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Magnetic Resonance Imaging (MRI)
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orange


Posts: 97
Joined: Jul 2011
Post: #21
27-07-2011 09:49 AM

Jane,
You are right. They do not want to know/search because they will never admit to be wrong. In the case of gadolinium toxicity the results can be devastating. The disease is rare, a man made one and there is no cure. The internet is full of reports from people who have suffered prompt/delayed side effects to this substance, but doctors and radiographers dismiss the lot.
This is another bomb ready to explode like that medication used in the 60s which harmed people but was considered safe.
I have read of a legal case brought up in the English court from a danish radiographer, who was the first one to talk about the problem.

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sillytilly


Posts: 25
Joined: Apr 2011
Post: #22
28-07-2011 04:39 PM

I had a CT scan (obviously slightly different to an MRI - MRI's are not as bad for you apparently) recently at Lewisham Hospital and I have to say it wasn't the best experience. The actual CT scan itself was absolutely fine, the radiographers and nurses were great. I had an abdominal CT scan so had to drink a massive white drink (possibly barium but they didn't tell me what it was - yes I probably should have asked) and then I had the IV dye injected into me while in the CT scanner. I thought all was absolutely fine until about an hour after the scan which was luckily when I got home. I was then stuck to the toilet for the rest of the afternoon, if you know what I mean. Although I have been having stomach problems (hence the CT scan) so it could be that it was unrelated to the CT scan/drink/IV. I did have a sore throat for a couple of days after the scan as well, but again this could have been unrelated and could have been a bug I picked up from being at the hospital, it's easy to pin every symptom on the scan/drink/IV. As other people have said, your doctor/consultant wouldn't recommend you for the scan unless it was absolutely necessary, yes there are risks - but you could just as easily die crossing the road outside Forest Hill Station. Good luck and I hope you feel better soon!

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sillytilly


Posts: 25
Joined: Apr 2011
Post: #23
28-07-2011 04:42 PM

orange - I would suggest NOT googling everything as well, if you start doing that you will start thinking all sorts of awful things, if you are worried ask your doctor/consultant not google.

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orange


Posts: 97
Joined: Jul 2011
Post: #24
29-07-2011 08:59 AM

I don't google everything but as my friend was not told about the injection in advance and found out she could have been allergic/ or having problems counter indicating it after, I have searched to know more and to make the correct choice at the time of the scan.

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sillytilly


Posts: 25
Joined: Apr 2011
Post: #25
29-07-2011 09:09 AM

I totally understand that and do feel awful for your poor friend, you are doing the right thing by researching. It is very difficult to make that decision, I would speak to your doctor though if you are worried as depending on your problem it may not be absolutely necessary for you to have it. However if you don't have it some things do not necessarily show up on the scan, which is a bit of a catch 22 situation as it means then that there are risks either way! Sorry I know that's not very helpful. Do double check with your doctor if it is necessary.

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brian


Posts: 2,002
Joined: Apr 2005
Post: #26
29-07-2011 01:27 PM

U agree with Silly Tilly
I have had about 6 CT Scans in last 2.5 years and you have to trust the Consultants to do their best and afvise you correctly.
I have tried to avoid taking advice from the internet.

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orange


Posts: 97
Joined: Jul 2011
Post: #27
24-08-2011 04:06 PM

my friend still has problems. She contacted an expert on this matter from Copenaghen University hospital who confirmed that she is suffering from effects of the drug leaked into her tissues. They do not know how long it is going to take for these effects to go off, but after 4 months she still has neuropathic pains/weird sensations, eyes flashing pains, lost quite a bit of hair etc...muscle pains. Yet she has and she had no kidney problems. She is now going to take action against the hospital, the negligent nurse and the drug company.
Always ask what they are injecting you with. Your consent must be well informed. It is illegal to give you a drug without letting you know what is for, what are the side effects or dangers and the alternatives. In her case nothing was told, except they needed to give her that injection. The drug used was one of the safest, yet, it still caused serious problems. This is what happens if you trust your consultant/hospital staff.

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dartmouth


Posts: 71
Joined: Feb 2011
Post: #28
31-08-2011 03:46 PM

I can assure you (as an MRI radiographer) that no part of the MRI examination, including the potential use of Gd-DTPA contrast agents (and NSF or indeed any kind of adverse reaction), is EVER dismissed by the radiographer, radiologist or referrer. VERY strict processes are in place to protect patients and ensure that no risk is placed upon them. As was stated earlier, NSF has only been linked directly to certain gadolinium based MRI contrast agents (most central London hospitals no longer use) used in patients with poor renal function. Your doctor will advise you on whether there should be any concern over this in your case.

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dartmouth


Posts: 71
Joined: Feb 2011
Post: #29
31-08-2011 04:45 PM

Furthermore, I would echo the advice that others have given in that one should be very careful using Google. Your referrer and the staff working in the imaging department you have been referred to are experts in their field and through constant review of good quality literature (unlike the website quoted earlier in this thread) and interdisciplinary research, are able to ensure that the care they provide is of the highest quality. It is simply not possible in the modern day NHS for any healthcare professional to ignore this duty of care.

Yes, people have bad experiences in hospitals but the majority do not. You must remember that each individual is very different and there are processes put in place for patient's protection. The most important rule is that benefit must always outweigh risk. If your doctor has referred you for an MRI scan, then they regard it to be important to your care.

A great deal of what has been talked about in this thread is simply scaremongering. There have been a handful of cases of NSF worldwide and the link with Gadolinium based contrast agents is still very much under investigation. Speak to your consultant about your concerns and if necessary, request a blood test to assess your renal function (eGFR and Creatinine). Your can rest assured that once you arrive in the imaging department, your care will be paramount. If, when it comes down to it, you object to the injection of contrast (if indeed you even need it), you do not have to have it. It will be detrimental to the quality of the report which is produced from the scan but NO healthcare professional would ever force you to undergo any procedure in a hospital which you do not consent to.

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orange


Posts: 97
Joined: Jul 2011
Post: #30
02-09-2011 10:41 AM

This thread is not to scare people but to make others aware. My friend is still suffering from symptoms caused by the leakeage of the toxic metal outside the veins. That's is a reality.
The website quoted in the thread reports a study done by one of the highest scientists on the subject, contrary to what radiographers and radiologist do not wish to admit. So far no radiographer/radiologist has been taken to court, but only pharmaceutical companies. As MRI scans are becoming more popular, especially among people in the middle age group, the problem is going to explode and there will be more legal cases. Modern medicine and big pharma are causing more problems than ever.
No hospital in London does blood tests on creatinine prior to the scan. There are over 800 cases reported so far with confirmed diagnosis of the NFS disease. The registration is voluntary, but there are several other cases unreported, also deaths and people hospitalised as a consequence of the bad administration of the drug. There are also cases of very severe reactions even with the very safe contrast agent used in London hospitals. No one knows how you react until you have the drug in your veins. This drug is very expensive, why are you wasting our money on something which is only a magnetic highlighter?
regarding the consent the patients give to hospitals, not always these consents are obtained legally as very little information is given on the drug and its toxicity. If you said to someone: Iam going to inject you with lead or arsenic, because that gives me a better picture of your scan, do you think that people would consent to it? I am sure they would think twice before signing the form. Unfortunately radiographers do not say much about the drug, except that you will have a little bit of sneezing afterwards, but they need it for your treatment. You sign the form because you trust them completely. It is only days, months after being exposed to gadolinium that you start to have problems. You phone the hospital and report your strange symptoms and they do not want to know. The only things they tell you is to go back to your GP (who does not know where to start to sort you out). They report every reactions to various agencies, but once that is done, they are out of the equation. That's what happens.
In my case I have had an ultrasound test which reassured me of my situation so I don't need to go for this rubbish. I started the thread to find out if anybody had bad experience, apart from my friend. Google and Internet have become the doctor's worse enemies. Thank God they exist. Patients start to get informed and fight back when things go wrong. Experiences are shared, medical negligences are let in the open.Perhaps this should make the medical professional body think twice and more carefully when administering drugs because the health of a patient is of a paramount importance.

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dartmouth


Posts: 71
Joined: Feb 2011
Post: #31
02-09-2011 03:27 PM

This thread is making people aware but regrettably, a lot of it is simply, factually incorrect.

- Gadolinium in its natural form is a rare earth metal which yes, would not be safe for injection but this could be said for almost all other
medicines with constituent parts which are potentially dangerous elements. The point is that the pharmaceutical companies chelate the Gd into larger moleclues where they are effectivly bound so tight so as not to cause problems. The body cannot break down these molecules. It is these larger molecules which can cause problems in those with renal impairment. Those who do not have renal impairment are able to excrete the contrast medium before it has any chance to linger in tissues.

- Youre absolutely correct that creatinine level is not routinely requested as part of routine bloods for patients having any form of contrast medium (iodinated or gadolinium based) but that is because it is now widely recognised in the literature that creatinine is not a reliable benchmark against which to judge whether a patients renal function is sufficient to cope with the contrast molecule. Glomerular filtration rate (eGFR), although estimated, is now the gold standard and despite your assumption, ALL patients having MRI scans where contrast is required in my instituion DO have this checked, whether they have known renal problems or not. In fairness, this is a recent decision made by the RCR but it is based on facts identified within peer reviewed research, NOT from biased websites and publications which are published on google. Noone in the medical profession would give any time to any articles published directly on the internet as such sites are NOT peer reviewed. This means that anyone can write a fact which may potentially be incorrect, and it will go unchecked (much like this thread). What is to say that the expert you refer to in your postings is in fact not on the payroll of a rival pharmaceutical company making a new form of the molecule?? This is much more likely than you may realise. It may sound like a negative thing but in fact, it is this competition which ensures constantly improving resources. However, it does not stop individuals making claims on public forums such as the internet.

- If your friend's problems were caused by 'the leakeage (sic) of the toxic metal outside the veins', then the problems are probably related to extravasation, not to the substance itself. Compartment syndrome is a problem, but could technically be caused by the extavasation of simple saline, which as we all know, is perfectly inert (although, to prove a point, the injection of its component parts would most probably be fatal). The extravasation of gadolinium based contrast is very painful admittedly, but that is why ALL staff administering contrast are very careful to test lines with saline prior to injection. The molecules of contrast are simply too big to 'leak' between the cells making up the three layers of vein wall by themsleves.

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dartmouth


Posts: 71
Joined: Feb 2011
Post: #32
02-09-2011 03:28 PM

- It is true that noone truly knows how one is going to react with the injection of contrast media. However, the same can be said for ANY other medicine you take if you have not taken it before. An astonishing number of people have penicillin allergies but it remains one of the best tools available in the fight against infection. However, processes are in place which effectivley prevent patients receiving penicillin based anti-biotics who may be sensitive. You can go into Sainsburies and buy any one of the cold and flu remedies on the shelf and potentially, have an allergic reaction. The point is, it is extremely rare. 1 in 1000 people will have a mild (not allergic) reaction (nausea) to gadolinium contrast agents, compared to 1 in 100 with iodinated contrast agents (those used in CT and X-Ray). Bizarrely, iodinated contrast agents do not command nearly as much interest. The rule here is that if contrast media is required (which, far from being something to make radiographers/radiologists lives easier but rather something which will make the difference between a right or wrong diagnosis), the risks are managed by careful and strict adherence to practices which have been decided after careful and accurate research.

- Yes, Gd based contrast media is VERY expensive, largely because of the time and money spent on designing molecules which are safe to inject. However, it is not money wasted if that contrast is the ONLY way a definitive diagnosis can be made. In my line of work, the type of patients who receive contrast are often those who require it to define and classify a type or grade of tumour which would be IMPOSSIBLE by any other non-invasive means. The only other option is invasive, life threatening deep tissue biopsy which has significantly higher risks associated with it. Another patient group are those with Multiple sclerosis where Gd-DTPA is the only contrast media sensitive enough to demonstrate active inflammation (active disease). Without this, there would be NO way of directly assessing and quantifying the success of treatment regimens and the science behind multiple sclerosis would be light years behind. The point I am trying to make is that without contrast media of this kind, we would be vastly behind in the diagnosis and treatment of many diseases, inlcuding cancer, MS, vascular diseases etc. This is why I regard your comments about medical staff injecting these drugs as they just want to make their life easier, so incredibly mis-informed.

- Radiographers will always talk to you about the contrast injection before even starting cannulation, as it is assault if they do not. However, I can assure you that no radiographer will state that it may cause 'a little bit of sneezing afterwards'. Sneezing is not a common side effect of any contrast injection and in fact, NO common side effects have been recognised in MRI agents. As such, no radiographer would state sneezing as a potential side effect. If it were, then it would surely be a pointless exercise anyway when the patient is required to be very still for perhaps 30 minutes after the injection whilst the images are acquired!

All in all, your are right that the health of the patient is of paramount importance. However, without the use gadolinium based contrast agents, it is an inescapable fact that modern medicine would not be where it is today and more patients would die from delayed and innaccurate medical diagnosis of some of the most serious diseases known to man. This is NOT an over statement. Of course, nothing is without risk. If it were, then I am sure we would all be having 6 monthly scans as a routine MOT (something which certain companies try to offer and something which the medical community are dead against). However, MRI is not becoming 'more popular' as you describe, as if patients had a choice whether to be in a situation where they need medical attention?! On the contrary, MRI is simply emerging as the gold standard imaging investigation for soft tissue disease, showing both anatomical and physiological information which is simply unrivalled by any other imaging test. The use of contrast media is an inescapable part of this and without it, those who require accurate diagnosis would not be in the relatively fortunate position they are in now, when compared to 20 years ago. I for one would have an MRI with contrast any day fo the week if it meant I was going to receive a fast and accurate diagnosis. Risks are accepted to be part of medicine as we are essentially working against nature to keep us healthier and living longer. Ultimately, medical profesisonals can only provide patients with enough information to make informed consent. However, patient CHOICE will always be the deciding factor.

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seeformiles


Posts: 269
Joined: Apr 2005
Post: #33
02-09-2011 10:55 PM

Thanks for the facts Dartmouth; your expertise is appreciated.

I also felt this thread was beginning to lean too heavily into scaremongering territory, which could be worrying many people unnecessarily.

It's easy to pick out cases where adverse reactions occur across a range of medical procedures, but some much needed context and up-to-date statistics will give a much more accurate picture. I'm not trying to dismiss the suffering of individuals but fortunately they are a small minority, and we shouldn't forget that.

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dartmouth


Posts: 71
Joined: Feb 2011
Post: #34
03-09-2011 09:31 AM

Excellently put seeformiles.

I, like my collagues, recognise anxiety and concern in patients coming for investigations which are not only scary in themselves, but which may also produce results which may not be necessarily good news. The task of overcoming this anxiety and guiding and supporting patients through their investigation is one of the biggest challenges which profesisonals such as those in my profession face. It is for this reason that I truly believe that posts such as those seen in this thread, aswell as the general tone of some wesbites which are aimed at 'informing' patients are arguably more destructive to the quality of care which can be provided to patients by health professionals, than helpful.

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orange


Posts: 97
Joined: Jul 2011
Post: #35
05-09-2011 11:24 AM

thank you for your information. You have given me reasons to reassure my friend on the experience. However I have seen myself the letter of the hospital saying that the only reaction was like hayfever (sneezing and itchy eyes). The study reported on this thread, confirms the study done by Yale university which is in charge of the International Agency for for the NFS and on nobody payroll. However, I wish to mention that some people who developed NFS were people without kidneys problems.
Gadolinium is very expensive and it would do better to spend the money on cancer drugs, rather than on a diagnostic tool.
How were things done before? Did we need to inject people with dangerous metals?
Do you have cases of extra-vasation at your hospital? What do you do to make amend in that case?

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dartmouth


Posts: 71
Joined: Feb 2011
Post: #36
06-09-2011 09:41 AM

oh dear, I fear I am fighting a hopeless battle.

1) There is NO common reaction to MRI contrast agents, including hayfever like symptoms.

2) If you think the money spent on gadolinium contrast agents as a diagnostic tool would be better spent on cancer drugs, can I ask how you think those cancers are diagnosed and more importantly, classified into a histological grade (how aggressive they behave)? A patient with a brain tumour for example would need a combination of drugs which could be chosen from literally hundreds of possible drugs therapies. That choice relies 100% on the accurate description of the exact subtype and grade of that tumour. Without this, the therapy would be pointless. Currently, contrast enhanced MRI is the gold standard (best method) for diagnosing,grading and monitoring tumours non-invasively, even more so with the advent of MRI perfusion imaging.

4) There is no International Agency for NFS (or NSF for that matter). Do you mean the International Centre for NSF Research (two very different types of institution). ICNSFR are a group at Yale or research possible cases of NSF with the aim of identifying potential causes, including the possibility of links between NSF and Gd. They state very clearly that very few cases of NSF have been identified (around 300 out of a population of many hundreds of millions) and that there is still a wide differential of potential causes. They talk clearly about the use of large volumes of contrast agent being a risk factor, which are simply not used in this country. They talk about contrast enhanced MR angiography (which does use higher volumes) which is not routinely used as first line of investigation in this country. We use more non-contrast enhanced MRA sequences or CTA. Also, American healthcare is very different to our own. My own experience has shown me that the private healthcare system over there results in patients having scans more often that patients would do in this country, again contributing to higher volumes of contrast. You should be very careful about drawing conclusions from research which is a) still ongoing b) has very low cohort sizes and c) is centred in a different location to the UK.

Furthermore, a quick google search has allowed me to identify at least [/u]three researchers at Yale University Biomedical Engineering Centre who are involved in the development of paramagnetic contrast agents.

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orange


Posts: 97
Joined: Jul 2011
Post: #37
06-09-2011 01:06 PM

Yes it is that organisation. I hear what you are saying.

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