Patient preference is another factor that makes a switch to MRIs problematic. “For the MRI, patients are placed in a tight tube, and some can get claustrophobic, especially when the scan is focused around the head and neck region,” he added. “If it’s your arm or your knee, that’s one thing. But if it’s your head, some patients just won’t tolerate the loud banging of the MRI.”
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September 2022
Many hospitals in our area had a very difficult time getting access to CT scans because of the contrast shortage. They ended up sending a lot of their patients to us, and we would do the scans. —Marlan Hansen, MD
Making the best decisions on imaging during a contrast media shortage also depends on the type of tumors and surgical procedures involved. “We do a lot of surgery for benign tumors such as vestibular schwannomas, meningiomas, and glomus tumors,” Dr. Hansen said. “They can be locally aggressive, but they’re pretty slow growing and aren’t going to metastasize. Delaying a procedure for your preferred imaging modality is an option—even up to several months is workable.
“That’s certainly not the case for my colleagues in head and neck surgery who are dealing with malignancies,” he stressed. “They require interventions withing a few weeks of diagnosis, because soon something that was resectable may no longer be resectable, or a mass that’s early stage may rapidly progress to an advanced stage.”
In such cases, “time is of the essence, and contrast media shortages can really become difficult and more fraught to navigate,” he said.
When MRIs May Be Preferred
One such colleague, Nadia G. Mohyuddin, MD, an associate professor of clinical otolaryngology at the Houston Methodist Research Institute in Texas, agreed that timely access to scans is critical for head and neck cancer patients, who represent a large portion of her patient base. Fortunately, she noted, her practice was not affected by the iodinated contrast shortage.
“When we ordered them, we would sometimes get notices in our EMR [electronic medical record] saying that the contrast is in short supply,” she said. “But I never had a scenario where they eventually denied my request for an iodinated scan.”
Even if CT scans become scarce, Dr. Mohyuddin voiced fewer concerns than Dr. Hansen over the prospect of switching to MRIs. In fact, she noted that MRI is her preferred agent for certain types of pathology. “When I’m dealing with nasopharyngeal carcinomas, sinonasal malignancies, or tumors of the sinuses that have the potential to spread into the intracranial location, and also salivary gland tumors, MRI is my preferred imaging modality,” she said.