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Commentary |
1 Chairman, Board of Chancellors, American College of Radiology, 1891 Preston White Dr., Reston, VA 20191.
Received April 6, 2007; accepted after revision April 6, 2007.
Address correspondence to A. V. Moore, Jr.
Keywords: American College of Radiology • gadolinium • MRI • MR safety • nephrogenic systemic fibrosis
The leadership of the American College of Radiology (ACR) congratulates Emanuel Kanal and the Blue Ribbon Panel on MR Safety [1] for the excellent article on MR safety in this edition of the American Journal of Roentgenology (AJR). The e-publication of this article was first placed on the AJR Website on March 1, 2007, and the ACR Website has a link to the article. In view of recent reports of nephrogenic systemic fibrosis (NSF) in renal failure patients receiving gadolinium, the article has engendered significant interest and comment. In particular, there was interest in the opinion expressed in the article that gadodiamide (Omniscan, GE Healthcare) should not be given to anyone with a glomerular filtration rate (GFR) less than normal (90 mL/min) and that hemodialysis should be performed within 2 hours of administration of gadolinium. As a result, the ACR has received numerous calls asking if this article represents ACR policy. The purpose of this commentary is to clarify exactly what constitutes ACR policy.
The highest level of ACR policy is a resolution adopted by the Council of the ACR. General resolutions may be submitted by a councilor, a state radiology society, or a subspecialty radiology society that has a seat on the Council of the ACR. General resolutions are discussed and can be debated word-by-word in reference committee and on the floor of the council at the annual meeting each spring in Washington, DC. Once passed by a majority of the council, a resolution becomes official ACR policy for the next 10 years, at which time it must be renewed or it sunsets.
Practice Guidelines and Technical Standards are special evidence-based resolutions developed by committees of experts via a rigorous and lengthy consensus process. Standards and guidelines are intended to be living documents that are regularly reviewed and revised to reflect changes in radiologic and radiation oncology practice. After completion, draft versions of Practice Guidelines and Technical Standards are posted on the ACR Website where all members of the ACR are invited to review and comment on them. The expert committees review and incorporate this member input into final versions that are then presented to the Council of the ACR as resolutions at the ACR Annual Meeting. Although Practice Guidelines and Technical Standards may be debated like other resolutions, both in the Reference Committee and on the floor of the council, and the Reference Committee may make recommendations concerning them, their evidence-based nature is recognized by the fact that they cannot be modified from the floor of the council.
At the next level, Blue Ribbon Panels and white papers are designed to help the ACR respond to emergent issues in a more timely manner than is permitted by the Practice Standards and Technical Guidelines development process. Such panels are also used to address matters of concern in which the scientific evidence is not as fully developed as required for Practice Standards and Technical Guidelines. In some cases, white papers are used as the basis for development of a standard or guideline on the same or a related topic.
The report on MR safety [1] in this issue of the AJR is the product of such a Blue Ribbon Panel. Although it represents the consensus of the experts on the panel, it has not been subjected to the full, rigorous standards and guidelines process, nor has it been adopted by the ACR policy-making body, the Council of the ACR. Thus, at this juncture, the report of the Blue Ribbon Panel expresses the consensus opinion of the panel members rather than formal ACR policy.
Over the next year, the recommendations of the panel will be considered, along with additional opinion and evidence, as our formal expert committees work to develop one or more technical standards or practice guidelines on this important topic. However, given the evolving nature of this issue and evidence regarding NSF, it is possible that there will not be sufficient hard data to support a guideline. Over the course of the next year, the ACR will make every attempt to update recommendations on the ACR Website as new data and guidance from the FDA become available.
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