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Imaging referrals impacted by supply chain issues

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Healthcare professionals, including GPs, have been asked to consider the current shortage of iodinated contrast media (contrast) diagnostic agents when referring patients for imaging.
 
The request, issued by the Therapeutic Goods Administration (TGA) and the Royal Australian and New Zealand College of Radiologists (RANZCR), is due to a ‘global shortage’ of contrast media caused by the recent COVID-19 lockdown in Shanghai.
 
‘The TGA recommends urgent conservation of stock until the shortage is resolved as current supply is very limited,’ a release posted on the health regulators website states.
 
‘GE Healthcare, the sponsor of Omnipaque [iohexol] and Visipaque [iodixanol], has notified the TGA of a shortage of multiple presentations of both these products due to reduced manufacturing capacity and freight delays.’
 
GE Healthcare is the largest supplier of contrast media in Australia and expects to resume normal supply in mid-June 2022. Any updates to the return to supply date will be published on the Medicine Shortage Reports Database.
 
In the meantime, the TGA is reportedly working with ‘a range of stakeholders’ to manage the shortage, including sponsors who are investigating the importation and supply of overseas registered non-ionic contrast media agents.
 
A RANZCR statement addressing the situation recommends that medical practitioners consult with a radiologist for advice on alternative imaging modalities or other strategies that could be used to diagnose and manage their patients prior to making a referral for a CT.
 
Practices and hospitals have been asked to consider the following strategies:

• Being judicious in the use of contrast for all modalities that use contrast
• Using non-contrast CT when acceptable
• Delaying non-urgent scans
• Where possible using other modalities such as MRI or nuclear medicine
• Coordinating between private practices and public hospitals to best serve patients in need of contrast CT scans

RANZCR also referenced recommendations from a recent journal article on practice management strategies for imaging facilities facing an acute contrast media shortage, reproducing the following (non-exhaustive) table as an example of how practices might prioritise patients based on clinical need.
 

Tier 1 Iodinated Contrast Media always needed	Tier 2 Non-contrast CT feasible	Tier 3 Alternative modality feasible	Tier 4 Deferment feasible
Emergent Stroke CTP Suspected dissection Level 1 trauma Cardiac catheterization Select oncology cases Clinical trial patients	Diverticulitis Appendicitis Hernia Bowel obstruction Fluid collection Non-vascular chest imaging Select oncology stating examinations	Gastrointestinal bleed Occult infection Pulmonary embolism Oncology staging Focal liver lesions	Asymptomatic annual staging Pulmonary modules smaller than 8mm Incidental finding workups

 
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contrast media diagnosis imaging radiology

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