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Shortage of contrast dye forces hospitals to ration CT scans and other procedures

Hospitals across the United States are being forced to ration medical tests and procedures after a lockdown in Shanghai hit a factory that produces a widely used contrast dye.

The dye, made by General Electric, is used for a variety of purposes, many of which save lives. Typically injected into patients’ veins, it provides higher contrast than imaging procedures such as dye-free CT scans. The increased contrast helps doctors more easily diagnose a brain bleed or clot, see how a heart or other organ is working, or determine if a tumor is growing or shrinking, among other things.

Due to the shortage, hospital systems from New York to California told NBC News they have begun to defer elective medical procedures and use alternative imaging and diagnostic tools that do not require dye. if applicable.

“It’s very difficult to know what damage is going to result from this, whether it’s from delayed diagnosis or misdiagnosis,” said Dr. Matthew Davenport, vice chairman of the quality and safety from the American College of Radiology. “And I’m sure there will be delayed diagnoses or misdiagnoses because we’re using imaging techniques that are not optimized, not perfect.”

He added that approximately 50 million scans with contrast are performed each year in the United States.

“Unfortunately, we don’t have the ability to give everyone contrast like we used to, so some will be the best of the wrong option: would I rather not have imaging, or a technique of imaging that isn’t optimal?” he said.

GE’s Shanghai plant is a major supplier of colorants to US healthcare systems. About 50% of U.S. hospitals and imaging centers likely use GE’s product, according to Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, though she added that the exact share is difficult to pin down.

“Most hospitals, for a product like this, would keep maybe a few weeks supply on hand,” Foster said. “But this shortage has been going on for a few weeks now.”

The shortage is the result of a strict lockdown imposed in Shanghai on March 27 as part of China’s “zero-Covid” strategy. This resulted in the closure of the GE plant for several weeks, although a spokesperson for GE Healthcare said in a statement that the plant had begun to reopen and “is working to return to full capacity as the local authorities permit it.

The spokesperson added that GE is accelerating deliveries by shipping by air, rather than sea, from its Shanghai plant as well as from a plant in Cork, Ireland, to address supply issues in the United States.

But even so, health systems do not anticipate immediate relief. The shortage could last into the summer, forcing healthcare providers to postpone lower-priority imaging as they ration inventory.

“Some are still weeks away,” Davenport said, referring to remaining stocks of dye. “But others are in big trouble and have days or a week left.”

In San Diego, Scripps Health said in a statement that it is limiting imaging procedures requiring contrast “to urgent and clinically necessary investigations.” For elective procedures, he added, alternatives such as ultrasounds and MRIs – which use a different contrast dye – are being considered. Some procedures are postponed for up to eight weeks if it is safe to do so.

Similarly, Northwell Health, New York’s largest supplier, said it is trying to maximize its current supply by “using non-contrast CT, ultrasound and MRI studies when clinically appropriate.”

Orlando Health, meanwhile, said it has established an “interdisciplinary team to evaluate our use of intravenous contrast and carefully manage our supply,” while ensuring the dye will be available for emergencies and other essential needs.

The actions of the three health systems are in line with recommendations from the American College of Radiology, which advised that during the shortage, hospitals postpone exams if they are not immediately medically necessary, perform non-contrast exams if possible or reduce the amount of dye. used per patient.

Davenport praised medical professionals who worked to conserve supplies of contrast dyes, but said he was still worried about the consequences. Opting for another type of scan without contrast could result in a 10 to 20 percent reduction in diagnostic accuracy, he said.

However, other dye sources are limited. Foster said members of the American Hospital Association have contacted the other major U.S. supplier, Bracco Imaging SpA of Italy, but haven’t had a chance to shop recently. Bracco did not immediately respond to a request from NBC News.

Contrast dye isn’t the first medically necessary item to run out during the pandemic. Personal protective equipment, ventilators and oxygen have all hit critical lows at times.

“There are a lot of conversations going on nationally about how to appropriately diversify much-needed sources of supply so that a weather event, a political event, whatever else happens doesn’t wipe out your ability to access that supply?” Foster said. “We need a gathering of all manufacturers, suppliers, federal agencies to think about: how do we create this more resilient supply chain?”

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