2 AJR:212, January 2019 tions seldom happen, most radiologists have had little to no experience in managing them. In one study specifcally assessing knowledge of using epinephrine within a radiology depart - ment, a drug integral to the treatment of mod- erate and severe adverse reactions, only 50% of participants identifed the correct dose of intra- muscular epinephrine and only 29% knew the dose for IV epinephrine [5]. At the University of Chicago Medical Cen- ter, two live didactic lectures covering diagno- sis, determination of severity, and management of contrast media reactions have traditionally been provided to radiology residents by a ra- diologist and radiology nurse. However, stud- ies suggest didactic lectures alone may not pro- vide adequate training [6]. Multiple studies have found that high- fdelity simulations are useful to provide the necessary training and a means of assessing residents’ skills and comfort levels [7]. In addition, knowledge retention has been High-Fidelity Simulation Training for the Diagnosis and Management of Adverse Contrast Media Reactions Saad Ali 1 Anup Alexander 1,2 Marcie Lambrix 3 Rishi Ramakrishna 1,2 Carina W. Yang 1 Ali S, Alexander A, Lambrix M, Ramakrishna R, Yang CW 1 Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, MC2026, Chicago, IL 60637. Address correspondence to S. Ali (saadali@uchicago.edu). 2 Department of Radiology, NorthShore University Health- System Evanston Hospital, Evanston, IL. 3 Simulation Center, University of Chicago, Chicago, IL. Special Articles • Original Research Supplemental Data Available online at www.ajronline.org. AJR 2019; 212:2–8 0361–803X/19/2121–2 © American Roentgen Ray Society T he frequency of adverse contrast media reactions to nonionic io- dinated contrast has been report- ed to range from 0.2% to 0.4%, with some studies reporting up to 0.7% [1, 2]. A large study in China reviewing 109,255 cases stratifed incidence based on severity, reporting 0.26% for mild reactions, 0.07% for moderate reactions, and 0.01% for severe reac- tions [3]. The frequency of adverse reactions to gadolinium, in comparison, has been re- ported by the U.S. Food and Drug Adminis- tration to range between 0.04% and 2.2% [4]. Although fairly uncommon, contrast media reactions are potentially life-threatening events that require prompt recognition and manage- ment by radiologists. Especially in the setting of a moderate to severe reaction, radiologists must be able to recognize and manage con- trast media reactions, at least until the arrival of a code team. Because contrast media reac- Keywords: contrast medium reaction, simulation doi.org/10.2214/AJR.18.19864 Received March 19, 2018; accepted after revision July 16, 2018. Based on presentations at the 2015 annual meeting of the American College of Radiology, Washington, DC; the 2015 annual meeting of the Chicago Simulation Consortium, Chicago, IL; and the 2016 annual meeting of the Society for Simulation in Healthcare, San Diego, CA. OBJECTIVE. Adverse reactions to contrast media are potentially life-threatening events that require prompt recognition and management by radiologists who may have little experi- ence with them. The objectives of this project were to develop and assess a simulation-based program that would equip radiology trainees with appropriate knowledge and skills to recog- nize and manage adverse contrast media reactions. MATERIALS AND METHODS. Fifteen adverse contrast media reaction scenarios were developed to run on high-fdelity adult and pediatric mannequins in a simulation cen- ter. Ninety-six radiology trainees (postgraduate year 2–6) participated in the program, which consisted of two didactic lectures and a simulation session. For each simulation session, seven scenarios were chosen. Objective quizzes assessing knowledge and subjective questionnaires assessing comfort were completed both before and after the simulation. A survey assessing the overall program was also completed. RESULTS. All 96 radiology trainees viewed the didactic lectures, attended a simulation session, and completed the pre- and postsimulation quizzes and questionnaires. Mean scores increased from 69% to 82% ( p < 0.001) and from 3.1 to 4.5 out of 5 ( p < 0.001) on the ob- jective and subjective tests, respectively. Statistically signifcant improvement was also seen when participants were separated according to level of training. On the fnal program evalua- tion survey, scores ranged from 4.5 to 4.7 out of 5. CONCLUSION. We describe the development of a high-fdelity simulation program with a larger variety of scenarios than in prior studies that can provide radiologists the knowledge and skills needed to recognize and manage adverse contrast media reactions. We saw a statis- tically signifcant improvement in knowledge and comfort levels across all levels of training. Ali et al. Contrast Media Reaction Simulation Training Special Articles Original Research Downloaded from www.ajronline.org by 54.209.76.56 on 10/16/21 from IP address 54.209.76.56. Copyright ARRS. For personal use only; all rights reserved