Rationale and Objectives
Severe reactions to radiographic contrast agents can be life threatening, and although they are rare, effective recognition and management are essential to improving outcomes. A high-fidelity radiology simulation course for radiology residents and technologists focusing on severe contrast reactions and immediate treatments was designed to test the hypothesis that knowledge would improve with this educational intervention.
Materials and Methods
A prospective pretest and posttest study design was used. Residents and technologists worked in teams of three to five members. Learning objectives focused on demonstrating when and how to use basic life support skills and epinephrine auto-injectors. Each resident and technologist was administered a pretest prior to the start of the case scenarios and a posttest following the debriefing session. Scores from the pretest and posttest for the residents and technologists were compared using a paired-samples t test.
Results
Nineteen radiology residents and 11 radiology technologists participated. The average test scores were higher and improved significantly following the simulation experience for both the radiology residents (57% vs 82%, P < .001) and technologists (47% vs 72%, P = .006). Anonymous evaluations demonstrated that the experience was well received by residents and technologists, with 97% of learners (29 of 30) rating the experience as extremely or very helpful. Important learning themes included the knowledge of epinephrine auto-injector use and basic life support skills.
Discussion
High-fidelity simulation for radiology residents and technologists focusing on epinephrine auto-injector use and basic life support skills during the first 5 minutes of a severe contrast reaction can significantly improve recognition and knowledge in treating patients having severe contrast reactions.
Severe reactions to intravenous radiographic contrast agents are rare events. A recent large-scale study of >12,000 consecutive nonionic iodinated intravenous contrast injections at a tertiary children’s hospital reported no severe reactions . Many large-scale studies of acute allergic-like reactions to intravenous gadolinium agents have report similarly low rates of severe reactions ≤0.1% . Nevertheless, these reactions must be quickly and effectively managed to ensure the best chance for survival. Many radiology residents and attending radiologists prepare for these emergencies by taking advanced cardiac life support (ACLS) or pediatric advanced life support courses. These curricula are dedicated to teaching the acute recognition and management of a broad set of patient problems, such as myocardial infarction or septic shock. The majority of the curricula is unlikely to be applicable to a radiologist. Finally, there is literature documenting the rapid decay of skills and knowledge in internal medicine and pediatric residents after participation in ACLS and pediatric advanced life support courses . Because radiology residents tend to use resuscitation skills less often than internal medicine and pediatric residents, it would be expected that radiology residents have an equal or greater decline in these skills.
Alternative forms of emergency training, such as high-fidelity simulation scenarios depicting contrast reaction events, may improve radiologists’ long-term performance during rare emergency events. High-fidelity simulation is gaining acceptance as an effective tool to train medical personnel in many disciplines. Indeed, simulation training has acquired applications in laparoscopic surgery, ophthalmology, emergency medicine, obstetrics and gynecology, pediatrics, and other high-acuity settings . Simulation training provides a safe and controlled environment and allows time for learners to reflect on their actions.
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Materials and methods
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Results
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Table 1
Demographics of Radiology Residents and RTs Regarding Experience with Codes and Contrast Reactions
Variable Residents ∗ RTs Postgraduate year (residents) 2 5 (26%) 3 4 (21%) 4 5 (26%) 5 5 (26%) Experience (RTs) (y) 13 ± 6.5 Number of codes experienced 0–2 15 (79%) 6 (66%) 2–5 1 (5%) 1 (11%) 6–10 2 (10%) 1 (11%) >10 1 (5%) 1 (11%) Number of potentially life threatening contrast reactions 0–2 19 (100%) 6 (66%) 2–5 0 (0%) 3 (33%) Certifications BLS 13 (68%) 9 (100%) ACLS 19 (100%) 0 (0%) PALS 0 (0%) 0 (0%)
ACLS, advanced cardiac life support; BLS, basic life support; PALS, pediatric advanced life support; RT, radiology technologist.
Data are expressed as number (percentage) or as mean ± SD.
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Discussion
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Appendix
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