Contrast Shortage

[Vandalia]

An old radiologist friend (in both senses) tells me that there is a major iodinated (CT) contrast shortage either here now or looming very shortly.

Anyone seeing this in their shop? Another reason I am glad I retired.

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[Tipsy McStagger]

Yep it exists. So far my hospital is not limiting inpatient & ED CTs requiring IV contrast but they've stopped all routine outpatient scans. We have a tiered approach to limit scans to certain departments and indications when our cache of contrast reaches a certain point. So far I'm still able to get the scans I need.

 

[emergentmd]

Our FSERs do not expect any IV contrast until atleast July and we will see.

Any CTs that do not explicitly need contrast such as CTAs are going plain which is good in 95% of non CTA/PE studies.

 

[southerndoc]

GE manufactures Visapaque in China. They have shifted some production to Ireland, but they cannot produce more than 20% of the national demand. We also use Bracco's Isovue, which is made in Germany. We have a large supply of both because the health system is large, but we have started limiting outpatient contrast studies. So far ED studies have free reign for contrast.

 

[wook]

Same here. limitations on contrasted studies, but temporarily on hold due to a huge patient surge we are having.

 

[EctopicFetus]

Serious question has anyone heard of limiting contrast in outpatient studies? Seems to me the ED would be the last place to limit this.

 

[PianoMedic]

Here’s my understanding: omnipaque is made in Shanghai which has been under lockdown. One other plant can make it but can’t produce anywhere near enough (maybe that’s the Ireland plant). Visipaque production is being diverted for omipaque at some places. Isovue had a quality issue and isn’t allowed to take new contracts until 2023. If you already have a contract with isovue, you can increase order sizes should you need to. The omnipaque shortage is expected to last until August. Our health system has varying levels of supply at each hospital. On average we have 2 weeks of contrast supply right now. No outpatient scans and haven’t been doing them for close to 2 weeks, maybe longer. ED scans are severely limited to only those that can’t be done any other way. I’m ordering a decent amount of VQ scans and getting decent reads from rads on them. I work at two of the health system sites and abdominal CTs are noncon unless already getting a PE scan (which I’m often not doing). CTAs get contrast still if you have high suspicion. We are discussing removing perfusion scanning if they are under 6 hours from onset of symptoms for LVO stroke. Likely to have further mitigation measures imposed as not all providers following recommendations. Even have a dot phrase that we can input into the chart that was made globally. I tell patients about it. Other shop in town uses isovue and they have no issues. One of the outpatient clinic systems (not affiliated directly with us) is also on isovue but not allowed to sell it to us I guess. Weird time to be in medicine yet again.

 

[gutonc]

Serious question has anyone heard of limiting contrast in outpatient studies? Seems to me the ED would be the last place to limit this.

Yes, it's happening at all 4 hospital systems where I have privileges (outpatient oncology here). 3 of them have explicitly stated that ED scans won't be affected and have priority for limited contrast.

The way it's being managed at my primary hospital is that all outpatient CT scans ordered with contrast are now being protocoled by a radiologist and non-con studies being requested if appropriate.

 

[TheComebacKid]

I think this will be an interesting. albeit frustrating experiment.

I hypothesize that given the degree of obesity in this country we could probably get away with doing less contrasted scans. Contrasted scans require IVs, I find cause more delays. For perfusion scans and PE/dissection protocol CTs I understand the utility, but I think non-contrasted scans are probably adequate for a lot of abdominal studies.

Also, what are the rates of renal failure in the before and after non-contrast world? I suspect, as do most EM physicians, that they are exactly the same.

My hospital system has cancelled outpatient contrasted CTs... will see how this goes.

I'm very curious about the medicolegal aspects of this... you missed a certain pathology because you used a non-contrast study. The radiologist wrote in the read "Within the limitations of this non-contrast study, no acute findings". You've been instructed by your medical director, radiology department and hospital CMO to stop using contrast... Seems like someone is getting set up to be the scapegoat.

 

[dadaddadaBATMAN]

I think this will be an interesting. albeit frustrating experiment.

I hypothesize that given the degree of obesity in this country we could probably get away with doing less contrasted scans. Contrasted scans require IVs, I find cause more delays. For perfusion scans and PE/dissection protocol CTs I understand the utility, but I think non-contrasted scans are probably adequate for a lot of abdominal studies.

Also, what are the rates of renal failure in the before and after non-contrast world? I suspect, as do most EM physicians, that they are exactly the same.

My hospital system has cancelled outpatient contrasted CTs... will see how this goes.

I'm very curious about the medicolegal aspects of this... you missed a certain pathology because you used a non-contrast study. The radiologist wrote in the read "Within the limitations of this non-contrast study, no acute findings". You've been instructed by your medical director, radiology department and hospital CMO to stop using contrast... Seems like someone is getting set up to be the scapegoat.

It depends on the study and the indication.

If you’re looking for appendicitis in a fat person, a lawyer can of course make an argument for inappropriate discharge, but it’s unlikely you’ll miss it in the first place and probably defensible.

In a skinny person with the same study, and high suspicion, I could see an argument for admission either for old school serial examination or for mri (more likely).

if you are looking for some subtle infectious (or probably worse ischemic) process I could see an argument for inappropriate dc with a negative study.

 

[Angry Birds]

I can’t order any iV contrast for abd scans

 

[Rad2013]

At least we don’t see as much meaningless incidental $h!t on all of these noncon abdominal CTs.

 

[PianoMedic]

And they’re still seeing the acute appy and most other real pathology that I’m worried about. At least my rads have been able to see the really bad stuff.