When the shortage was announced, Vanderbilt University Medical Center (VUMC) identified a reserve of seven to 10 days’ worth of ICM on hand. They recognized immediately that extraordinary steps would be needed to conserve the remaining supply. Laveil M. Allen, MD, Executive Medical Director and Section Chief of Emergency Radiology, and Reed A. Omary, MD, MS, Chair of the Department of Radiology and Radiological Sciences, VUMC, Nashville, TN, USA, and co-authors share actions taken to develop mitigation, communication, prioritization, and procurement strategies.

“Imaging services are the eyes of medicine and preserving our ability to diagnose the most critically ill patients is essential to quality care,” explained Dr. Allen.


A radiology command center team (RCCT) was created immediately. They tracked contrast exhaustion risk (CER) levels, which were updated each day to reflect the volume of contrast on hand and estimated supply remaining. A tiered strategy for outpatient imaging centers was created to identify patients whose need for a contrast image was critical and patients whose studies could be delayed or replaced by an alternative study. Outpatient CT orders across the system were collected centrally and reviewed by a subspecialty radiologist on the RCCT to confirm the tier level or suggest a tier change with the referring clinician. Communication across the health care system was key.

VUMC’s combined strategy of setting up an RCCT, forming multidisciplinary partnerships, and implementing contrast mitigation strategies reduced contrast use by 50% in less than seven days. "Hopefully, our shared mitigation strategies can provide clarity on a path forward in this time of crisis," noted Dr. Omary.

At the University of North Carolina, Chapel Hill, the Department of Radiology’s mitigation strategy made protocol changes across the board to conserve ICM for uses in which alternative options are not available. Every contrast-enhanced CT examination already scheduled is being scored by a radiologist as “contrast-enhanced,” “non-contrasted,” “reschedule,” or “route to alternative examination to prioritize contrast administration.”

Some patients are being redirected to an MRI or ultrasound study. Because MRI requires pre-authorization, institutional leadership is engaging with payer leadership to explain the potential increase in MRI orders to hasten the authorization process and prevent unnecessary delays.

With improved workflows, reduced inefficiencies, and nursing staff freed up from intravenous line placements for contrast-enhanced CT redeployed to MRI, the department has achieved significant contrast use reduction, exceeding their target of 50%.

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