From the March 2015 issue of HealthCare Business News magazine


“There is a general perception that all iodine contrasts (CT) are alike and all gadolinium-based (MR) contrasts are alike, but they do differ a bit,” says Pering. Over time, a body of evidence has formed that helps cardiologists make informed decisions about when to use contrast and when it could be a hazard. There are also recommended usage rules for cardiologists to consult on a patient-by-patient basis. Bhella at JPS Health Network says those considerations affect not only what contrast to use on a given patient, but which ones a facility will choose to keep in stock.

The first reason he started using Definity, the ultrasound from Lantheus, was simply because it was what his fellow cardiologists were already using — but that had not always been the case, “We had other agents in the hospital before my tenure, but the hospital chose Definity.” It’s a decision that Bhella says needs to be made with consideration to patient population and the safety profile of a given contrast agent.


Bayer’s Pering also stresses the importance of obtaining a thorough history of the patient. In particular, she says, finding out about any allergic predisposition or kidney or any organ failure is essential in doing an individual risk-benefit assessment. While some physicians may give medication before injection of contrast agents in order to limit the likelihood of adverse reactions, Pering says that practice requires further research before it can be responsibly recommended.

Bhella says, for ultrasound contrast, the American Society of Echocardiography provides appropriate use criteria which can inform proper usage. Those guidelines, coupled with asking the right questions of the patient, and knowing the product you are using, can take most of the risk and mystery out of contrast usage.

“Ask a patient if they have ever received a contrast agent before. Find out if they have known allergies, as certain allergies would preclude certain contrast agents,” says Bhella, who adds that individual contrasts are packaged with guidelines that help inform a patient’s candidacy.

Ultrasound
While contrast in ultrasound is nothing new, there are only a few companies competing in the domestic market. Bayer, for instance, stepped away from the ultrasound market over a decade ago and currently has no plans of getting back into it. For Bhella, there are a number of factors that go into selecting an ultrasound contrast, deciding when to use it, and upon whom.

One advantage of ultrasound, (versus CT and MR) is the mobility of the modality, says Bhella. It is portable and does not emit radiation. The use of contrast with ultrasound sometimes depends on circumstances that arise from that flexibility.

March 2015 Magazine

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