MRI images and view plain film images with windowing zoom and pan functionality - just like a PACS workstation.

It looks very good, but note that you need a reasonable computer with a broadband connection and adobe flash player. Some computers in some UK hospitals may not be up to the job.

I've added a permanent link to this site, which I via Sumer's excellent Radiology site (where, ahem, MidEssexRay has recently had an honourable mention).

Investigation of suspected malignant pleural effusion

Good article in the latest BMJ:

Rahman NM, Davies RJ, Gleeson FV.
Investigating suspected malignant pleural effusion.
BMJ. 2007 Jan 27;334(7586):206-7.

These are the BTS guidelines referred to in the above article:

Maskell NA, Butland RJ; Pleural Diseases Group, Standards of Care Committee, British Thoracic Society.
BTS guidelines for the investigation of a unilateral pleural effusion in adults.
Thorax. 2003 May;58 Suppl 2:ii8-17.

I note that the BMJ appears to have started a series on "Rational Imaging". Good idea.