Everyone agrees that contrast media reactions are bad for patients. But contrast reactions also have an economic cost to imaging facilities, a cost that’s detailed in a new article in JACR.
Patient contrast reactions are one of the main reasons why medical imaging isn’t always as noninvasive as everyone likes to think it is.
- Reactions can range from mild responses like skin rashes to more severe and even fatal episodes, like the case of a Brazilian woman who died after getting CT contrast in 2025.
But contrast reactions can also be expensive for medical imaging facilities, even though they occur rarely (0.2% to 0.7% of scans, per published literature, with severe reactions far less common).
- To get a handle on these expenses, the Mayo Clinic’s Jennifer McDonald, PhD, and Robert McDonald, MD, PhD, tracked the costs involved in preventing and managing contrast reactions over five years at their institution.
The McDonalds tracked 364k CT studies and 254k MRI exams that used contrast from 2019 to 2024 at Mayo Clinic, recording the number of physiologic or allergic-like patient reactions and the cost of medications and treatment for them, finding…
- The reaction rate was slightly higher for CT compared to MRI (0.3% vs. 0.21%).
- More CT cases than MRI required transfer to the emergency department (6.3% vs. 3.5%) or escalation to hospital care (2.1% vs. 0.2%).
- Median costs per patient across the entire dataset were higher for CT than MRI ($15 vs. $1.66).
- But severe reactions were expensive, with one CT case costing $238k for a nine-day hospital stay, while the most severe MRI case cost $7.4k for a one-day stay.
- The amount of extra time required in the radiology department was similar between CT and MRI (25 and 27 minutes).
- Two patients in the cohort died, but for reasons unrelated to contrast administration.
The authors then calculated the amount of extra work required in radiology to manage reactions, which they estimated came out to 13 additional hours in CT and 9.5 hours in MRI per 10k exams.
The Takeaway
Most radiology departments are doing a good job keeping contrast reactions to a minimum, while vendors are developing new agents with better safety profiles. The new study provides a useful benchmark against which imaging facilities can measure themselves.
