How a Contrast Media Shortage Is Affecting Medical Scans in the U.S.

A COVID-19 lockdown in China temporarily shut down an important production facility for iodinated contrast media, a drug commonly used to enhance medical scans. Here’s how the shortage is impacting health care.

Fact checked on May 24 2022 by Vivianna Shields, a journalist and fact-checker with experience in health and wellness publishing.
Hospitals across the United States are being impacted by a recent shortage of iodinated contrast media (ICM). Given to patients intravenously during certain medical scans, this type of medication enhances the ability to see blood vessels and organs, helping health care professionals diagnose potential problems—such as infection, inflammation, and cancer—based on those images.
 
“Imaging is a multidisciplinary consult service that extends to impact most areas of medicine,” Laveil Allen, MD, executive medical director of the Vanderbilt University Medical Center Radiology Department, told Health. The contrast is what allows providers to see clearly through a patient’s body, much like eyeglasses can assist our vision. “Imaging services are the eyes of medicine, and preserving our vision is an essential component to providing care,” he adds.

The shortage is being caused by the temporary shutdown of a GE Healthcare production facility for ICM in Shanghai, China, due to a COVID-19 lockdown. The company is one of the major contrast media manufacturers, alongside Bracco, Bayer, and Guerbet. “When that plant was shut down, GE was suddenly unable to meet the supply-demand of its existing customers,” Matthew Davenport, MD, FACR, vice-chair of the American College of Radiology (ACR) Commission on Quality and Safety, told Health.


“They have since moved up the production capability in their facility in Cork, Ireland, and began airlifting contrast media to the United States. Nonetheless, there’s still an acute supply chain shortage,” said Dr. Davenport. He added that GE has informed that a level of normalcy should be reached by June 30, but considering the backlog and potential shipping challenges the crisis could continue throughout the summer.

Affected Hospitals and Health Systems
The shortage is affecting all hospitals that relied on GE Healthcare as their preferred vendor. According to Dr. Davenport, most health systems have agreements to buy contrast from specific manufacturers. “Any place that had preferred vendor contracting with GE was massively affected because they didn’t have any redundancy in their supply,” he said.
 
The extent to which each institution will be impacted also depends on how much stockpile of ICM they had before the shortage. “I’m familiar with some institutions which had a pretty large stockpile, so they’re going to be able to ride this out without too much effect,” said Dr. Davenport. “Others do not have much contrast available, and they will not necessarily make it to the end of the shortage. So, it is a serious issue.”
Mitigation Strategies
In an attempt to avoid a situation where the contrast media simply runs out, institutions around the country are adopting strategies to reduce its use to the minimum amount necessary. The ACR recently released a statement recommending a series of mitigation strategies.
The committee includes using alternative exams that don’t require ICM, such as magnetic resonance imaging (MRI) or ultrasound. In certain cases, providers may opt to perform a CT scan without contrast.
“Appendicitis is a good example,” said Dr. Allen. “We routinely scan the patient with contrast to identify if they have appendicitis. It can increase the sensitivity and specificity of the exam. But we can also identify it on a non-contrast CT exam.”
It is also possible to reduce the dose of contrast based on the patient’s weight. Another measure that has been adopted is to repackage contrast media into smaller volumes to eliminate waste. Non-urgent exams and procedures may also be postponed.
According to Dr. Allen, he and his colleagues at the Vanderbilt University Medical Center immediately formed a radiology command center to develop a series of tactics to handle the shortage when they were first alerted. The changes, according to an article accepted for publication by the Journal of the American College of Radiology, reduced contrast usage by about 50% in less than seven days at their health system.
 
“The big thing is that we want to make sure we have contrast for our most critically ill patients to perform life-saving imaging or procedures that require contrast,” said Dr. Allen. The use of ICM is indispensable, for example, in cases of stroke, when it is used to diagnose the condition through a CT scan and to potentially treat it through neurointervention. Contrast is also necessary in cases of a heart attack during cardiac catheterization, a procedure that is used both to diagnose and treat the condition.
Impact on Patients
With these measures in place, patients with scheduled exams or procedures may get a call from their hospital to postpone their appointment. Or they may learn they will undergo a different imaging technique than what was originally planned.
“These decisions are being made thoughtfully by physicians and other health care providers who have the patient’s best interests in mind,” said Dr. Davenport. “They never want to be in the situation where they have to make these decisions, but they’re doing it in a way that is as thoughtful as possible and putting the patient first. So, I think there is some amount of reassurance to this.” Dr. Davenport noted that it is always a good idea to talk to your health care provider to discuss the alternatives.
“Because your examination is altered from what it was originally scheduled to be, it does not mean that your care will be any less,” added Dr. Allen. “We will not sacrifice our patients’ care. Just be cognizant that you may have been scheduled for one exam, and you may be contacted and instructed that you’re going to get an alternate exam to find an answer to the same problem.”

As the Delta variant courses through New York City, many young Black New Yorkers remain distrustful of the vaccine.

A construction site safety manager in Queens said that as a Black man, he was more worried about the prospect of being stopped by the police than he was about getting Covid-19.

A graduate student in the Bronx who had not gotten vaccinated said her worst fears seemed confirmed when a vaccine that the government was directing to Black and poorer neighborhoods was briefly suspended over a small number of dangerous blood clots.

And a civil rights activist in the Bronx said he grew suspicious when he heard last year that politicians were prioritizing minority neighborhoods for coronavirus vaccinations.

“Since when does America give anything good to Black people first?” said the activist, Hawk Newsome, a 44-year-old Black Lives Matter leader who is unvaccinated.

All three situations reflect a trend that has become a major concern to public health experts: Young Black New Yorkers are especially reluctant to get vaccinated, even as the Delta variant is rapidly spreading among their ranks. City data shows that only 27 percent of Black New Yorkers ages 18 to 44 years are fully vaccinated, compared with 48 percent of Latino residents and 52 percent of white residents in that age group.

This vaccination gap is emerging as the latest stark racial disparity in an epidemic full of them. Epidemiologists say they expect this third wave will hit Black New Yorkers especially hard.

“This is a major public health failure,” said Dr. Dustin Duncan, an epidemiologist and Columbia University professor.

In interviews, dozens of Black New Yorkers across the city — an aspiring dancer in Brownsville, a young mother of five in Far Rockaway, a teacher in Canarsie, a Black Lives Matter activist in the Bronx, and many others — gave a long list of reasons for not getting vaccinated, many rooted in a fear that during these uncertain times they could not trust the government with their health.

The fact that the virus hit Black neighborhoods disproportionately during the first wave made

many extra wary of getting vaccinated: They feel that they have survived the worst and that the health authorities had failed to help them then.

But ultimately, many also said they would get vaccinated if forced to do so.

“If it’s going to be mandatory to work, I’ll have no choice,” said Kaleshia Sostre, a 27-year-old from Red Hook, Brooklyn, who teaches parenting classes to young mothers.

In Canarsie, Brooklyn, a 21-year-old college student, Justin Mercado, said Mayor Bill de Blasio’s recent announcement that dining in a restaurant would require proof of vaccination got his attention. He is now likely to get vaccinated.

“I want to go on a date sometime and enjoy life as much as I can before this strain shuts us back down,” Mr. Mercado said.

For months, the city had focused its vaccination campaign on older residents who are at higher risk of hospitalization and death.

But lately the city has begun to reach out more to young New Yorkers, offering $100 payments for first doses, urging students to get vaccinated before school starts and nudging employers to pressure their employees to get vaccinated.

“We’re not done yet,” said Dr. Torian Easterling, the chief equity officer of the New York City Health Department. “We’re continuing to announce more interventions and more strategies to support New Yorkers getting vaccinated.”

In interviews, Black men and women said that much of their distrust of the coronavirus vaccine was shaped by their own experiences with discrimination or their identity as Black Americans.

“I’m supposed to worry about getting sick when I go outside, versus getting killed by a cop or something like that?” said Jayson Clemons, 41, the construction site safety manager from Queens. After years of trying to be careful not to give the police a reason to stop him — avoiding cars with window tint or rims, and making sure when commuting that his attire clearly marked him as a construction worker — he said he refused to be preoccupied by Covid-19.

He said he would rather put his trust in masks and hand sanitizer — which he credits with keeping him healthy as he worked at construction sites throughout the pandemic — than a new vaccine that the government is pushing people to take. “They came out with one so fast for Covid, and now they want to pay you to take it,” he said. “It seems fishy.”

Some Black women described the need they felt to conduct their own research — and ask around — before deciding if the coronavirus vaccine was safe.

“It takes a little bit of hyper-vigilance when you’re a woman of color,” said Jazmine Shavuo-Goodwin, 31, who believes she encountered medical racism when doctors were dismissive of her severe stomach problems. “There’s a lot of homework you have to do, because your doctors may not truly listen to you, to your full complaint, before they’ve already diagnosed you.”

Ms. Shavuo-Goodwin helps manage dental clinics for Medicaid patients and is studying to be a clinical therapist. Both her job and school require her to be vaccinated against coronavirus, but she has yet to get a shot.

“I’m out of compliance,” said Ms. Shavuo-Goodwin, who is Black and lives in the South Bronx. “I have done heaps of research looking for things that would make me confident and comfortable getting the vaccine, but honestly I haven’t.”

All three vaccines being used in the United States have received an emergency authorization from the Federal Drug Administration. At least one of the vaccines is expected to get full approval by the fall.

When the vaccination campaign began last year, Mr. de Blasio said he intended to prioritize the same Black and Latino neighborhoods that were hardest hit during the devastating initial wave.

Love opens up about his battles with mental illness Kevin Love sits down with Jackie MacMullan to discuss suffering with anxiety and depression, and his first panic attack, which came on the court.

Screen Shot 2018-08-22 at 8.59.53 PMLOS ANGELES — I WAS JOSTLING for position with a gaggle of journalists and losing ground, sandwiched four-deep in a sea of bodies during media availability at the 2018 NBA All-Star Game in Los Angeles.

It was hardly an ideal environment to broach such a sensitive, personal topic as mental health, but Cavaliers forward Kevin Love had hinted three weeks earlier in Cleveland that he might be ready to share. At that time, I was interviewing Channing Frye in the Cavs’ locker room regarding his depression following the deaths of his parents, while Love, sitting at the adjacent locker, listened intently to our conversation.

“We all go through something,” Love said, cryptically, as I stood up to leave.

Now Love was perched on a dais in a ballroom at Staples Center in front of a long, flowing black curtain, fielding innocuous questions regarding his workout regimen. I navigated my way to the front of the pack and lofted Love a couple of warm-up questions regarding Frye. Once Love acknowledged that Frye’s candor was “an important step” toward putting a face on mental health, I had my opening.

“Have you ever,” I shouted above the din of the All-Star media day madness, “sought professional counseling?”

Suddenly, silence. The incessant chatter at surrounding podiums persisted, but in the vacuum of Kevin Love’s space, everyone stopped, turned … and waited. Love fixed his eyes on me, hesitated ever so slightly, then straightened his broad shoulders and leaned into the microphone.

“Yes,” he answered firmly.

READ MORE: http://www.espn.com/nba/story/_/id/24382693/jackie-macmullan-kevin-love-paul-pierce-state-mental-health-nba

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