ContrastSafe
ACR Contrast Administration Dashboard
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Iodinated Contrast
Gadolinium (GBCA)
Reaction Management
Protocols
Patient Parameters
Weight (kg)
eGFR (mL/min/1.73m²)
Leave blank if not available
Prior Contrast Reaction
None
Mild (urticaria, flushing)
Moderate (bronchospasm, hypotension)
Severe / anaphylaxis
Medications
Metformin / biguanides
NSAIDs / nephrotoxics
Thyroid Disease
None
Hyperthyroidism / Graves
Planned RAI therapy
Contrast Concentration
Iohexol 300 mg I/mL (Omnipaque 300)
Iohexol 350 mg I/mL (Omnipaque 350)
Iopamidol 370 mg I/mL (Isovue 370)
Iodixanol 320 mg I/mL (Visipaque 320)
Study Type
CT — Standard (1.5 mL/kg)
CT Body — Obese (2 mL/kg)
CTA (max 150 mL)
Cardiac CTA (80–100 mL)
Enter patient parameters to assess contrast safety
Patient Parameters
Weight (kg)
eGFR (mL/min/1.73m²)
Select GBCA Agent
Dose Regimen
Standard (0.1 mmol/kg)
Double dose (0.2 mmol/kg)
Dialysis
Not on dialysis
Haemodialysis
Peritoneal dialysis
Enter parameters to assess GBCA safety
Reaction Assessment
Patient Weight (kg)
Reaction Severity
Mild
— Urticaria, itching, flushing, nausea
Moderate
— Bronchospasm, facial edema, hypotension
Severe
— Anaphylaxis, cardiac arrest, loss of consciousness
Select reaction severity to view management protocol
Elective Premedication Protocol
For patients with prior moderate/severe contrast reaction — elective studies
13 hrs
Methylprednisolone 32 mg PO (or prednisone 50 mg PO)
7 hrs
Methylprednisolone 32 mg PO (or prednisone 50 mg PO)
1 hr
Methylprednisolone 32 mg PO + Diphenhydramine 50 mg IV/IM/PO
Scan
Use lowest osmolality non-ionic agent; have resuscitation equipment ready
ACR Manual on Contrast Media 2023
The 13h/7h/1h regimen is the standard elective protocol. Diphenhydramine is an adjunct — steroids are the essential component.
Urgent Premedication Protocol
When 13-hour protocol cannot be completed
OPTION A — 5-hour protocol
5 hrs
Methylprednisolone 40 mg IV q4h × 3 doses
1 hr
Diphenhydramine 50 mg IV
OPTION B — 1-hour protocol (emergency)
1 hr
Methylprednisolone 40 mg IV + Diphenhydramine 50 mg IV
Scan
Accept higher breakthrough rate (~5–10%)
Metformin Protocol
eGFR ≥30
Continue metformin; no restrictions. Monitor renal function per clinical need.
eGFR <30
Hold metformin at time of contrast. Restart 48 hours after procedure once renal function confirmed stable.
Emergency
Do not delay emergency imaging. Hold metformin after contrast; monitor renal function.
Thyroid Protocol
Euthyroid
No restrictions. Iodine load from contrast is transient.
Hyperthyroid
Consult endocrinology. Iodinated contrast may precipitate thyroid storm or iodine-induced thyrotoxicosis.
RAI planned
Delay contrast for 6–8 weeks before RAI therapy; contrast iodine saturates thyroid uptake.
Emergency Contacts
CODE TEAM
2222
Internal extension
ACR CONTRAST HOTLINE
ACR Manual
acr.org/contrast
Always have resuscitation equipment available
Crash cart, oxygen, suction, IV access, epinephrine 1:1000 ready before contrast administration in high-risk patients.