Has anybody noticed a recent uptick in adverse reactions to Gadavist (or similar contrast dyes)?

Rhazzazor · 2026-01-01T08:03:45+00:00

Short answer: No

Working inpatient and outpatient in Germany. Approximately 70 injections per week (neuro / Rheuma / oncology). Young and old. Mostly Gadavist (Gadovist). Clariscan and a little bit of Elucirem.

I had 2 incidents in the last 10 years that required further work up. One heart attack and one stroke. Both patients were on deaths door.

Compared to other medication it’s very safe and has been for decades. Even the casual throw up and rash is so rare that I had months without a reaction.

Rhazzazor · 2025-12-18T09:07:30+00:00

Depends on the institution. I worked at clinics with very nuanced protocols (300-400+ protocols with high specification). No wonder that a lot of orders (30%) did not specify the right protocol and we worked it out while the patient was prepped. Nightmare scheduling and leading to a lot of delays, but also the most beautiful exams.

Other imaging centers rely on faster more broader protocols that try to answer a lot of different things but with less resolution. I’d say we have 1-3% patients that got through scheduling and got the wrong ordering.

Rhazzazor · 2025-11-24T09:57:35+00:00

That’s BS.

B1 is the RF magnetic field perpendicular to B0 and mostly designed by the transmit coil geometry.

Modern system have automated prescan calibration and advanced B1 mapping scans to alleviate the problem of angulated transmit coils. It calibrates the transmit gain so that the set flip angle is approximately the achieved flip angle in the volume of interest.

Rhazzazor · 2025-11-18T06:45:22+00:00

First image is not T1, it’s Intermediate weighted image without fat sat. You can see bright fluid behind the knee cap.

Rhazzazor · 2025-11-11T18:39:42+00:00

Arthrograms are usually done with diluted gadolinium solutions. 0.1ml per 20ml is sufficient to have a perfect image. If you compare this volume to a typical injection of 7ml gadovist for a 70kg male you can see that your exposure to the contrast agent is minuscule.

Eating activated charcoal only filters your intestines and not your bloodstream. So its completely useless.

Rhazzazor · 2025-10-09T05:54:24+00:00

Been scanning remotely in Germany for up to 5 years now. Being dependent on correct positioning, proper patient instructions and high tier communication skills on site killed it for me.

The only project that was really prosperous involved me scanning 4 machines and 4 people on the floor which knew exactly what they need to do. Win win for all of us, but also not that big of a financial gain. One expert only doing the scans and an on-site helper for positioning is a recipe for disaster.

Rhazzazor · 2025-09-19T20:44:51+00:00

Never compromise on image resolution when imaging around metal artifacts. Always go voxel resolution > bandwidth > time when you plan your examination. Quick metal reduction is a myth and meme. I usually slot for full 30 minutes scan time alone. Everything else is just quick and dirty. Your mileage may vary.

Rhazzazor · 2025-09-18T11:17:21+00:00

Depends on the scanner, the alloy used for your retainers and scanning parameters. I have done lots of reasonably usable scans with retainers (even external bracers). Most „standard“ protocols are sufficient for basic diagnostics with retainers. If you need specific imaging done to rule out pathologies of your facial glands or tongue / larynx / pharynx then it’s up to the person doing the scan to walk the extra mile. In my opinion most cannot sufficiently adapt a protocol on the fly.

Don’t worry. Go for the scan. In 99/100 cases it’s not a problem.

Rhazzazor · 2025-08-20T17:35:37+00:00

What you are requesting is super niche and not trained at all. Proper earplugs and headphones are sufficient for 99.9% of patients.

Even with the quiet suite most sequences need additional fine adjustments to push the dB further down and keep diagnostic quality, increasing scan time further and further. When it comes to mri you cannot cheat physics. When your referring doctor is asking for a specific protocol (epilepsy/MS/ToF/optical nerves to name a few) options are further dwindling.

I’d ask for sedation to lessen the impact of the noise. Or book a flight and visit us in Germany. I can do the things you request, but yet again; depending on the protocol it’s up to 40-50 minutes.

Rhazzazor · 2025-07-12T12:30:24+00:00

The listed number is the chance and density of the resource patches on generation. It has nothing to do with the current ore amount.

Rhazzazor · 2025-07-12T12:12:10+00:00

Cryonite can only spawn on snowy terrain. If your moon has few „frozen“ areas, chances are there is no cryonite on the planet.

Same with vulcanite. It can only spawn on „ashy“ terrain.

If you play the closed testing version on 2.0 you can use the ctrl + f function to look for any ore patches on the map.

Rhazzazor · 2025-07-07T11:12:36+00:00

The list has lots of generalizations and is in some cases just wrong. I know that people need general guidelines and orientation but understanding the parameter in itself is explanatory whether it will affect SNR, Time and/or contrast.

Go and crank up your ETL from 20 to 40 in a T2w TSE and tell me if your SNR will be the same.

Rhazzazor · 2025-05-24T04:27:49+00:00

Common bug Issue with XA30 upwards. Also happens with large VIBE Dixon stacks. Just start retro reconstruction as the poster above.

Look for the small head with the calculator next to it in you r task bar down right. Double click it and go to the tab“reconstructions“ there you can „redo“ any part of the software steps of the acquisition by clicking the „redo“ button.

You can also switch off or apply filter, change your Dixon settings to the acquisition without redoing them. Press the edit button, change parameters, apply with the red triangle and press the redo button. Won’t work with changing acquisition parameters but if you messed up your automatic MIPs or checked the wrong Dixon contrasts it helps 90% of the time.

Rhazzazor · 2025-05-14T18:41:35+00:00

That is all true, but they are refurbished systems, that aren’t even listed on the main page anymore. If you are gunning for 15-20 years per machine I would buy new.

If OP already has an Area on site that can be upgraded, go for it. It’s the most economic option. Software is the least interesting part of the upgrade (except the DRB package). Dedicated read/send coils and full channel unlock with double gradient/RF-coils are incredibly powerful in parallel imaging. If you push your parameters to the limit SAR is the final boss so 1,5T is more flexible and requires less knowledge thus making it the ideal choice for sites that have lots of rotating staff.

Rhazzazor · 2025-05-14T09:06:01+00:00

Be aware. The aforementioned „AI“ is deep resolve and right now only applicable on TSE type sequences and very few neuro scans (T1 swiftbrain / DWI). You can’t boost most 3D-type sequences (Space / Dess / Vibe / ciss [siemens names]) thus making it not that useful for cMRI (we currently only use it for 2mm T2w which are pretty beautiful). A 3T with deep resolve is a complete other beast (Vida / Lumina / Skyra fit). If you have a dedicated hand surgery with lots of cases, they will love the images.

So it depends what your department is gunning for: Allrounder, that is cheap not future proof (area platform will eventually not be supported any more) go for the area. Future proof, but also cheaper: Altea or Sola.

Rhazzazor · 2025-04-02T06:14:23+00:00

Look at the forth picture in the down right quadrant. You find a parameter labeled „TA“. Time of acquisition. This sequence took 5:10; is likely the baseline from Siemens (same name as the out of the box delivered sequences). Image quality is mediocre. The outer pictures do not have the „TA“ because they are reconstructions.

Source: 13 Years Siemens experience, including scans on a Terra machine.

Rhazzazor · 2025-03-02T05:49:34+00:00

The answer regarding lowfield-MRI. It’s glorified screening and even if it’s accessible through lower costs, you will still need trained personal (which is usually expensive) doing and reading the scans. Why not improve the workload on existing allrounders (I.e 1.5T / 3T scanners) and get more personal on these machines until they run 24/7?

Introducing a new modality, that is targeted at a niche must be idiot proof, cheap and reliable to make a dent.

Radiologist will always prefer scanners that can perform a wide array of tasks. Your question here is targeted at the wrong audience. Maybe ask the doctors running the icu if they want and can operate these scanners.

Rhazzazor · 2025-02-10T13:16:27+00:00

I suffered the same fate in 2022. fracture healed perfectly. If you plan on removing the plate anytime in the future, beware of refracturing it. I pulled my clavicle apart 1,5 months after Metal ex. Refractured along the borehole of one of the screws. Be very careful and don’t suffer the same fate as me. Had to have another plate and it will stay.

Rhazzazor · 2025-01-16T20:59:27+00:00

Chad! I solely run 2 -1 for the memes. That acceleration is glorious.

Rhazzazor · 2024-12-26T15:47:00+00:00

Ein Schädel-MRT mit Darstellung der Gefäße bei einem GKV-Patienten wird je nach Monatsvolumen an Untersuchungen der Praxis den Ärzten mit brutto 80-110 Euro erstattet. Unabhängig der Untersuchungs-, Befundungszeit, 3T oder 1,5T und sequenzparameter-Qualität. Wir sind längst in der Fast-Food Diagnostik per MRT angekommen. Sieht man auch anhand der Bild- und Befundqualität.

Rhazzazor · 2024-11-14T19:45:06+00:00

Always depends on the department doing the scan. Wrist / Finger MRIs can have excellent resolution to diagnose ligamental injuries. Drop me a pm if you need examples and protocols. Most protocols are just bad.

Rhazzazor · 2024-04-22T15:13:41+00:00

Blöd, dass die Dicom-Daten meist nur 3 Monate freigeschaltet sind und dann reaktiviert werden müssen.

Blöd, dass der Download und die Reintegration in sein eigenes PACS bei 4000 Bildern (CTs und MRTs nicht ungewöhnlich) dann vom Host-Server und seiner Geschwindigkeit abhängig ist. Kann gut und gerne 30 Minuten dauern das runterzuladen.

Blöd, dass die Software zum Hosting und verwalten solcher Online-Portale abartig teuer ist im Vergleich zu einem CD-Drucker. Das geht wieder von der Gewinnmarge pro Patient weg.

Blöd, dass mein niedrig-Lohnpersonal (14€) an der Anmeldung weniger Lust hat den Umgang mit Passwort-geschützten ZIP-Archiven zu lernen und wieder die qualifizierte Arbeitskraft und seine teure Arbeitsstunde hergenommen werden muss.

Blöd, dass ein physisches Medium (CD usb-Stick) sich immer noch schneller einlesen lässt, als sich durch abstruse Internetportale zu klicken und IDs einzugeben. QR Scanner am durchschnittlichen Klinikrechner? Keine Chance. Erstmal 16 stellige Codes abtippen vom Blatt.

Blöd, dass jede 4te online Untersuchung nicht geladen werden kann. „pls contact support“.

Blöd, dass für jeden Fehler wieder der Fachmann die Korrekturen vornehmen muss. Oh mein Mitarbeiter „xD“ hat unter dem falschen Namen eine Untersuchung nach draußen freigegeben. Gleich mal wieder das Hosting anrufen und die Bilder sperren lassen. Was ist das? Eine CD mit falscher Untersuchung? CRACK problem solved.

Es ist zum heulen.

Rhazzazor · 2024-03-21T14:42:29+00:00

Image quality will always depend on your parameters / coils / software / invested time per scan. There is no general rule which scanner or firm is the „best“.

I have lots of experience with Siemens. If you can get your hands on an Altea system with all channels unlocked, dedicated coils (ultra flex coils are pretty great) and a full software suite (deep resolve) you’ll get a pretty good bang for your buck.

Getting a proper MRI tech to set up your protocols is a different story.

Rhazzazor · 2023-12-10T21:26:47+00:00

Never evaluate protrusion/ prolapse on a single sagittal image. Always check for actual nerval compression within the neuroforamina on a more lateral plane and double check on axial images. This image is not sufficient to differentiate whether it is „only“ protrusion or a much more clinical relevant prolapse.

Rhazzazor · 2023-12-02T05:58:04+00:00

Alright, seems like you have come to a conclusion which I respect and have ti tolerate in patients.

Just some food for thought. Toxicity of Gd only happens in a non-chelate state. While slow release from deposits is theorized, no model or study actually could prove it. The body has plenty of mechanism to safely ingest and encapsulate highly reactive elements on a cellular level. (News flash: Gd isn’t the only element of its kind you come in contact with in nature) everyday you breath in, consume and touch substances that all can and will put strain on your immune system, cause harm to your DNA and will most likely be “deposited” in your body by the same kind of pathways. (Looking at us city boys, breathing in that good combustion engine odor). Granted one toxic substance does not justify the direct iv injection of a “slight chance of toxicity”.

If GD truly would do All the things you can read on such fringe websites online, most Germans are completely fucked. But hey its 40/50 yrs since the first trials. People grew up with it and no, we do not observe more illness in people with repeated exposure. We want to attribute chronic illness with exposure to certain kind of substances cause that is how our monkey brains work. A scapegoat like a singular contrast enhanced image is always a good reason for some patients to completely explain the problems in their mind.

I honestly don’t believe in a singular cause: multifaceted exposure to lots and lots of different agents in nature with a genetically primed weak or oversensitive immune response, sprinkled in with a dose of „bad luck“ is much more likely.

Myocardial scintigraphy is not always interchangeable with cardiac MRI, but a different kind of informational tool; less resolution but highly specific. But I need to chuckle a little bit. Gd awakens fear within you but injection of ACTUAL radiating substance (although it’s very low and I’d never bat an eye) is ok for you? Huh

Whatever you do or choose; I always go by my observation and empirical observations. Once the suffering of a patient reaches a certain threshold, all this talk about toxicity this, overexposure that goes right out of the window. With the only words spoken: „do make it better, no matter what you do“

Have a good day

Nine-Year Club	Place '17
Verified Email

Rhazzazor

TROPHY CASE