Original Publication
Open Access

Curriculum for the Management of Contrast Media Reactions, Contrast Induced Nephropathy & Nephrogenic Systemic Fibrosis

Published: January 31, 2013 | 10.15766/mep_2374-8265.9333

Included in this publication:

  • Contrast Reactions, CIN & NSF teaching file.ppt
  • Instructor's Guide - Contrast reactions, CIN & NSF teaching file.doc
  • Web Link Access_9333.pdf

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Radiologists supervising imaging studies using contrast media should have the necessary knowledge and skills to deal with adverse contrast media reactions and their appropriate management. The aim of this curriculum is to educate practicing radiologists, residents, fellows, non-radiology house staff covering contrast administration after hours, and hospital code teams regarding current recommendations for dealing with contrast media reactions, contrast-induced nephropathy and nephrogenic systemic fibrosis. Various drugs used in the management of these reactions are reviewed in detail and an algorithmic approach to the management of these reactions is provided. We also review the medication regimens that can minimize the risk of these complications. Our curriculum incorporates the current guidelines as recommended by the American College of Radiology in their manual on contrast medium published in 2012. Pretest questions have been provided for self-assessment.

We encourage all physicians responsible for contrast media administration and reaction management to review this curriculum on a regular basis, at least biannually. Algorithms provided are also a good resource for placement in radiology suites and hospital crash carts.

This teaching file is based on the original PowerPoint presentation authored by Dr. William H. Bush, Jr., Clinical Professor of Radiology (Retd.) at University of Washington. It is regularly updated and has been used for teaching our residents and fellows.

Educational Objectives

  1. To review acute reactions to contrast media and their management. Algorithmic approach to the management of these reactions has been outlined.
  2. To discuss premedication regimens employed in susceptible patients prior to administering the contrast media.
  3. To review contrast-induced nephrotoxicity and nephrogenic systemic fibrosis along with guidelines for administering contrast media in different stages of renal failure. Interventions that can minimize the risk of these complications have been discussed.

Author Information

  • Puneet Bhargava, MD: University of Washington School of Medicine
  • Adeel Seyal: Harris Medical Center
  • Chandana Lall: University of California, Irvine
  • Mariam Moshiri: University of Washington
  • Jennifer Schopp: University of Washington
  • Jennifer Favinger: University of Washington
  • Carolyn Wang: University of Washington
  • Neeraj Lalwani: University of Washington
  • Martin Gunn: University of Washington
  • William Bush: University of Washington

None to report.

None to report. 


Favinger J, Bastawrous S, Bhargava P. Management of Acute Contrast Media Reactions: Assessing Preparedness of a Tertiary Care Veterans Affairs Medical Center. Journal of the American College of Radiology. Available online 22 February 2013 from http://dx.doi.org/10.1016/j.jacr.2012.12.019


Bhargava P, Seyal A, Lall C, et al. Curriculum for the management of contrast media reactions, contrast induced nephropathy & nephrogenic systemic fibrosis. MedEdPORTAL. 2013;9:9333. https://doi.org/10.15766/mep_2374-8265.9333