An Empiric Medicare Claims-Based Utilization Approach to Mitigating the Iodinated Contrast Shortage

Duszak, Richard; Hemingway, Jennifer; Christensen, Eric; Saindane, Amit M.; Hughes, Danny R.; Rula, Elizabeth Y.

doi:10.1016/j.jacr.2022.05.012

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…A staged response was adopted, drawing upon guidance that has been issued by professional bodies, including the American College of Radiology (ACR), and various authors from affected institutions. 2,[4][5][6][7][8][9] GE has reported that its factory in Shanghai has recommenced operations, with production expected to normalize in mid-June. 2 While we have started receiving some new inventory in Australia, the lag-effects of the shortage, uncertainty associated with the pandemic, disruption of supply chains, reactive 'panic' buying across the globe, and lack of transparency regarding production mean that the imbalance between supply and demand may well last longer than anticipated.…”

Section: Introductionmentioning

confidence: 99%

“…Many radiology departments and practices therefore introduced strategies to reduce ICM consumption, in order to conserve inventory for those critical CTs and procedures which are necessary to prevent death or significant morbidity. A staged response was adopted, drawing upon guidance that has been issued by professional bodies, including the American College of Radiology (ACR), and various authors from affected institutions 2,4–9 …”

Section: Introductionmentioning

confidence: 99%

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Impact of iodinated contrast media conserving interventions and lessons for the future

2022

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Introduction: A severe shortage of iodinated contrast medium (ICM) has forced radiology departments around the world to implement strategies to reduce contrast utilization. The aim of this study was to evaluate the effect of these interventions on ordering practices and ICM consumption for computed tomography (CT). Methods: Our radiology department instituted several ICM-conserving interventions on 13 th May 2022, encompassing: (i) improved triage; (ii) diversion to alternative modalities and non-enhanced CT (NECT); and (iii) reduction in ICM dosing. The impact of these changes on contrast-enhanced CT (CECT) scan numbers, and ICM consumption in the first 28 days post-intervention, was quantified and compared with the preceding 12 months. Sub-analyses of CT pulmonary angiography (CTPA), abdominal and pelvic CECT (CECT AP), and 'Code stroke' CT numbers and the impact on alternative modalities was also performed. The t-test for unpaired samples was used to assess the statistical significance of change. Results: The average daily number of CECT (all), CECT (inpatient and ED), CTPA, CECT AP, and 'Code stroke' CT scans decreased significantly (P < 0.01), by 58.6%, 68.8%, 74.1%, 88.0%, and 37.5%, respectively. The number of NECT, NECT abdomen and pelvis (NECT AP), and nuclear medicine lung ventilation:perfusion (VQ) scans increased significantly (P < 0.01), by 41.6%, 608.2%, and 165.8%, respectively. ICM consumption also decreased significantly (P < 0.01), by 65.3% (75.8% for ED and inpatient scans). Conclusion: Interventions in CT alone, focused on improving patient triage to CECT while avoiding deferment of any outpatient oncology studies, have achieved an approximately two-thirds reduction in ICM consumption.

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