How Much Did the Recent Contrast Shortages Affect Otolaryngologists?

Severe shortages of iodinated contrast media used in computed tomography (CT), which peaked this spring due to a COVID-19-related shutdown of a GE Healthcare plant in Shanghai, China, have resolved based on the company’s recent announcement that the facility has returned to full production.

Although several practitioners contacted by ENTtoday said they were fortunate in having steered clear of the shortages, even during their peak, they stressed that, given the unpredictable nature of the healthcare supply chain, it’s critically important to consider ways to effectively navigate future contrast shortfalls.

That unpredictability was underscored in a July 15, 2022, press release from GE Healthcare. Despite continuing to operate at full capacity, “we expect some ongoing reduced availability … as we continue to restabilize global supply,” the company noted. “We continue to keep our customers informed so they can plan accordingly.”

Clinical Community Effects

Marlan Hansen, MD, chair and professor of otolaryngology at University of Iowa Healthcare in Iowa City, said his center did not experience any shortages of contrasted CT scans. “It wasn’t just me personally; I queried our other head and neck surgeons, and none of them reported significant problems,” said Dr. Hansen. “We were very fortunate.”

The larger clinical community, however, was not unaffected. “Many hospitals in our area had a very difficult time getting access to CT scans because of the contrast shortage,” he noted. “They ended up sending a lot of their patients to us, and we would do the scans.”

Still, given the unsettled nature of the iodinated contrast supply chain, otolaryngologists should be considering when it may be appropriate to switch to alternative scanning modalities, Dr. Hansen said. Although he acknowledged that gadolinium-based contrast agents, which are used for magnetic resonance imaging (MRI), are most often cited in this context, he noted that there are several caveats.

“Could I use an MRI instead? Sure, in selected cases,” he said. “But for many of the skull base surgeries I perform, I need CTs to visualize the bony structures involved. If I’m trying to really nail down the type and extent of bony destruction present, such as mandible erosion, I wouldn’t want to be in a position of relying exclusively on MRI for that.”

MRI also faces some logistical hurdles. First and foremost, they take much longer to perform—between 20 and 90 minutes, versus about 15 minutes for a CT scan, Dr. Hansen noted. “If you have to funnel all of your contrasted scans onto an MR scanner, there’s going to be a logjam and you won’t be able to get all the necessary studies done.”