Federal & State Legislative Advocacy

Earlier this year, a global shortage of iodinated contrast media impacted facilities using Visipaque and Omnipaque, specifically purchased through a single multinational company. The single supplier for many US facilities is in Shanghai, which was affected by COVID lockdowns. The facility operations have resumed, but the supply remains significantly diminished.

ACR's recommendations for rationing existing supplies:

• Utilize alternative studies to answer the clinical question such as non-contrast CT, MR with or without gadolinium-based contrast media, ultrasound with or without ultrasound contrast agents,
  nuclear medicine, or PET/CT, when feasible. Please refer to the ACR Appropriateness Criteria^® guidelines for indicated alternative studies as needed. (Scroll down to AC Portal and use the “Explore by scenario” icon.)
• Look for alternative versions of contrast agents, which may be marketed under a different brand name or intended clinical use. (Note: US market availability may differ from global availability.)
• Source contrast from other vendors, if able, and consider having at least two vendor products on formulary
• If you currently have access to higher volume single-use vials, contact your institutional pharmacy to determine if it is possible to repackage vials in smaller aliquots to reduce waste (institution level).
• Minimize individual doses administered to reduce waste. Some options include:
  • Weight-based dosing for CT in available aliquots/vial sizes to avoid waste
  • Reducing dose in conjunction with low kVp protocols that improve contrast conspicuity
  • Reducing dose and acquire studies with dual-energy protocols (where available) that improve contrast conspicuity
• Reserve higher concentration (mg iodine / ml) agents for angiographic studies and multiphase studies, which require optimal vascular visualization.
• Use alternatives to nonionic contrast for oral, rectal, genitourinary administration (examples: iothalamate meglumine or diatrizoate). Consider barium-based products for oral opacification in CT and PET/CT, as well as alternative iodine-based agents (ionics). (Please refer to the ACR Contrast Manual APPENDIX A: Contrast Media Specifications Table for oral contrast agents).
• Work with other departments, such as Urology, Radiation Oncology, Pain Management, Gastroenterology, Vascular Surgery and Cardiology, which utilize iodinated contrast to prioritize limited supply usage.

ACR continues to encourage stewarship of contrast. The ACR also encouraged FDA assistance with several measures to relieve the shortage. This included temporary approval for Bracco's Iomperol and allowing US facilities to purchase Bayer's foreign labeled contrast media. ACR also worked with RBMA to allow more flexibility in prior authorization from payers.