Feature
IR approach to contrast media preservation strategies
By Nikki Keefe, MD, Kush R. Desai, MD, FSIR, Maureen P. Kohi, MD, FSIR, and Gloria Salazar, MD, FSIR
I
nterventional radiology performs a vast array of percutaneous vascular and nonvascular procedures in a variety of care settings, with
varying degrees of acuity. For many procedures, iodinated contrast media (CM) is integral to the safe and effective delivery of procedural care.
Recently, GE Healthcare announced a supply chain disruption affecting the global supply of iohexol and iodixanol (Omnipaque and Visipaque; GE, Chicago) due to COVID-19 restrictions in China affecting the GE contrast facility in Shanghai, China.
20 IRQ | SUMMER 2022
This disruption has depleted 80% of their supply, with the remaining 20% produced in Cork, Ireland.
In response to this shortage, the American College of Radiology (ACR) Committee on Drugs and Contrast Policy has published a guidelines statement that advocates for1
:
• Diverting diagnostic imaging to other modalities (unenhanced computed tomography, magnetic resonance (MR) imaging, and ultrasound) when possible
• Use of alternative brand contrast agents
• Reduced individual dosing
• Supply prioritization based on patient acuity.
IR practices are faced with instituting changes in patient care to preserve contrast uses in which alternative options are not available or in emergent scenarios. In this article, we discuss the initial approach to case prioritization, as well as a few short-term strategies for management of existing supply to minimize waste.
Approach to case prioritization Mitigation efforts include creating a priority matrix for procedures that require iodinated CM versus procedures that are not emergent, those that can be performed with alternative interventional imaging modalities (intravascular ultrasound [IVUS], intracardiac echocardiography) or alternative CM.
While supply may vary across institutions, a common approach is deferral of all elective procedures that require iodinated CM to a later time. In emergent procedures where iodinated CM is needed, efforts to
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