Optimizing the Use of Iodinated Contrast Media: Conservation Strategies Used Across Canada During the 2022 Shortage

This report summarizes information collected through a survey on the strategies used across Canada to conserve ICM supplies during the shortage, including:multidispensing practices used in medical imaging and pharmacy departments to conserve ICM supplydilution practices in medical imaging departments used to extend ICM supplychanges in ICM volumes used before and after the shortagethe adoption of other ICM conservation strategies (including weight-based dosing or using alternative imaging modalities).The report also explores the survey respondents’ perceived impact of reducing ICM volumes on image quality related to visibility of contrast (contrast conspicuity) and the perceived effect of reducing the ICM dose on patients’ adverse reactions.

A shortage of iodinated contrast media (ICM) used in contrast-enhanced CT exams led to the adoption of necessary conservation strategies across Canada.Conservation strategies included multidispensing from single-use and multiuse ICM bottles, diluting or reducing ICM dose volumes, switching to weight-based dosing from fixed-based dosing, lower tube voltage, performing unenhanced CT scans, using alternative imaging modalities, or prioritizing urgent cases. One of the more common alternative conservation strategies was to prioritize urgent cases for contrast-enhanced CT exams.
Most medical imaging staff who responded to a national survey on ICM conservation strategies reported they would return to their regular doses used before the shortage despite little to no perceived effect on the contrast conspicuity of images or on patient adverse events with reduced ICM volumes.

The ICM shortage represents an opportunity to reconsider ICM usage practices given environmental sustainability concerns with ICM and potential cost savings in reducing its use.