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Statement from Drugs and Contrast Media Committee on Supervision of Contrast Material Administration

Feb. 26, 2024

On site, there must be a radiologist or other physician* OR qualified person who is acting under the general supervision of a physician. This individual must:

  1. Have received training and meet institutional periodic competency guidelines at evaluating patients and diagnosing and differentiating different types of adverse reactions to contrast material.
  2. Be able to recognize when medical intervention is required for a hypersensitivity immediate reaction or physiology adverse event due to contrast administration.
  3. Be trained and legally permitted to administer prescription medications (e.g. antihistamine, intravenous fluid, beta agonist inhalers, epinephrine) and other appropriate interventions independently or under a standing orders/algorithmic approach under state law or regulations, and under local, institutional, site, and facility policies, guidelines and rules. These interventions are those indicated for urgent response to a contrast material adverse event as listed in the ACR Manual of Contrast Media or similar local policies or guidelines.
  4. When qualified to act under general supervision of a physician, be able to consult with the supervising physician within an appropriate timeframe.
  5. Has minimum BLS certification.
  6. Understand when to call for assistance and how to activate emergency response systems.
  • If the general supervision by a physician is performed remotely, the process should comply with all federal/state law or regulations and local, institutional, site, and facility policies, guidelines, or rules related to telemedicine. This remote general supervision should be available whenever contrast material is administered and include the standard post administration monitoring as dictated
    by all federal/state law or regulations and under local, institutional, site, and facility policies, guidelines, or rules.
  • Overall staffing should take into account the timeliness of available emergency response systems.

 

*"Other physicians" includes radiology residents and fellows.

Frequently Asked Questions

No. The supervision levels of the imaging study and supervision levels of contrast administration must meet all applicable regulations pertinent to the practice setting.

  1. “General supervision” is defined by CMS meaning that “the procedure is furnished under the physician’s overall direction and control, but that the physician’s presence is not required during the performance of the procedure.”

    If the general supervision by a physician is performed remotely, the process should comply with all federal/state law or regulations and local, institutional, site, and facility policies, guidelines, or rules related to telemedicine. This remote general supervision should be available whenever contrast material is administered and include the standard post administration monitoring as dictated by all federal/state law or regulations and under local, institutional, site, and facility policies, guidelines, or rules.

  2. “Direct supervision” means that the physician must be present and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room where and when the procedure is performed.

  3. “Personal supervision” means the definition specified at 42 CFR 410.32(b)(3)(iii), that is, the physician must be in attendance in the room during the performance of the service or procedure.

The supervision level for diagnostic radiology imaging procedures may be different than the supervision level for contrast administration supervision. Potential patient risks may be realized when using intravenous contrast agent/medium. Having a qualified healthcare professional onsite to recognize an issue and to manage the medical response to a potential adverse event in these instances improves the quality of the procedure and reduces any potential patient risk.

The definitions and competency of the numerous qualifications, skills, roles and training requirements of specific nonphysician health care providers who may be permitted to supervise contrast administration at a specific location are inconsistent among the various entities that define, regulate, or credential the performance of contrast administration supervision across the country. It is a dynamic list of positions and position titles. ACR cannot define reliably all possible qualified individuals who may be permitted to perform this function.

ACR has no policy on how or when contrast administration supervision competency should be assessed. The statement is meant to leave this policy determination to the facilities, practices, and institutions for their specific practice environment in accordance with existing state and federal laws and regulations.

Yes. There still needs to be a person on site with appropriate training to recognize contrast reactions and be trained and legally permitted to administer prescription medications and other appropriate interventions indicated for urgent response to a contrast material adverse event independently or under a standing orders/algorithmic approach under state law or regulations, and under local, institutional, site, and facility policies, guidelines and rules.

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