Is Your Institution Ready for the Next Big Medical Supply Shortage?

Earlier this year, radiologists faced a serious challenge: a shortage of iohexol iodinated contrast media (ICM), an agent used in critical diagnostic tests and interventions. Due to the COVID-19 pandemic, one of the two major manufacturers of ICM shut down a factory in Shanghai, leading to an 80% reduction in ICM output.

Studying the lessons learned from this experience can help with planning for other potential shortages of contrast media as well as other agents that have been in short supply recently, such as lidocaine.

Using Multidisciplinary Mitigation Strategies

David D.B. Bates, MD, an abdominal radiologist and director of computed tomography (CT) at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City, noted that his institution experienced a significant reduction in contrast shipments.

“Fortunately,” Dr. Bates said, “we started taking steps before the shortage really kicked in. We heard it was a possibility and began planning a multi-tiered approach to prioritize contrast use where it was most necessary and to optimize use of the contrast we had.”

Dr. Bates and others at his institution formed an Emergency Contrast Shortage Committee and worked closely with fellow radiologists, pharmacists, nurses, CT technologists, clinical colleagues in other departments and the hospital administration to ensure radiologists could continue to provide the best imaging possible.

“Quickly forming a multidisciplinary team is critical,” Dr. Bates said. “Our committee met seven days a week during the peak of the shortage.”

Dr. Bates noted the pharmacists at his institution worked with his team to repackage smaller aliquots.

Listen to Dr. Bates discuss his institutions preparations for the contrast shortage:

The University of North Carolina (UNC) at Chapel Hill used similar strategies to manage the effects of the contrast shortage, according to Maureen Kohi, MD, Ernest H. Wood Distinguished Professor and chair of the Department of Radiology.

“Working closely with our colleagues throughout the hospital who also rely on iodinated contrast media, we developed strategies to reduce waste, use alternative procedural/imaging modalities and seek alternative contrast agents,” Dr. Kohi said.

Dr. Kohi and colleagues developed robust algorithms for diagnostic, vascular and interventional radiology and published them in several peer-reviewed manuscripts.

According to Dr. Kohi, one method of responding to a CT contrast shortage— postponing imaging to conserve contrast supplies—should only be done if it does not compromise clinical care.

“We developed a triage system through a collaborative effort to allow for postponing only routine outpatient imaging, such as oncology patients undergoing annual surveillance who have no evidence of residual disease,” Dr. Kohi said. “Otherwise, patients received contrast media, either at a full dose or a lower dose, or underwent an alternative imaging study, such as contrast enhanced magnetic resonance imaging, when appropriate.”