Interventional cardiology

Contrast dye shortage: Avoid CT scan requests ‘wherever feasible’, specialists urged


Clinicians have been urged to be aware of possible limits on cardiovascular CT imaging due to a major shortage of dye used in the scans.

With supplies currently limited around the world, radiologists have noted that iodinated contrast media are always needed for imaging for cardiac catheterisation and stroke CTP, and have recommended that other imaging modalities be used for some imaging such as in diagnosis of pulmonary embolism.

All asymptomatic staging and incidental finding workups should be deferred where feasible, according to advice from the TGA and the Royal Australian and New Zealand College of Radiologists (RANZCR) released on Tuesday.

It comes after COVID-19 lockdowns forced the closure of GE Healthcare’s plant in Shanghai, which is the primary supplier of iodinated contrast media to Australia.

GE Healthcare says the factory has begun re-opening this week, but it expects an 80% reduction in supplies through to the end of June.

“We are working to return to full capacity as soon as local authorities allow,” the company told US industry publication Health Imaging.

Supplies were expected to improve over the next few weeks thanks to a boost in production at its other main factory in Ireland, spokesperson added.

In the meantime, RANZCR stressed limited supplies of IV contrast were still available for high priority patients, including those with Level 1 trauma, emergent stroke CTP, cardiac catheterisation and select oncology cases.

However, it added non-contrast CT ought to be possible for others such as those with suspected appendicitis or hernia.

“RANZCR recommends that medical practitioners considering referring a patient for a CT during this time consult with a radiologist for advice on alternative imaging modalities or other strategies that could be used to diagnose and manage their patients,” it said.

In a statement the TGA advised clinicians to “consider the current shortage of iodinated contrast media (contrast) diagnostic agents when referring patients for imaging.”

It advised practices and hospitals to consider strategies such as:

  • 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.

Separately, the Department of Health announced it would offer a temporary MBS item for PET using the radiopharmaceutical fluorodeoxyglucose (FDG) to assist with cardiac viability testing.

This followed a supply shortage of the radiopharmaceutical thallium-201 (Tl-201), which had meant item 61325 could not be used.

The item would be available until 30 September and carry the same rebate of $329 (75% = $246.75, 85% = $279.65).

Iodinated Contrast Media always needed Non-contrast CT feasible Alternative modality feasible 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 staging examinations
Gastrointestinal bleed
Occult infection
Pulmonary embolism
Oncology staging
Focal liver lesions
Asymptomatic annual staging
Pulmonary modules smaller than 8mm
Incidental finding workups

Source: RANZCR

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