Short-, Mid-, and Long-term Strategies to Manage the Shortage of                     Iohexol

Grist, Thomas M.; Canon, Cheri L.; Fishman, Elliot K.; Kohi, Maureen; Mossa‐Basha, Mahmud

doi:10.1148/radiol.221183

Cited by 36 publications

(30 citation statements)

References 5 publications

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“…contrast use by 50% for interventional radiology, interventional neurology, interventional cardiology, and electrophysiology [ 5 ]. Numerous statements and strategies have recently been published on addressing the ICM shortage [ 1 , 3 , 4 , 7 , 8 ]. The American College of Radiology (ACR) Committee on Drugs and Contrast Media released strategies to reduce the use of i.v.…”

Section: Discussionmentioning

confidence: 99%

The Effect of an Iodinated Contrast Material Shortage on Ordering Patterns in the Emergency Department

Hahn¹,

Chacko²,

Mohan³

et al. 2022

Cureus

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IntroductionIodinated contrast media (ICM) is essential to emergency department care in differentiating and delineating life-threatening pathologies. In May 2022, due to the COVID-19 outbreak, there was an unprecedented disruption in the manufacturing of iodinated contrast. The primary goal of this study was to describe the effects of an ICM shortage on the ordering patterns of emergency medicine physicians. MethodsThis was a retrospective, observational study with a pre-/post-test design. The study included two 28-day periods. All subjects who underwent a CT were included in the study. The subgroup of patients who underwent a repeat CT with ICM contrast within 1-24 hours was identified. ResultsDuring the pre-and post-implementation study periods, 4,574 and 3,973 CT studies were performed. The median length of stay (p=0.013) and time to first CT (p<0.001) both decreased during the postimplementation period. During the post-implementation period, more non-contrast CTs were ordered (p<0.001). During the post-implementation period, there was an increase in non-contrast studies followed by a repeat study with contrast (p=0.003). ConclusionsA global ICM shortage resulted in a shift in the ordering patterns of Emergency Medicine (EM) physicians. More non-contrast CT scans were ordered. However, there was also an increase in repeat imaging with ICM material.

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Section: Discussionmentioning

confidence: 99%

The Effect of an Iodinated Contrast Material Shortage on Ordering Patterns in the Emergency Department

Hahn¹,

Chacko²,

Mohan³

et al. 2022

Cureus

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“…Delaying elective or outpatient contrast-enhanced CT imaging (CECT) was recommended for ordering providers by 1 month or 3 months depending on the necessity of ICM, a similar strategy reported by Grist et al . [ 8 , 18 ]…”

Section: Reducing Contrast Ct Studies Strategymentioning

confidence: 99%

“…Carbon dioxide (CO 2 ) angiography is successful in patients in whom ICM is contraindicated such as in severe renal disease of ICM allergies [ Figure 5 ]). [ 8 ] Gadolinium (Gd) can be used even in patients with renal insufficiency at a dose <0.3–0.4 mmoL/kg body weight. [ 20 ] At our institution, maximum dose Gd and CO 2 angiography were widely adopted.…”

Section: Alternative Contrast or Studies Strategymentioning

confidence: 99%

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Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

Gopireddy

Virarkar

Vulasala

et al. 2023

JCIS

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Iodinated contrast media (ICM) shortages and secondary supply chain problems due to Coronavirus Disease lockdowns in China significantly impacted radiology operations nationwide. The lack of ICM necessitated operational workflow changes designed to ration contrast use, particularly in the hospital setting. In this manuscript, we share our strategic methods with advanced process/outcome metrics to monitor the effectiveness of our strategy under a coordinated multidisciplinary team effort. Alternate studies such as substituting magnetic resonance angiography for computed tomographic angiography for emergency department patients were studied to measure the suitability of these examinations for specific diagnoses. This article presents readers with a comprehensive crisis management strategy deployed at our institution, emphasizing various options with a limited ICM supply, and minimizing the impact on clinical care.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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A recent shortage in the global supply of iodinated contrast media (ICM) has required health service providers to review their contrast administration policies and implement strategies to conserve inventory. This article will review the current best practices in head and neck imaging for a variety of common presentations and provide examples where alternative imaging can be considered due to the recent ICM shortage. Ultrasound and MRI techniques can feature heavily in many diagnostic processes in head and neck pathology, and a variety of common presentations can be appropriately investigated through clinical evaluation or naso-endoscopy. In many instances, for the routine assessment of non-acute adult and paediatric head and neck presentations, the use of contrast-enhanced CT can be safely minimised to conserve ICM if required.

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Short-, Mid-, and Long-term Strategies to Manage the Shortage of Iohexol

Cited by 36 publications

References 5 publications

The Effect of an Iodinated Contrast Material Shortage on Ordering Patterns in the Emergency Department

The Effect of an Iodinated Contrast Material Shortage on Ordering Patterns in the Emergency Department

Metrics-driven successful strategy by emergency and radiology driven task force to mitigate global CT contrast media shortage in a safety net hospital

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

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