Comparison of Strategies to Conserve Iodinated Intravascular Contrast Media for Computed Tomography During a Shortage

Davenport, Matthew S.; Chu, Philip; Szczykutowicz, Timothy P.; Smith‐Bindman, Rebecca

doi:10.1001/jama.2022.9879

Cited by 27 publications

(27 citation statements)

References 3 publications

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“…Identifying the clinical indications for ICM required input from ED, trauma, and inpatient services to develop alternative imaging studies. [11,14] In our institution, noncontrast CT examinations were quickly adapted substituted when applicable, resulting in a significant drop in contrast ultrasound. [19] For instance, magnetic resonance angiography (MRA) can be substituted for CTA in patients with suspected aortic dissection or pulmonary embolism with stable hemodynamics.…”

Section: Reducing Contrast Ct Studies Strategymentioning

confidence: 99%

“…In the 2 nd week of June, the best practice alerts were removed to encourage providers to resume standard ordering patterns of contrast studies. [11,12,24] CONCLUSION e global shortage of ICM has led to disruption in imaging operations, and the institutions are undertaking mitigation strategies without compromising on clinical excellence. We achieved an 80% reduction in contrast usage by adopting a comprehensive approach driven by process and quality metrics.…”

Section: Revamping Strategymentioning

confidence: 99%

“…Engagement with key stakeholders at the beginning of a crisis is imperative to developing an effective strategy. [ 11 ] At our institution, the radiology team served as the primary decision-maker on decreasing contrast usage while offering alternative imaging modalities when applicable. The pharmacy department took ownership of centralized inventory management.…”

Section: Overarching Strategy and Background Analysismentioning

confidence: 99%

“…Identifying the clinical indications for ICM required input from ED, trauma, and inpatient services to develop alternative imaging studies. [ 11 , 14 ] In our institution, non-contrast CT examinations were quickly adapted substituted when applicable, resulting in a significant drop in contrast consumption [ Figure 3 ]. Similarly, there was an increase in available contrast from GE in mid-June as the production at the Shanghai plant expanded.…”

Section: Reducing Contrast Ct Studies Strategymentioning

confidence: 99%

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Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

Gopireddy

Virarkar

Vulasala

et al. 2023

JCIS

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Iodinated contrast media (ICM) shortages and secondary supply chain problems due to Coronavirus Disease lockdowns in China significantly impacted radiology operations nationwide. The lack of ICM necessitated operational workflow changes designed to ration contrast use, particularly in the hospital setting. In this manuscript, we share our strategic methods with advanced process/outcome metrics to monitor the effectiveness of our strategy under a coordinated multidisciplinary team effort. Alternate studies such as substituting magnetic resonance angiography for computed tomographic angiography for emergency department patients were studied to measure the suitability of these examinations for specific diagnoses. This article presents readers with a comprehensive crisis management strategy deployed at our institution, emphasizing various options with a limited ICM supply, and minimizing the impact on clinical care.

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Section: Reducing Contrast Ct Studies Strategymentioning

confidence: 99%

Section: Revamping Strategymentioning

confidence: 99%

Section: Overarching Strategy and Background Analysismentioning

confidence: 99%

“…Identifying the clinical indications for ICM required input from ED, trauma, and inpatient services to develop alternative imaging studies. [ 11 , 14 ] In our institution, non-contrast CT examinations were quickly adapted substituted when applicable, resulting in a significant drop in contrast consumption [ Figure 3 ]. Similarly, there was an increase in available contrast from GE in mid-June as the production at the Shanghai plant expanded.…”

Section: Reducing Contrast Ct Studies Strategymentioning

confidence: 99%

See 2 more Smart Citations

Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

Gopireddy

Virarkar

Vulasala

et al. 2023

JCIS

View full text Add to dashboard Cite

show abstract

“…There has been an exponential increase in the number of CT examinations in the last two decades. In 2019, more than 90 million CT scans were performed in the United States [ 4 ], up from 85 million in 2011 [ 5 ], 62 million in 2007 [ 6 ] and 57 million in 2000 [ 7 ]. CT is the major source of radiation exposure to the general population from medical imaging, which is evident from the fact that while CT represents only ~6.3% of all diagnostic radiologic procedures, it contributes to ~43.2% of the collective radiation dose given to the patients [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia Subjects

et al. 2022

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Since the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an unprecedented increase in the acquisition of chest computed tomography (CT) scans. Nearly 616 million people have been infected by COVID-19 worldwide to date, of whom many were subjected to CT scanning. CT exposes the patients to hazardous ionizing radiation, which can damage the genetic material in the cells, leading to stochastic health effects in the form of heritable genetic mutations and increased cancer risk. These probabilistic, long-term carcinogenic effects of radiation can be seen over a lifetime and may sometimes take several decades to manifest. This review briefly describes what is known about the health effects of radiation, the lowest dose for which there exists compelling evidence about increased radiation-induced cancer risk and the evidence regarding this risk at typical CT doses. The lifetime attributable risk (LAR) of cancer from low- and standard-dose chest CT scans performed in COVID-19 subjects is also discussed along with the projected number of future cancers that could be related to chest CT scans performed during the COVID-19 pandemic. The LAR of cancer Incidence from chest CT has also been compared with those from other radiation sources, daily life risks and lifetime baseline risk.

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Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department

et al. 2023

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ImportanceIntravenous (IV) contrast medium is sometimes withheld due to risk of complication or lack of availability in patients undergoing computed tomography (CT) for abdominal pain. The risk from withholding contrast medium is understudied.ObjectiveTo determine the diagnostic accuracy of unenhanced abdominopelvic CT using contemporaneous contrast-enhanced CT as the reference standard in emergency department (ED) patients with acute abdominal pain.Design, Setting, and ParticipantsThis was an institutional review board–approved, multicenter retrospective diagnostic accuracy study of 201 consecutive adult ED patients who underwent dual-energy contrast-enhanced CT for the evaluation of acute abdominal pain from April 1, 2017, through April 22, 2017. Three blinded radiologists interpreted these scans to establish the reference standard by majority rule. IV and oral contrast media were then digitally subtracted using dual-energy techniques. Six different blinded radiologists from 3 institutions (3 specialist faculty and 3 residents) interpreted the resulting unenhanced CT examinations. Participants included a consecutive sample of ED patients with abdominal pain who underwent dual-energy CT.ExposureContrast-enhanced and virtual unenhanced CT derived from dual-energy CT.Main outcomeDiagnostic accuracy of unenhanced CT for primary (ie, principal cause[s] of pain) and actionable secondary (ie, incidental findings requiring management) diagnoses. The Gwet interrater agreement coefficient was calculated.ResultsThere were 201 included patients (female, 108; male, 93) with a mean age of 50.1 (SD, 20.9) years and mean BMI of 25.5 (SD, 5.4). Overall accuracy of unenhanced CT was 70% (faculty, 68% to 74%; residents, 69% to 70%). Faculty had higher accuracy than residents for primary diagnoses (82% vs 76%; adjusted odds ratio [OR], 1.83; 95% CI, 1.26-2.67; P = .002) but lower accuracy for actionable secondary diagnoses (87% vs 90%; OR, 0.57; 95% CI, 0.35-0.93; P &lt; .001). This was because faculty made fewer false-negative primary diagnoses (38% vs 62%; OR, 0.23; 95% CI, 0.13-0.41; P &lt; .001) but more false-positive actionable secondary diagnoses (63% vs 37%; OR, 2.11, 95% CI, 1.26-3.54; P = .01). False-negative (19%) and false-positive (14%) results were common. Interrater agreement for overall accuracy was moderate (Gwet agreement coefficient, 0.58).ConclusionUnenhanced CT was approximately 30% less accurate than contrast-enhanced CT for evaluating abdominal pain in the ED. This should be balanced with the risk of administering contrast material to patients with risk factors for kidney injury or hypersensitivity reaction.

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Comparison of Strategies to Conserve Iodinated Intravascular Contrast Media for Computed Tomography During a Shortage

Abstract: Author Contributions: Dr Smith-Bindman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 27 publications

References 3 publications

Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia Subjects

Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department

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