Cancer care

Contrast dye shortage: defer oncology scan requests ‘wherever feasible’, radiologists advise

A global shortage of iodinated contrast media has prompted radiologists to urge clinicians to defer or use alternative imaging modalities where possible in oncology diagnosis, monitoring and treatment.

With contrast dye supplies currently limited around the world, radiologists have released Australian-specific guidance on imaging modalities that can be used for oncology patients.

Advice from the TGA and the Royal Australian and New Zealand College of Radiologists (RANZCR) notes that contrast dye is regularly used in more than 50% of CT imaging and also in other imaging modalities such as fluoroscopy, as well as in interventional radiology.

But shortages have developed 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 are 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 said 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 select oncology staging examinations.

“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.

“RANZCR endorses the recommendations of the America College of Radiologists (ACR) Committee on Drugs and Contrast Media that radiology practices and hospitals implement a range of strategies to conserve current supplies of contrast to manage patient care,” it added.

These strategies include using alternative studies to answer the clinical question such as non-contrast CT, MRI with or without gadolinium-based contrast media, ultrasound with or without ultrasound contrast agents, nuclear medicine, or PET/CT, when feasible.

The shortage has become a global issue with overseas groups such as the Radiological Society of North America warning that US hospitals dependent on ICM are postponing treatment-monitoring imaging for cancer patients as they attempt to preserve the contrast material for the most urgent cases.

“I can’t overstate the importance of iodinated contrast for really critical diagnostic tests,” said Professor Geoffrey Rubin, chair of radiology at University of Arizona, Tucson.

“This isn’t an ancillary tool. This is something that’s used many, many times every day for both lifesaving decisions in the setting of trauma and for managing cancer patients and determining the appropriate care for them,” he said.

Professor Rubin said use of iodinated contrast media should be prioritised based on clinical need, and  contrast media conservation boosted with anti-wastage protocols and good communication between radiology departments and with referring physicians.

“This is a moment in time to work together and think creatively to help support care for patients who may not have access to the contrast material,” he said. “Radiologists are resourceful people and we will make our way through this without having to compromise patient care.”

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
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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