There is currently a global shortage of iodinated contrast media that is likely to last several months. The below recommendations address how we can conserve iodinated contrast media in order to be able to allocate the limited supply to those patients who need it most.
Effective immediately, the SGO Clinical Practice Committee recommends* the following:
- Minimize ordering of non-essential contrast-enhanced computerized tomography (CT) scans. If the results of a scan will not change your management, it should not be ordered.
- Increase the interval between scans when clinically acceptable to do so. Where National Comprehensive Cancer Network (NCCN) surveillance guidelines state a range for surveillance, default to the longer end of that range (e.g., if surveillance is recommended every 6 to 12 months, default to every 12).
- For assessment of peritoneal disease, order oral non-iodine contrast alone (without IV contrast) and counsel patients on the rationale for such orders to facilitate the use of oral contrast.
Do not use IV contrast for a routine CT chest. - In the absence of known pleural effusions ventilation/perfusion (V/Q) scans in lieu of CT pulmonary angiogram can diagnose pulmonary embolism.
- Clinical Trials: For patients on clinical trials, it is preferable to continue with the same modality scan at the pre-prescribed time point to permit assessment of response and maintain the integrity of the trial. Check with study sponsors to confirm the preferred alternative to CT with IV contrast.
- For non-clinical trial patients, whenever possible, and if clinically appropriate, use MRI and nuclear medicine alternatives to CT. Be aware, however, that availability of these alternative modalities will also then be impacted by the increased demand created by a shift from CT scanning. Switching to an alternative modality may make assessment of treatment response more challenging.
We hope that this guidance will help SGO members determine the most efficient use of iodinated contrast media while experiencing supply shortages. For questions or further guidance, please email sgo@sgo.org.
*These recommendations are not meant to be a substitute for clinical judgement at the individual patient level, nor should they supersede other policies at the institutional level. All decisions should be made in the context of the unique circumstances where members practice, including other local resource considerations. We encourage members to work closely with their institutions to ensure that patients’ needs are being met.