Supplies are tight right now for a high-demand contrast dye used in CT scans at hospitals in Minnesota and across the country. While hospitals aren’t canceling procedures, health care leaders say the shortage is creating some anxious days.
Called Omnipaque or iohexol, the intravenous contrast dye helps doctors better see clots, tumors, blood vessel injuries and inflammation in cases like appendicitis. It’s one of several contrast agents in short supply.
“We use it like water. It’s just, it’s there, we use it all the time,” said Dr. Gopal Punjabi, department chair of radiology at Hennepin Healthcare in Minneapolis. “Our current supply is about four weeks’ worth. I think in about two or three weeks we’ll have to start making some hard decisions if we don’t locate more contrast.”
Those decisions could include reserving IV contrast only for patients with severe trauma, and postponing any elective scans, although Punjabi said the hospital still hopes to avoid that.
“We're doing all the scans that are being ordered. We are not canceling anything. We are not rescheduling anything. We're doing exactly the same scans. We are doing them with contrast,” he said. “But what we are doing is we're reducing the volume of contrast and leveraging technology to make the images look similar to what they would with the usual dose of IV contrast.”
The hospital is also exploring other treatment options for patients, including ultrasounds and MRIs, that would get similar results. It’s also looking into sourcing contrast dye from other hospitals, stockpiling supplies and finding alternative suppliers in the long-term.
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“It's really important for us not to be this vulnerable again,” Punjabi said.
The shortage has also hit local VA hospitals in the region. The VA Midwest Health Care Network said in a statement that it’s “implementing a variety of contingency plans and conservation strategies” including ultrasound and MRI technology.
Allina Health and Mayo Clinic also say they are conserving supplies to help manage the current supply shortage. Nationally, that includes the contrast dye iodixanol, known by the brand name Visipaque.
‘Highest priority for use’
Omnipaque is manufactured at just a few facilities in the world, including one in Shanghai, China. That plant was forced to close for several weeks due to the COVID-19 lockdown there, creating a supply strain across the U.S., including New York and Alabama.
GE Healthcare, which operates the facility, said the Shanghai plant has now reopened, and that it expects to be operating at about 50 percent capacity by the end of this week, with continued improvement over the coming weeks. The company said it’s also expanded production at its manufacturing plant in Cork, Ireland, to mitigate any shortages.
On Monday, the U.S. Food and Drug Administration described Omnipaque as “currently in shortage” but said it expects increasing supplies throughout the next two months, with stocks returning to normal in July. The American Hospital Association said in a statement that its leaders have conveyed their concerns over the dye shortage to the Biden Administration.
“It’s used in imaging centers every day, and it's used multiple times a day for many patients,” said Dr. Mathew So, president-elect of the Minnesota Radiological Society. “It improves our ability to see organs and when some diseases are present, such as infection or cancer.”
“A routine annual follow up for a non-life-threatening condition would probably be OK to do without the contrast, or we could wait a few weeks and perform it later when the supply has improved,” he added. “But if you had a concern for an immediate life-threatening condition, such as the rupture of a major blood vessel like the aorta, we would absolutely have to perform that using contrast. So that would receive the highest priority for use.”
The Minnesota Hospital Association said it's monitoring the situation and has reached out to its members to offer help managing the situation. The dye shortage is “another urgent reminder that we need to build strong and redundant supply chains” for key medical supplies, the group said in a statement.
It’s a concern Punjabi shares. The dye shortage has raised questions about what other widely used medical products are potentially vulnerable to supply shock.
“Just makes you wonder about all the other things in health care that's just taken for granted,” Punjabi said. “What's next? I mean, could it be insulin? Could it be blood pressure medications? Who knows?”