Supply chain disruptions have created critical shortages of Omnipaque (iohexol) and Visipaque (iodixanol), iodinated contrast media agents used in imaging studies for the diagnosis and treatment of disease. GE Healthcare, the manufacturer, had to shut its plant in Shanghai, China, due to local COVID-19 policies, disrupting 80% of their production.
Investigators provide clinicians with guidance on alternative imaging methods for interventional radiology procedures and strategies to maintain the short supply for emergencies, a press release announced. The guidance has been published in the Journal of Vascular and Interventional Radiology (JVIR).
“As interventionalists, adaptation is at the core of our specialty, and this situation has proved no different,” said lead author Nikki A. Keefe, Department of Radiology, University of North Carolina at Chapel Hill (Chapel Hill, USA) and her co-authors. “We have developed an initial approach to case prioritisation, and we also looked at short-term strategies for the management of existing supply to optimise utility and minimise waste.”
In response to this shortage, the American College of Radiology (ACR) Committee on Drugs and Contrast Policy has published a guidelines statement. Using these guidelines as a foundation, Keefe and her co-authors offer a set of practical solutions for dealing with the current situation.
The authors recommend creating a priority matrix covering the following categories: procedures that require iodinated contrast media versus procedures that can be deferred; those that can be performed with alternative imaging modalities such as intravascular ultrasound; and those that can be performed with an alternative contrast media.
With maximum dose recommendations, gadolinium (Gd) can be used in the vascular system even for patients with renal insufficiency. Carbon dioxide has been used as a safer alternative to iodinated contrast media in patients with renal dysfunction or allergy, although there are some associated risks. To prevent ischaemia, dosages should be timed one to two minutes apart. While alternate contrast agents have limitations in defining the anatomy of large diameter vessels such as the aorta, digital stacking of images may improve visualisation.
Intravascular ultrasound has an established role in vascular procedures, and it can obviate the use of contrast media and decrease radiation exposure and procedural times. With appropriate training, clinicians can apply intravascular ultrasound for procedures such as inferior vena cava filter placement and transvenous biopsy.
GE Healthcare recently announced that it has been able to reopen its Shanghai facility, but distribution and other supply chain issues may linger. “That being said,” Keefe and co-authors cautioned, “with China’s zero-COVID-19 policy, a shutdown may unfortunately happen again, and it would be prudent to have a plan in place should shortages recur.”