We interviewed Alan H. Matsumoto, MD, FSIR, FACR, FAHA, professor of radiology and chair of the department of radiology at the University of Virginia, vice chair of the American College of Radiology (ACR) Board of Chancellors, and the chairman of the ACR Commission on Interventional and Cardiovascular Radiology. He explains the iodine contrast shortage situation and the impact is it having on hospitals making tough decisions to triage patients to determine if they will get a contrast CT scan or an interventional or surgical procedure requiring contrast.
The University of Virginia divided patients into 3 tiered groups. The first for acute patients that need care immediately because their serious condition could be life or limb threatening. The second for intermediate risk patients that need a procedure or imaging for further care, but the doctors feel imaging and procedures can be put off for a couple weeks. The third group was for non-life threatening elective procedures, followup visits and non-essential exams, Matsumoto explained.
He said their health system used this triage system to call back thousands of patients to delay their exams or procedures.
The University of Virginia radiology department then met with their pharmacy and infection control staff to determine how to reused extra, left-over contrast from the exams and procedures that are performed. It was decided it could be used as oral contrast for gastrointestinal exams, since the infection risks were very low. Matsumoto also said they use any left over contrast from multi-use vials after more than four hours from initial puncture for oral contrast for gastrointestinal exams for up to 24 hours. He said it was determined multi-use intravascular contrast containers should otherwise be disposed of after the four-hour limit due to sterility concerns.
"We decided we could use this contrast in what is considered non-sterile procedures, like in the gastrointestinal track , stuff that you might have to drink, so we do not have to use precious iodinated material that came sterile, because technically your mouth and intestines are not sterile," Matsumoto said.
Using multi-dose vials, conserving and using left over contrast and triaging patients and deferring some, he said they were able to reduce their contrast usage by 75%.
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Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com