Contrast shortage in Interventional Radiology: A single center review of changes in practice patterns and radiation quality using alternative contrast protocols

Purpose: In early 2022, there was a global shortage of iodinated contrast medium Iohexol (Omnipaque; GE Healthcare), which is the dominant supplier of iodinated contrast media (ICM) in the United States. The purpose of this study was to assess the protocols initiated in Interventional Radiology (IR) during the extreme contrast shortage and study the effects of the protocols on image quality, radiation doses, and procedure times.

Methods/Materials: Following IRB approval, a retrospective review was performed of all procedures in IR during a 4-week period before and after the contrast shortage protocol. The contrast shortage protocol included reduction of power injections, alternative contrast media agents, and alternative imaging modalities utilized. Images from the procedure were deidentified on Picture Archiving and Communication Systems (PACS) and blind reviewed by 3 board certified Interventional Radiologists for diagnostic quality (1-5 years experience). Variables such as contrast amount used, procedure time, fluoroscopic time, and radiation dose were compared.

Results: A total of 398 procedures were performed during the study period; 196 pre-contrast shortage and 202 post-contrast shortage protocol. 5 procedures (2.5%) were performed with non-ICM in the pre-contrast shortage protocol period compared to 53 (26%) after implementation. The average ICM volume used was reduced from 39.6 mL to 29.6 mL after implementing the new protocol (p= 0.01). Feeding tube and nephrostomy tube exchanges contributed the most to ICM reduction (minus 12.6 and 8.6 mL respectively). For all fluoroscopic procedures, the average radiation dose was significantly decreased (208.55 vs 127.37 mGy, p = 0.04). For visceral angiograms, no change was noted for the ICM amount (p=0.08); however, radiation dose (p = 0.02), fluoroscopic time (p = 0.03), and procedure time (p = 0.04) were significantly reduced. During the blind imaging review, there was a 9% increase in nondiagnostic images produced during the contrast shortage protocol period (13.3% pre protocol, 22% post protocol implementation).

Conclusions: Implementation of contrast shortage protocols can significantly reduce the use of iodinated contrast media, and decreases radiation dose.