Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists

Abstract

Due to a contrast shortage crisis resulting from the decreased supply of iodinated contrast agents, the American College of Radiology (ACR) has issued a guidance statement followed by memoranda from various hospitals to preserve and prioritize the limited supply of contrast. The vast majority of iodinated contrast is used by CT, with a minority used by vascular and intervention radiology, fluoroscopy, and other services. A direct consequence is a paradigm shift to large volume unenhanced CT scans being utilized for acute and post traumatic patients in EDs, an uncharted territory for most radiologists and trainees. This article provides radiological diagnostic guidance and a pictorial example through systematic review of common unenhanced CT findings in the acute setting.

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

“…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.…”

“…4,5,19,41 In this scenario, trained staff and the necessary supplies (e.g., MRI contrast agents or radiopharmaceuticals for nuclear medicine) for alternative imaging technologies would also need to be readily available, 4 and clinicians may need refresher training on interpreting images from non-contrast-enhanced CT scans. 50 Assessments of the effects associated with strategies to reduce use of ICM would help inform future planning. Reductions in ICM usage may not necessarily result in overall cost savings when staff time and the costs of alternative imaging services are included.…”