“We were very fortunate in never having any patient for whom we could not obtain a CT scan,” Dr. Reh told ENTtoday. “As per self-referral laws pertaining to private medical practices in Maryland, we cannot own scanning equipment. So, we farm out our scans to different radiology companies, and they were able to meet the needs of our practitioners and patients.”
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September 2022Dr. Reh echoed the fact that, given the unpredictable nature of healthcare supply chain logistics, future shortages of iodinated contrast agents for CT scans may well occur. If that were to happen, questions of whether to delay procedures could come up.
“Fortunately, a lot of the CT scans we order are for noncritical procedures,” he said. “But if we had a patient who required an urgent CT scan, I’m very confident that, in most cases, we could switch to MRI and get enough diagnostic information to proceed.”
The other option would be to first order a noncontrast CT scan, review the information obtained regarding bony windows and other key structures, and then order an MRI with gadolinium. “This basically gives you all of the information you need for the case,” Dr. Reh said.
As for some practitioners’ preference for CT scans in skull base surgery, this has not been Dr. Reh’s experience. “When I was at Johns Hopkins, where we did lot of those types of surgeries,” he said, “I found that MRIs actually excel at showing soft tissue windows and demonstrate to a much better degree than CT scans the location of the tumor and its extent of invasion. It’s pretty much the gold standard for figuring out where the tumor’s going, and I think most skullbased surgeons feel that way.
“Having said that, however, like most people, surgeons are creatures of habit, and they like what they like when it comes to diagnostic and surgical tools,” he added. “I can see how shortages could be a negative in terms of choice and comfort.”
David Bronstein is a freelance medical writer based in New Jersey.
Beyond Contrast Shortages
The iodinated contrast media shortage isn’t the first time the supply chain for head and neck surgery procedures has broken down. Other medication and device shortages can cause headaches in otolaryngology offices.
For Marlan Hansen, MD, chair and professor of otolaryngology at University of Iowa Healthcare in Iowa City, all of these shortages underscore just how fragile the healthcare supply chain has been, particularly during the COVID-19 pandemic, when he saw first-hand the disruption caused by shortages of personal protective equipment and other key items. He also cited past shortages of external processors and batteries needed for optimal cochlear implant function.