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The Great Contrast Shortage of 2022-Lessons learnt in Australia.

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The iodine-based contrast media shortage significantly impacted CT scan delivery, reducing contrast-enhanced CT, CT pulmonary angiogram, and CT neck angiogram rates by up to 50%. Ventilation/perfusion scans partially compensated for CT pulmonary angiograms, but no alternative existed for CT neck angiograms in stroke cases.

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Area of Science:

  • Radiology and Medical Imaging
  • Healthcare Supply Chain Management
  • Public Health Crises

Background:

  • Computed tomography (CT) is a vital diagnostic tool, frequently utilizing iodine-based contrast media (IBCM) for enhanced imaging.
  • Global supply chain disruptions, notably from the SARS-CoV-19 pandemic, caused a critical IBCM shortage in mid-2022.
  • This shortage posed a significant challenge to routine medical imaging services.

Purpose of the Study:

  • To evaluate the impact of the 2022 IBCM shortage on CT imaging services in Western Australia.
  • To analyze changes in the utilization of specific CT examinations, including contrast-enhanced CT (CECT), CT pulmonary angiogram (CTPA), and CT neck angiogram (CTNA).
  • To assess the extent to which alternative imaging modalities compensated for the reduction in IBCM-dependent scans.

Main Methods:

  • A single-center retrospective analysis compared CT scan provision before and during the IBCM shortage period.
  • Data included total CT scans (noncontrast CT [NCCT] and CECT), CTPA, and CTNA examinations.
  • The study also examined the frequency of alternative imaging techniques like ventilation/perfusion (V/Q) scans, carotid Doppler ultrasound, and magnetic resonance angiograms (MRAs).

Main Results:

  • CT examinations showed a consistent increase in frequency since 2012.
  • During the shortage, CECT, CTPA, and CTNA rates dropped significantly (49%, 55%, and 44% respectively, P < 0.001).
  • V/Q scan frequency increased fivefold, while carotid Doppler ultrasound and MRAs remained stable.

Conclusions:

  • The IBCM shortage critically impacted healthcare delivery, necessitating resource conservation and risk-based patient triage.
  • While V/Q scans offered a partial substitute for CTPA, no effective alternative was found for CTNA in stroke evaluations.
  • Healthcare systems must prepare for future IBCM shortages by exploring alternative imaging strategies and supply chain resilience.