Radiologists are feeling the effects of the lack of contrast media

Radiologists are feeling the effects of the lack of contrast media

The lack of iodinated contrast agents (ICMs) due to the cessation of General Electric (GE) production in Shanghai, China, has a profound impact on radiological procedures worldwide.

As he stated earlier Medscape Medical NewsThe lack of contrast agents for CT imaging has been caused by recent limitations of COVID-19 in China. This shortage is expected to last at least until the end of June 2022. Most of the world’s supplies of contrast media are produced in a single plant in Shanghai. The media is then distributed by GE Healthcare.

“It’s a very big problem at my hospital and we’re in emergency mode,” said Justin M. Finn, MD, a diagnostic and interventional radiologist at Flagler Hospital, St. Augustine, Florida. “Everything I do involves contrast.”

Dealing with the shortage involved deciding how to save supplies while providing optimal patient care. For example, Finn explained that they tried to perform as many evaluations as possible for diagnostic procedures using methods that do not require contrast agents, rather than those that do. “We are in compliance with the recommended substitutions, such as instead of brain CTAs we will try to obtain a brain MRA,” he said. Medscape Medical News. “Instead of contrast CT, we’ll try to get bone scans of nuclear medicine and so on.”

At the clinical level, this is not only a huge inconvenience, but can also affect patient care. “Some of the recommended alternatives have lower diagnostic sharpness,” Finn explained. “For example, a nuclear medicine perfusion scan is a very good scan and has less radiation than PE [pulmonary embolism] study, but you will not collect smaller PE and you will only get a risk score. The PE study is definitive and can change management. “

Using alternatives “opens up several mistakes for us,” he said. “And there may be legal risks.”

For example, “If we want to rule out diverticulitis, it’s something we can see by a non-contrast scan,” Finn said. “But what you can escape is the kidney mass, because you can’t fully examine the blood vessels or organs.”

ARRS strategy

The American X-Ray Society (ARRS) has issued management strategies to help equipment and imaging centers cope with the shortage. The guidelines were published in American Journal of Roentgenology.

“Raising awareness of ICM shortages throughout the hospital system is an important first step,” co-authors Joseph Cavallo, MD, MBA, and Jay Pahade, MD, of the Department of Radiology and Biomedical Imaging at Yale’s School of Medicine.

ICM plays a primary role in performing contrast CT (CECT), CTA, conventional angiography and venography, and sciascopic examination. Although only one agent – iohexol (Omnipaque) – is known to be directly affected by the closure of the Shanghai plant, the effects have spread to the ICM market, which appears to be relatively limited in supply. Excess stocks of other ICMs, such as iodixanol (Visipaque, GE), iopamidol (Isovue, Bracco), iopromide (Ultravist, Bayer) and ioversol (Optiray, Guerbet), were quickly depleted as radiological facilities tried to increase their inventories or find alternatives, the authors of ARRS write.

Recognizing that in order to continue to provide “optimal care for patients with urgent or life-threatening imaging indications, thus minimizing the overall impact on patient care, practice leaders will need to rapidly evaluate their contrast supplies, prioritize screening indications, and reduce expected short-term use of ICM. “

Alerting hospital units that often refer to CECT, such as oncology, surgery, and emergency departments, as well as other ICM users (cardiology, vascular surgery, GI, radiation oncology, urology), can help align conservation strategies across the institution.

“The effects will vary from place to place,” Cavallo told Medscape. “Any facility that has very low ICM stocks should already operate in limited capacity. There are many press releases about some locations that delay non-surgical imaging or interventions, and non-urgent outpatient imaging is likely to experience the greatest delays due to relative lack of sharpness.”

Cavallo pointed out that radiologists are likely to read more non-contrast images that would normally be taken with contrast. “In some cases, this could make it difficult to make an accurate diagnosis,” he said. “Radiologists will also be consulted more often as doctors discuss individual patients to determine a suitable alternative view.”

Hospitals are likely to seek additional information from radiologists, who can be examined without contrast while still providing a high level of care. “In addition to the specific tips related to the direct reduction of ICM, which we outlined in the article, I would emphasize the need to work with ordering physicians and consultants,” Cavallo added.

The authors note that common indications for CECT can be stratified as needed by three primary means of reducing ICM use: direct ICM dose reduction; alternative diagnostic imaging modalities or CT contrast agents; and postponement of shooting.

Finn noted that he and his colleagues are very strict about the amount of contrast they use and the contrast with which they use it. “We don’t open bottles unless we have to, and when we open them, we use as little as possible,” he said. “We dilute the contrast as much as we can without affecting the diagnostic quality. It’s a diagnostic challenge to how much we can dilute and not do the patient a disservice.”

Finn described the situation as “scary … and very reminiscent of the days of the COVID pandemic, when people ran out of veils. We never used the veils again after the procedure, but then we suddenly wore them all day. It became a new normal.”

As recommended by the American Hospital Association on May 12, a GE Healthcare official said the Shanghai facility had returned to 25% production capacity and hoped to reach 50% capacity within the next week. Part of the production was moved to a plant in Cork, Ireland, and to speed up deliveries, it began to be sent to the United States by air. Although this development is encouraging, normal production is not expected to resume for at least another month.

Pahade is a consultant for GE Healthcare and Clario. Cavallo and Finn did not disclose any relevant financial relationships.

AJR Am J Roentgenol. Published on May 13, 2022. Abstract

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