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What a New Low-Dose Contrast Agent Could Mean for Lifelong Imaging: Gadoquatrane and Pediatric MRI

At the 2025 RSNA conference, researchers and pediatric imaging experts shared new findings on gadoquatrane, an emerging MRI contrast agent that may offer meaningful benefits for children who require repeated MRI scans throughout their lives.

Tether Supervision

Dec 9, 2025

Contrast Media

Contrast Media

Contrast Media

At the 2025 RSNA conference, pediatric imaging specialists presented new data on gadoquatrane, an emerging MRI contrast agent engineered to deliver strong diagnostic performance with dramatically lower gadolinium exposure. For children who undergo repeated MRI scans throughout their lives, a lower-dose agent could offer a safer and more sustainable long-term imaging pathway.

What did the Quanti pediatric study show?

The Quanti pediatric study evaluated gadoquatrane in patients younger than two years old through age eighteen. The dosing protocol used only 0.04 Gd per kilogram, which represents an approximate 60 percent reduction compared with the standard 0.1 mmol Gd per kilogram dose applied with most traditional gadolinium-based contrast agents. Despite the substantial dose reduction, researchers reported robust enhancement and clear lesion delineation. The safety and pharmacokinetic profiles were consistent with those seen in adults, supporting early signals that a lower dose may not compromise clinical utility.

Why does gadoquatrane work at lower doses?

During RSNA interviews, Konstanze Diefenbach, M.D., explained that gadoquatrane’s high relaxivity is central to its lower dose requirement. High relaxivity increases the strength of the MRI signal, allowing radiologists to achieve comparable diagnostic value even when using significantly less gadolinium. Dr. Diefenbach emphasized that this advantage is embedded in the molecular structure itself, enabling reliable enhancement at reduced dosing.

Why is this significant for pediatric imaging?

Talissa Altes, M.D., a pediatric imaging expert, highlighted the long-term impact of these findings. Many children with chronic or complex conditions undergo numerous MRIs across childhood and adolescence. Reducing cumulative gadolinium exposure by more than half represents a meaningful safety improvement, particularly for patients who rely on MRI as a recurring part of their care plans. Dr. Altes noted that gadoquatrane may become a valuable option for clinicians who must balance diagnostic accuracy with long-term safety.

What questions remain?

The RSNA data is encouraging, but large-scale, real-world pediatric use will require continued monitoring. Future research will need to evaluate performance across diverse patient groups, examine long-term outcomes, and assess how low-dose agents integrate into daily workflows in both community imaging centers and large pediatric hospitals.

How does this fit into broader imaging trends?

The discussion around gadoquatrane reflects a wider transition within radiology. Imaging centers are increasingly focused on lower-dose, safer, and more predictable contrast materials, especially for vulnerable populations such as children. As new agents emerge, imaging teams will need consistent supervision models, clear communication pathways, and pediatric-specific safety protocols to support technologists during contrast preparation and administration.

Tether Supervision supports this shift by delivering real-time access to supervising radiologists during pediatric and adult contrast administration. With more than 45,000 supervised contrast hours across 85 imaging centers nationwide, Tether is the largest and most experienced virtual contrast supervision platform and on-site contrast supervision in the United States. This scale allows imaging teams to adopt new contrast agents like gadoquatrane with confidence, supported by pediatric-specific readiness protocols, rapid escalation pathways, and immediate consultation during adverse events.

Our platform helps imaging centers standardize their workflows, reduce variability in contrast administration, and stay fully aligned with CMS and ACR supervision requirements. By providing continuous, CMS-compliant oversight without the need for on-site radiologists, Tether Supervision enables safer contrast use, faster response times, and more consistent care for vulnerable pediatric populations who undergo repeated MRI exams throughout their lives.

Reference

Glutig K, Jurkiewicz E, Gao Z, et al. The Quanti pediatric study: pharmacokinetics and safety of gadoquatrane in pediatric patients undergoing contrast-enhanced MRI with a reduced gadolinium dose. Presented at RSNA, November 30 to December 4, 2025.

Take the uncertainty out of contrast supervision.

We’ll support your team every step of the way, from onboarding and training to live supervision and ongoing quality improvement.

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Take the uncertainty out of contrast supervision.

We’ll support your team every step of the way, from onboarding and training to live supervision and ongoing quality improvement.

Schedule a call
Schedule a call

Take the uncertainty out of contrast supervision.

We’ll support your team every step of the way, from onboarding and training to live supervision and ongoing quality improvement.

Schedule a call
Schedule a call

Read more from Tether Supervision

Tether is the leading platform for virtual contrast supervision, built for speed, safety, and seamless imaging operations.

Expert perspectives on safe, efficient contrast workflows and clinical readiness.

Tether is the leading platform for virtual contrast supervision, built for speed, safety, and seamless imaging operations.

The Environmental Cost of Contrast Media: New Medicare Data Reveals a Growing Challenge for Radiology

A growing body of research is drawing attention to an often overlooked issue in diagnostic imaging: the environmental impact of contrast media. New findings published in JAMA Network Open show that contrast agents used in CT and MRI imaging place a significant and measurable burden on ecosystems, prompting experts to call for stronger contrast stewardship across the healthcare system.

How much contrast is being used in the Medicare population?

The study examined contrast utilization among Medicare beneficiaries between 2011 and 2024. Over this 13-year period, patients in this population received an estimated 13.5 billion milliliters of contrast media. Most of this volume came from iodinated contrast used in CT scans, while gadolinium-based contrast agents accounted for around five percent of total use. Researchers noted that this reflects only the Medicare fee-for-service population. The true national volume is significantly higher when including Medicare Advantage and commercial insurance.

Why are experts concerned?

Contrast agents do not fully break down in the human body. After administration, they enter wastewater systems, where they can persist and accumulate in rivers, lakes, and drinking water supplies. Both iodine and gadolinium are non-renewable resources, and ongoing exposure raises legitimate concerns about long-term ecological impact. Florence Doo, MD, MA, the study’s lead author, emphasized that understanding the specific imaging exams responsible for the greatest contrast burden is essential for developing sustainable stewardship strategies.

What did the researchers analyze?

The team used Medicare Part B fee-for-service claims from 2011 to 2024 to assess exam volume, contrast type, dosing levels, and changes in utilization related to major events such as the COVID-19 pandemic. The dataset covered 169.3 million contrast-enhanced imaging studies across 82 CPT codes. CT imaging of the abdomen and pelvis generated the largest amount of iodinated contrast at more than 4.4 billion milliliters, while MRI of the brain accounted for roughly 221 million milliliters of gadolinium-based contrast during the same period.

How has contrast use changed over time?

The study found consistent growth in contrast use beginning in 2014. Between 2014 and 2019, iodinated contrast use increased by more than five percent per year, and gadolinium use rose by three and a half percent annually. Usage declined sharply during 2020 due to the pandemic, then rebounded quickly in 2021 and stabilized by 2024. A small subset of procedures accounted for the vast majority of usage, with six CT exams responsible for most iodinated contrast and seven MRI exams driving the majority of gadolinium use.

What solutions are experts proposing?

The authors identified several opportunities for the imaging community to reduce unnecessary contrast use and limit environmental impact. Reducing inappropriate or duplicative imaging can make an immediate difference, as can adopting weight-based dosing to avoid excessive administration. More efficient vial management can reduce waste. The researchers also highlighted promising innovations on the horizon. Artificial intelligence may eventually support virtual contrast imaging that replicates enhancement without the need for physical contrast agents. Biodegradable contrast agents and expanded use of ultrasound microbubble technologies are also being explored as potential long-term solutions. Although still under development, these approaches could reduce chemical waste, improve sustainability, and lower patient exposure.

Why this matters for imaging centers

The environmental impact of contrast media is becoming an important operational and ethical consideration in radiology. Understanding where contrast is used most heavily helps imaging centers identify opportunities to adjust protocols without compromising diagnostic accuracy. As lower-dose agents and novel alternatives emerge, radiology teams will also need reliable supervision models, consistent communication pathways, and strong pediatric and adult safety protocols to maintain high-quality care.

How Tether Supervision supports contrast stewardship and safer workflows

Tether Supervision plays an important role in helping imaging centers adapt to modern contrast stewardship demands. Through real-time radiologist oversight during contrast administration, Tether supports technologists and on-site teams and ensures immediate access to expert guidance during adverse reactions. The platform’s scale also provides meaningful experience. With more than 85 imaging centers relying on Tether and over 45,000 hours of supervised contrast exams completed, the organization has developed one of the most robust virtual supervision networks in the United States. This expertise helps imaging teams standardize their contrast protocols, reduce avoidable repeat imaging, and stay aligned with CMS and ACR supervision requirements while also supporting the long-term shift toward safer and more sustainable contrast use.

Looking ahead

Radiology is entering a period in which contrast stewardship, environmental responsibility, and patient safety increasingly intersect. The Medicare data make it clear that contrast use has grown at a scale large enough to warrant national attention. With better information and emerging technologies, imaging providers can take meaningful steps toward reducing waste while maintaining diagnostic performance. Tether Supervision continues to support this transition by providing the oversight, consistency, and clinical guidance needed to adapt safely to new contrast practices.

Read the full study on the JAMA Network: here.