The Contrast Media Safety Committee of the European Society of Urogenital Radiology produced guidelines on nephrogenic systemic fibrosis (NSF) in 2007 [1]. Since then, more data have been published and different opinions have been presented. Therefore, the Committee decided to critically review the literature for new evidence and to update its guidelines for reducing the risk of NSF. The potential long-term problems from retention of small amounts of free gadolinium in the body after procedures enhanced with gadolinium-based contrast media are also considered.