Effective Friday, May 27
Kettering Health Radiology Phone Numbers
Hamilton: PRI – (513) 867-2496
All other facilities: KNRI – (937) 395-8627
As we continue to monitor the IV contrast for imaging, we have implemented a few steps for preservation of supply as the nationwide shortage is becoming more severe with many healthcare facilities limiting various types of imaging for certain patient populations.
At Kettering Health, just as our fellow institutions, we too feel the need to implement even more tactics to help with supply shortages. We believe this will be lasting through the summer months and likely into early fall.
Kettering Health is monitoring our supplies daily and currently we are at approximately 18-30 days’ supply with inventory slowly coming in on a less than 20% allocation basis.
Because of the newly determined, prolonged duration of this shortage, we are implementing additional restrictions on the use of IV contrast with a goal of maintaining our inventory for the coming months. The changes are outlined below.
Tier 1
Continue to provide CT/procedure with contrast when these clinical conditions are suspected.
- Acute Stroke
- Major trauma
- Ischemic bowel
- R/o pulmonary embolus
- Symptoms consistent with a vascular emergency such as an aortic aneurysm rupture or dissection
- Ischemic Limb
- Acute abdominal pain with peritoneal signs
- Initial staging of a new cancer diagnosis
- Follow-up scan for previous imaging findings suspicious for a new cancer diagnosis or other urgent/emergent condition
- Treatment planning for urgent/emergent surgery or procedure
Tier 2-5
- In most cases, we will proceed with performing the CT without contrast. In most clinical scenarios, completing a CT scan without contrast is a better clinical option than postponing the scan altogether for 3 months or longer.
- In selected cases, the Protocoling provider may recommend an alternate imaging test in lieu of a CT scan with IV contrast.
- In a minority of cases, we may still ask Ordering providers to consider deferring the CT scan with IV contrast until a later time.
Tier 6
Postpone unless otherwise indicated
For the purposes of this memo, these definitions are used:
- “Ordering provider” – the physician or advanced practice provider who orders an imaging test
- “Protocoling provider” – the imaging or procedural physician who determines the “protocol” for the imaging test including whether contrast is used or not
Process for Review of CT Scans with IV Contrast:
- The ordering provider must include enough detail/information in the imaging order for the protocoling provider to determine the priority tier level for the CT scan. The ordering provider will be required to include the tier level from the list below directly in the order.
- Taking into account the information from the ordering provider, the protocoling provider will determine the tier level for the scan and then:
- If Tier 1 -* proceed with CT scan with IV contrast.
- If Tier 2-5 -* proceed with a CT scan without contrast, recommend a different imaging modality or recommend deferral of the scan.
- If Tier 6 – postpone unless otherwise indicated
- If the scan is changed to a “without contrast” protocol, a statement will be included in the imaging report noting this change to the order due to the IV contrast shortage.
- If a different modality or deferral of the scan are recommended, Radiology/Procedural staff will communicate directly with the Ordering provider team via phone or electronic message.
- This review process will be used for both newly ordered CT scans and for scans that have already been protocoled and scheduled.
Suggested Documentation in Epic
This patient was evaluated during a time of global shortage of iodinated contrast media. Based on guidance from the American College of Radiology, best practices, and local institutional approaches an alternative path for evaluating and managing the patient may have been employed in order to provide optimal care during this shortage. The current situation has been discussed with the patient and the patient consents to the course of treatment.
Guidelines on a case-by-case basis, through consultation with Radiology. If you are attempting to order a CT scan that must include IV contrast, but the clinical scenario does not meet Tier 1 criteria and the scan is not approved for an exception, you may consider scheduling the exam through a non-KH imaging provider if it needs to be completed without delay.
Our team will continue to monitor our incoming supply, our utilization, and our inventory of IV contrast and will communicate any modifications to this process to ordering providers. We may need to continue to modify the Tier criteria or the ordering process further based on the impact of these changes. If you have any questions, please contact:
Hamilton: PRI – (513) 867-2496
All other facilities: KNRI – (937) 395-8627
Flowchart for Tiers 2-6
Mitigation Tactics:
- Tactic #1: Supply chain is working with our current supplier, other vendors, and other healthcare organizations to maximize our incoming supply of contrast.
- Tactic #2: Departments of Radiology have shifted protocols where feasible to limit waste as well as volume of contrast for particular studies
- Tactic#3: Cardiology has switched to manifold injections, elimination of certain Cath lab imaging as well as other techniques to limit the amount of waste and usage of the contrast
- Tactic#4: If an alternate imaging modality can provide meaningful clinical information, the Ordering provider should order the alternate imaging modality.
- For example, a RUQ ultrasound in lieu of an abdominal CT scan.
- When applicable, the Ordering provider should strongly consider documenting in the EMR that an alternate imaging modality was ordered due to the IV contrast shortage.
- The Protocoling provider may also contact the ordering provider to recommend an alternate imaging modality based on the indication for the test and the clinical scenario.
- Tactic #5: If a scan “without contrast” can provide meaningful clinical information, the Ordering provider should order it “without contrast”.
- When applicable, the Ordering provider should strongly consider documenting in the EPIC that a CT scan “without contrast” was ordered due to the IV contrast shortage.
- The Protocoling provider may choose to protocol the exam without contrast based on the indication for the test and the clinical scenario. This change will be documented in the final report for the imaging study.
- Tactic #6: Based on the prioritization criteria outlined below, at this time, we will be performing the majority of Tier 2-6 CT scans with a “non-contrast” protocol.
- This change will be documented in the final report for the imaging study.
- In most cases, we will not be postponing these CT scans with IV contrast to a later date given the longer expected duration of the contrast shortage.
Prioritization Tiers
