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.”
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.”