How low can we go? Strategies and recommendations to combat the iodinated contrast shortage

Abstract

After GE Healthcare, one of the major producers of iodinated contrast dye, was forced to close their Shanghai factory due to a recent COVID-19 outbreak, iodinated contrast media shortages have rocked healthcare systems to their core. Clinicians nationwide are now caught between the desire to provide patients with optimal care and the need to conserve the minimal remaining supplies of iodinated contrast media. While GE Healthcare has reopened their factory and other sources of contrast agents have become available, experts report that levels may not return to normal through June 2022. Thankfully and ironically, radiology departments are all too familiar with COVID-19 associated operational disruptions and have been quick to adapt and implement novel protocols to evade this and other crises. Overall, this shortage emphasizes the importance of interprofessional communication, adaptation, and preparation for future emergent situations as this is not the first iodinated contrast material shortage and it likely would not be the last.

Optimizing the Use of Iodinated Contrast Media for CT: Managing Shortages and Planning for a Sustainable and Secure Supply

“…16 The GE Healthcare factory closure resulted in a sudden, unanticipated shortage of ICM globally as other manufacturers were unable to rapidly scale up production to meet the demand. 5,13,[16][17][18][19][20][21] Shortages of ICM products were reported by the US FDA in May 2022. 22 In June 2022, iodixanol injection and iohexol injection were added to Health Canada's list of tier 3 drug shortages 23 : Tier 3 drug shortages are those likely to have the greatest potential impact on the health care system.…”

“…Technology may be used to enhance image quality, such as dual-energy CT and lower kilovoltage peak (kVp) imaging. 1,4,5,7,9,13,17,18,25,33,39,40,43,50 Other examples of how technology may be used to enhance image quality include adjusting imaging settings for different parts of the body to optimize visualization, 50 using artificial intelligence or machine-based learning for postprocessing to facilitate image enhancement, 2 using saline flush techniques to ensure complete delivery of ICM dose into the circulatory system, and the use of injector pump systems, particularly those with the ability to collect and analyze data on exam protocols There are 2 main types of iodinated contrast media: ionic and nonionic� 52 Nonionic contrast media have a lower osmolarity than ionic and do not dissociate into charged particles in a solution, making them safer for patients and more widely used than the older, ionic forms of contrast media.…”

“…64 Increasing domestic production of critical medical products may be another option to help improve the strength of supply chains. 5, 18 At least 1 guidance document proposed the requirement for vendors to use production facilities at more than 1 location. 65 Rather than supply chain resilience, a recent analysis by Ivanov refers to supply chain viability.…”

“…As well, some authors have noted that longer-term patient follow-up may be needed to determine whether ICM conservation measures have negatively affected patients through missed diagnoses or delays in treatment. 4,18,20,38 Costs and Staff Impacts…”

How to prevent a repetition of the ‘not so global’ contrast media shortage of 2022?

“…The radiology community stepped up to the challenge, suggesting ways to overcome the shortage, prevent exhausting supplies entirely, and allay the impact on patient care. Several papers proffered recommendations to conserve IBCM 9–11 . Radiologists and referring specialists were encouraged to develop strategies to mitigate overall demand for imaging examinations, prioritise indications, decrease the frequency of contrast use (i.e.…”