- A global shortage of two common intravenous (IV) contrast fluids is prompting some medical facilities to delay routine imaging procedures such as CT scans,
- Industry officials say the shortage is due to the temporary shutdown of a production facility in China.
- Experts say the delays may impact people who need diagnostic imaging tests.
- Medical facilities are being urged in some cases to use alternative procedures such as ultrasound technology.
Hospitals and medical facilities around the United States are rationing intravenous (IV) contrast imaging procedures amid a global shortage.
The U.S. Food and Drug Administration has reported shortages of two forms of contrast medium fluids known as Iohexol and Iodixanol, both commonly used in CT scans.
GE Healthcare, manufacturers of the products, advised that the shortage was due to a lockdown and subsequent temporary shutdown at a production facility in China.
The shortage is forcing physicians to reserve the limited supply of IV contrast material for life or death scenarios.
“Something I never would have dreamed would have ever happened in my career… we are having to triage and essentially ration care due to lack of supply of a basic diagnostic necessity,” Dr. Joy Henningsen, a diagnostic radiologist in Alabama, told Healthline.
“In triage, you always prioritize life-or-death situations above all else, and that’s exactly what we’re doing during this shortage,” she explained. “Iodinated IV contrast is very precious right now, so we’re saving it for things like severe bleeding, severe trauma, procedures in the angiography lab.”
Henningsen says the majority of people in a hospital setting are likely to be impacted in some way by the shortage.
“It’s difficult to imagine patients who won’t be affected by the shortage. Most patients sick enough to be in the hospital require regular medical imaging utilizing iodinated IV contrast, then there are the countless people showing up at hospitals every day of the week with new symptoms waiting for new diagnoses not to mention patients with known diagnoses being imaged serially for surveillance,” she said.
In a statement posted online this week, Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, said normal production of contrast IV was expected to resume in late June.
Until then, hospitals across the United States are implementing conservation strategies to provide care for patients.
“Rationing contrast and ensuring every available drop of contrast dye is used efficiently, and postponing some scans that can be postponed, to give a few examples,” Foster said.
Dr. James Leo is the chief medical officer of MemorialCare in Fountain Valley California. He says that although the shortage has yet to impact his facility’s ability to care for patients, they are preparing for shortages.
“We have asked all our physician colleagues to reduce contrast utilization wherever possible, such as choosing approved alternate imaging methods when appropriate, and only using IV contrast when no other substitute is available,” Leo told Healthline. “Our physicians also are working alongside our radiology teams to develop conservation protocols, to avoid waste.”
The American College of Radiology Committee on Drugs and Contrast Media this week issued recommendations for addressing what they described as an “emergency.”
Among the recommendations are using alternative imaging procedures such as non-contrast CT or ultrasound without contrast agents, minimizing individual doses of contrast agents, and collaborating with departments like cardiology and vascular surgery to properly prioritize limited supply.
The shortage only relates to iodinated contrast, which is not the same as IV contrast used in other imaging studies such as MRIs.
“It’s important for people to understand that this shortage is not for all types of IV contrast, but rather a specific type of IV contrast used in one of the more common imaging modalities, such as CT scans. Because CT scans are so common, this shortage will affect a tremendous number of patients, hence the concern,” Henningsen said.
“(The shortage) may have an impact on the healthcare system in so many ways, but its most significant effect could be missed or delayed diagnoses,” she said. “We are already reeling from delayed diagnoses due to many patients skipping routine screening exams at the beginning of the pandemic, so another large setback at the population level delaying time of diagnosis could be significant. It’s always better for the patient the earlier disease is detected.”