Shortages of iodinated contrast media (ICM) due to pandemic-related lockdowns and transportation disruptions have exposed vulnerabilities in supply chains for essential medical supplies. Radiology associations, government agencies, and clinicians have suggested various strategies to address ICM shortages and strengthen supply chains. A systems approach to managing ICM shortages could help ensure the involvement of health care providers from all relevant clinical specialties, administration and purchasing, as well as government and industry. Clear communication is key to managing a critical shortage of ICM. Use of contrast-enhanced CT has increased and the ICM shortages may provide an opportunity to assess optimal use of ICM and reduce unnecessary exams. ICM use carries environmental consequences that have not yet been fully managed. Strategies to reduce the use of ICM may also help mitigate the environmental impact.