At ECR 2026, the session “Tailoring contrast media protocols in current practice” examined how contrast use is becoming more individualised across MRI, ultrasound, CT and mammography. Across the presentations, a common thread emerged: safety depends not only on the contrast agent itself, but also on screening, communication, protocol design and preparedness for reactions. Speakers showed that person-centred practice means adapting contrast decisions to the patient in front of you rather than relying on a fixed routine.
MRI Safety and Communication
Tiago Alexandre Ferreira de Castela focused on MRI contrast management as a balance between technical safety and person-centred care. He explained that gadolinium-based contrast agents are generally very safe, but still require careful attention to molecular structure, patient risk factors and clinical need. In his account, the key distinction is between microcyclic and linear agents, with microcyclic forms presented as safer because they hold the gadolinium ion more tightly. He stressed that practice should begin with screening for renal impairment, prior allergy, pregnancy, breastfeeding and other comorbidities, while also keeping protocols aligned with guidelines and using the lowest suitable approach. As he put it, “choose is always the safest agent”, “tailor the communication” and “all eyes on patient.”
He also gave substantial weight to communication. MRI itself can already create anxiety, and the addition of contrast may heighten this further. For that reason, he argued that staff need to understand who is in front of them and match explanations to the patient’s health literacy. He described communication as “the make or break for many patients” and called for “clear and patient friendly communication” that helps reduce anxiety and support informed cooperation. In parallel, he underlined the need for readiness in case reactions occur, especially in the first minutes after injection. Teams must be able to distinguish physiological effects such as warmth, nausea or vasovagal reactions from allergic-like reactions, stop injection when needed, maintain venous access, call for help and remember the constraints of the MRI environment when emergency care is required.
Ultrasound as a Problem-Solving Tool
Jamie Wild showed how contrast-enhanced ultrasound extends the modality from macrovascular to microvascular assessment through gas-filled microbubbles that circulate freely and increase reflection properties. He presented ultrasound contrast as a practical and safe option that adds diagnostic detail without radiation and without nephrotoxicity. In his words, it is “a really good problem solving tool”, “another diagnostic option” and a way of “putting some lesions to bed.” His cases focused mainly on liver and renal imaging, where contrast-enhanced ultrasound helped classify lesions that had remained indeterminate on CT or MRI. In benign cases, this allowed follow-up to be avoided, while in more concerning cases washout patterns supported the identification of malignancy.
A central point in his presentation was that the value of ultrasound contrast lies not only in image enhancement, but in the speed and confidence with which it can settle uncertainty. He described being able to move beyond simply seeing a lesion to characterising it through enhancement behaviour. That can spare patients months of waiting for MRI in some settings and reduce the burden of prolonged surveillance. At the same time, he did not suggest that safety concerns can be ignored. He reviewed relative and absolute contraindications, noted the importance of risk-benefit analysis, and highlighted that severe anaphylaxis, if it occurs, is likely to happen within minutes of injection. His practical emphasis was on preparedness: screening questionnaires, awareness of hypersensitivity and having emergency equipment ready, especially in ultrasound departments that may be less equipped than CT suites.
Personalising CT and Mammography Protocols
Svea Deppe Moerup approached CT contrast use from the perspective of protocol design. Her main argument was direct: “not one protocol for all our patients.” She described how broad weight groups and fixed protocols can result in some patients receiving too much contrast and others too little, producing suboptimal examinations and sometimes repeat scanning. Her team therefore worked to harmonise protocols across three sites while taking patient weight, circulation, body habitus, renal function and clinical indication into account. They also examined the actual tube voltages being used and adjusted contrast volume with saline flush strategies, particularly at lower kV, where less IV contrast could still achieve sufficient enhancement.
The benefits she described were both clinical and practical. Some patients, especially those attending repeatedly for follow-up, noticed that reduced contrast volumes made the experience more comfortable. She reported that the revised approach could “reduce the feeling of the warmth”, lower pressure in some groups, reduce the risk of subcutaneous injection and save contrast overall. At the same time, larger patients who previously received too little contrast could receive more appropriate dosing. Her summary was that protocol tailoring improves image quality, patient comfort and resource use at the same time.
Cristina Poggi turned to contrast-enhanced mammography, presenting it as an increasingly important technique in breast imaging, especially where breast density reduces the sensitivity of conventional mammography. She said that mammography remains “the mainstay of early detection breast cancer”, while contrast enhancement adds functional alongside morphological information. She also described CEM as “a very important problem solving tool” and “a very promising technique.” Her presentation covered how iodine-based contrast is used with dual-energy acquisition, how timing and compression affect image quality, and how all projections should be completed within 10 minutes to avoid washout from the breast parenchyma.
Poggi repeatedly returned to safety and standardisation. She stressed patient screening for prior reactions and renal function, fasting before the examination, dose adjustment for each patient, and the importance of clear instructions about transient sensations during rapid infusion. She also highlighted radiation dose optimisation, good positioning and compression to minimise artefacts and repeat imaging. Above all, she argued that “communication is fundamental” and that “the crucial importance of a proper training” for the breast team is itself a key safety measure. Yet she also noted that there is still “a lack of agreement on the protocol”, making consensus-based guidance an important next step.
Conclusion
Taken together, the session showed that tailoring contrast media protocols is no longer a narrow technical adjustment but a broader clinical approach. Whether in MRI, ultrasound, CT or mammography, the speakers pointed to the same priorities: careful screening, patient-specific protocol choices, clear communication and readiness to respond when problems arise. Rather than treating contrast administration as routine, the session framed it as a process that should be adapted to the patient, the modality and the clinical question each time.
Source & Image Credit: ECR 2026
