“Navigating the COVID-19 pandemic has helped radiology departments become more nimble and develop rapid response functionality to manage crises, including the iohexol contrast shortage, and potential future crises that we will face,” observed senior author Mahmud Mossa-Basha, MD, Professor, Vice Chair, Quality and Safety, and Medical Director, MRI, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

While most reports published about the ICM shortage have been clinically focused, a group of researchers has published a new study using empiric utilization data that could help prioritize and inform health system decisions by focusing mitigation efforts on areas in which contrast media are more frequently used. They obtained and retrospectively analyzed data from the Medicare Physician/Supplier Procedure Summary Limited Data Set for 2019. This dataset includes 100% of 2019 Medicare Part-B fee-for-service claims.


Researchers extracted national counts for services for all contrast-enhanced CT services by body region and site of service (inpatient and outpatient hospital, office, and emergency department) and separated those codes into CT angiography (CTA) and nonangiographic CT services. They found that utilization of contrast-enhanced CT was highest in the hospital outpatient and emergency department settings. Overall utilization was highest for the abdomen/pelvis and chest in those settings, with abdomen/pelvis the most frequently rendered by far. The ratio of CTA to nonangiographic contrast-enhanced CT was greatest by far for the brain in the emergency department followed by the inpatient hospital setting. Across all places of service, this ratio is highest for brain, head/neck, and chest.

“Radiology practices and departments may find their greatest mitigation impact focusing on abdominal/pelvic and chest CT in the emergency department and hospital outpatient settings, as well as brain and head/neck CTA in the emergency department and hospital inpatient settings,” explained lead investigator Richard Duszak, Jr, MD, Professor and Vice Chair and Director of the Imaging Policy Analytics for Clinical Transformation (IMPACT) Research Center, the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.

“We believe that the highlighted site of service and body region differences may help guide the creation of the most impactful specialty teams. Identification of settings and scenarios where CTA is most frequently used may help guide alternative imaging care pathways and most effectively and safely re-allocate resources to alternative modalities,” Dr. Duszak added.

“The field has responded rapidly to the contrast shortage. Any lasting changes, such as patterns of referral or utilization remain to be seen,” commented Ruth C. Carlos, MD, MS, Professor, University of Michigan, Ann Arbor, MI, USA, and Editor-in-Chief of the Journal of the American College of Radiology.

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