Shortage of iodinated contrast agent: Updated guidance for CT scans

The global supply chain shortage of iodinated contrast continues, with substantial impact felt across multiple health care systems across the country. With efforts across VUMC, iodinated contrast agent usage at VUMC has decreased by 50 percent. Additionally, the VUMC pharmacy team recently procured a shipment of iodinated contrast.

While this shipment provides some immediate relief, conservation measures must continue, as the situation remains fluid and changes day-to-day.  Again, supplies of iodinated contrast are not expected to be fully restored until August 2022.

Clinicians should continue to:

1. Order an alternative imaging exam, if appropriate, such as non-contrasted CT, ultrasound, or MRI. Review the ACR guidelinesto evaluate suitable alternate options.
2. Continue to reduce contrast dosing levels to the lowest threshold that maintains appropriate diagnostic quality.
3. Reschedule non-emergent and non-urgent examinations (Tiers III, IV & V in the Contrast Tiers List)

Starting immediately, Outpatient contrasted CT imaging for Tiers I and II will resume. These tiers are reserved for Emergent and Urgent clinical indications, respectively.  Clinicians should review the Tier Chart for appropriate prioritization of clinical indications.

The process for having a new Tier I or Tier II contrasted CT approved is as follows:

1. Place the order as usual in Epic.
2. Within the order composer, click on the link to the RedCap surveyand provide the required information.
3. The completed RedCap surveywill trigger consultation by an attending Radiologist to confirm the appropriateness of the contrasted examination. You will receive a reply message or restricted-class email noting confirmation of order placement or recommendations for alternative steps.
4. If you need to speak immediately to an attending Radiologist or need the exam performed on the same day, please page 615.831.4220 (7 am – 7 pm) or call 615.343-7185 (7pm – 7 am).

Clinicians who previously placed an order for an outpatient contrasted CT that they believe meets the criteria for Tier II, should contact the attending Radiologist (as outlined in step 4 above) to have the order reviewed with the new criteria.

Please note, that while we are currently moving into Tier II for outpatient contrasted CTs, it will likely prove necessary periodically to adjust approved tiers depending on supply chain and other factors.

Additional information will be provided as the situation develops. The patience and understanding of VUMC employees are appreciated as we work through these unusual circumstances and ensure we continue to deliver excellent care to our patients.