Prudence recommended despite “pre-shortage levels” of contrast media

Nikki A Keefe

Iodinated contrast media agents, namely Omnipaque (iohexol) and Visipaque (iodixanol), are frequently used in imaging studies for both diagnosis and treatment. GE Healthcare, the manufacturer, had to shut its plant in Shanghai, China, due to local COVID-19 policies, which created a domino effect in the supply chain, as seen in recent months. In May and June of 2022, clinicians were offered guidance on alternative imaging methods for interventional radiology procedures

Speaking to Interventional News about hers and colleagues’ article, which was published in the Journal of Vascular and Interventional Radiology (JVIR), lead author Nikki A Keefe (Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, USA) outlines the current iodinated contrast media supply situation, and what the response to her recommendations has been among radiologists.

Taking the American College of Radiology (ACR) Committee on Drugs and Contrast Policy’s guidelines statement as a starting point, Keefe and her co-authors recommended using a priority matrix to help manage radiology services in the face of the contrast media shortages. The matrix should encompass the following types of procedures: those requiring 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.

Keefe first underscores to Interventional News the impact of the shortage on radiology services: there were many cancellations and delays for non-emergent procedures, and alternative agents used. “Many procedures were transitioned,” she expands, citing how the traditional gastrostomy tube placement replaced the balloon-assisted gastrostomy tube placement, non-contrasted computed tomography (CT) replaced sinogram, and ultrasound-guided saline injections replaced fluoroscopy-guided contrast injections for tube placements.

The article’s lead author also relays how she, personally, “received many questions about using gadolinium, gastrografin and carbon dioxide in unique methods such as within angioplasty balloons.”

From a patient point of view, Keefe details how they were often “not familiar with the cases performed in the usual manner”, so remained largely unaware of procedural changes caused by the shortage, such as the employment of different imaging modality. Many, however, were acutely aware of the delays in imaging and their procedures.

“It would be interesting to see how radiation doses changed during this period, as perhaps patient doses decreased due to increased utilisation of ultrasound,” Keefe muses, while also contemplating how doses may actually have increased “if interventionalists were less familiar with alternative contrast agents and therefore the procedure was made more challenging and lengthier”

Regarding the current state of contrast media availability, Keefe asserts that it seems to be at “pre-shortage levels”, owing to Bracco’s increased production and importation to the US market and GE Healthcare’s production having returned “to normal”.

However, “it may be prudent to continue to utilise some of the mitigation strategies full-time,” Keefe advises, citing that nephrology colleagues of hers are in support of such an approach. “Use of air, carbon dioxide, and intravascular ultrasound where applicable can decrease both patient and provider radiation dose during the procedure,” the lead author suggests. Keefe goes on to say that “this may not increase procedural time but perhaps [even] decrease it, while providing [higher-quality] diagnostic imaging in certain situations.”


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