Navigating Supply Chain Disruptions of Iodinated Contrast Agent for Neuroimaging and How Business Intelligence Can Help the Decision Process

Abstract

A recent coronavirus disease 2019-related shutdown of the main production facility of iohexol in China has led to massive shortages of iodinated contrast material across the globe. This shortage has also jeopardized neuroimaging. In this article, we describe remedies to reduce iodinated contrast material use for stroke imaging, which is its primary use in neuroimaging, that we have implemented in our hospital network.ABBREVIATIONS: BI ¼ Business Intelligence; CE ¼ contrast-enhanced; coronavirus disease ¼ COVID; ECR ¼ endovascular clot retrieval; ICM ¼ iodinated contrast material; Tmax ¼ time-to-maximum T he latest knock-on effect of the coronavirus disease 2019 (COVID-19) pandemic is a global shortage of iodinated contrast medium (ICM) triggered by the shutdown of GE Healthcare's main production facility of iohexol (Omnipaque; GE Healthcare) during the latest lockdown in Shanghai at the end of March 2022. The combination of the company's Just-in-Time inventory management and lean production strategies that afforded competitive pricing ($0.13/mL for our institution) and GE's large global market share of ICM has led to a massive disruption in the global supply of ICM, which caught many of us by surprise. With stock levels dwindling and unclear information on when the factory will return to full capacity or make up for the production shortfall, many hospitals are scrambling to source more ICM from elsewhere. This unusual sudden demand, in turn, leads to an additional squeeze on the ICM supply chain. Several professional interest groups, including the American College of Radiology 1 and the American Society of Hospital Pharmacists, 2 have issued guidance documents on how to address the current ICM shortage, including various strategies for conservation of contrast material for those diagnostic tests and interventions that are time-critical and without which patients would die or have considerable morbidity. A recent clinical perspective in the American Journal of Roentgenology highlighted several broad strategies to conserve ICM at imaging facilities. 3 This perspective focusses on the most frequent indication for contrastenhanced (CE) CT in neuroimaging: Code Stroke.

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

“…In addition to the strategies proposed by the previously stated agencies, clinicians at hospital systems globally have described their experiences and plans for managing ICM shortages, including those reported by institutions in Australia, 4,20,31,32 Germany, 33 and the US. 1,5,7,16,17,19,[34][35][36][37][38]…”

“…For example, clinicians in the US and Australia determined contrast-enhanced CT was commonly used for abdominopelvic indications, for which alternative options (including CT without contrast) are available. 32,55 The American College of Radiology's ACR appropriateness criteria provides guidance on alternative imaging modalities. 56…”

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

“…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.…”

“…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 …”

Lessons learnt from the global iodinated contrast media shortage in head and neck imaging

“…3 In response, strategic health departments and medical imaging providers have been required to rapidly assess their current contrast usages and implement strategies to conserve limited supplies for most time critical indications, such as stroke presentations and acute lower gastrointestinal bleeding. 4,5 The American College of Radiology (ACR) Committee on Drugs and Contrast Media has recently issued guidance on conserving ICM during the supply shortage, with their recommendations largely endorsed by the Royal Australian and New Zealand College of Radiologists (RANZCR). 6,7 These strategies include utilising alternative imaging modalities to answer clinical questions, weight-based contrast dosing and lower kVp CT protocols to improve the conspicuity of ICM.…”