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Radiologists urge 'prioritization' and 'alternative agents' during contrast shortage

by John R. Fischer, Senior Reporter | June 28, 2022
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ACR's guidelines urge providers to prioritize contrast media use and rely on alternative agents.
With providers still experiencing contrast media shortages from GE Healthcare’s factory shutdown, a group of radiologists has published guidelines with alternative imaging methods and strategies for maintaining supplies.

The company closed its Shanghai facility in March in response to a COVID-19 lockdown in the city, halting worldwide distributions of Omnipaque (iohexol) and Visipaque (iodixanol). While the facility has now regained most of its operational capacity, the impact of the shortages is still lingering. The company said on its website that it will “help them [customers] plan several weeks ahead as supply progressively recovers.”

Based on recommendations made by the American College of Radiology, Dr. Nikki Keefe, in the department of radiology at the University of North Carolina at Chapel Hill, and her colleagues have come up with interventional radiology practices that emphasize “case prioritization” and “short-term strategies” for navigating these challenges.

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They first advise creating a priority matrix for procedures that require iodinated contrast media and ones that can be deferred, as well as one for when alternative imaging modalities can be used, and another for when alternative contrast media can be applied. They also recommend department heads from both diagnostic and interventional teams, including non-radiological divisions, work together to manage contrast media usage. Additionally, a central pharmacy and inventory system for distribution should be put in place.

Among the alternative contrast agents they list are gadolinium for renal insufficiency, carbon dioxide for renal dysfunction, gastrografin for gastrointestinal access and catheter exchange, and cystografin for genitourinary access and procedures including nephrostomy and nephroureteral stent placement and exchanges. Also, with appropriate training, intravascular ultrasound can be used for vascular procedures without contrast media usage and decrease radiation exposure and operation times.

Other suggestions include relying on multiuse valved equipment and diluting contrast media with saline to stretch supplies and reduce waste; and digitally stacking images to improve visualization.

Keefe says that providers should consider making these protocols permanent, as “with China’s zero-COVID policy, a shutdown may unfortunately happen again, and it would be prudent to have a plan in place should shortages recur.” She also says, “they may serve patients in the long term by minimizing both contrast media load and radiation exposure.”

The guidelines were published in the Journal of Vascular and Interventional Radiology.

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