The shortage underscores the importance of sourcing contrast from different vendors, something that can shield institutions from any interruptions in the supply chain. “This is where working with the pharmacy and other teams is really going to be imperative.” “With guidance from the institutional pharmacy, there are ways we can safely take single-use products and make them multiuse, but it has to be done in the appropriate environment and with the appropriate equipment,” said Andy Bierhals, MD, MPH, vice chair, Quality and Safety at Washington University’s Mallinckrodt Institute of Radiology, St. Another option involves repackaging higher volume single-use vials in smaller aliquots. This is something that’s used many, many times every day for both lifesaving decisions in the setting of trauma and for managing cancer patients and determining the appropriate care for them.”ĭuring the shortage, institutions may consider using alternative studies like non-contrast CT, MRI or ultrasound to answer the clinical question. “I can’t overstate the importance of iodinated contrast for really critical diagnostic tests,” said Geoffrey Rubin, MD, professor and chair of radiology at University of Arizona, Tucson. Across the U.S., hospitals dependent on ICM are postponing treatment-monitoring imaging for cancer patients as they attempt to preserve the contrast material for the most urgent cases. While radiology has faced prior shortages linked to COVID-19, such as low supplies of saline solution and pre-filled contrast cartridges, the ICM shortage is likely to be far more consequential. The factory has since been reopened, but GE expects an 80% reduction in supplies through the end of June. In an April 19 letter to consumers, GE Healthcare announced it would be limiting orders of Omnipaque™. The shortage of iohexol iodinated contrast media (ICM) traces its origins to the recent COVID-19-related shutdown of a factory in Shanghai. ©RSNA, 2020.Close coordination between radiologists and other specialists is crucial to ensuring optimal patient care through the global shortage of iodinated contrast media, according to radiology leaders. Proper use of phase-contrast imaging requires an understanding of the many practical and technical factors and unique physics principles underlying the technique. Phase-contrast imaging is an important tool in the arsenal of MRI examinations and has many applications. This imaging modality is most commonly used in the liver for evaluation of cirrhosis and steatosis, although research on the assessment of other organs is being performed. Shear waves created by using an impulse device can be velocity encoded, and this velocity is directly proportional to the stiffness of the organ, or the shear modulus. A more recently identified application is in MR elastography. Three-dimensional imaging can yield highly detailed flow data in a technique referred to as four-dimensional flow. At vascular analysis, phase-contrast imaging can be used to visualize arterial and venous flow, and this application is used most commonly in the brain. This measurement can aid in the diagnosis and direct management of normal pressure hydrocephalus or be used to evaluate the severity of stenosis, such as that in Chiari I malformations. In neurologic imaging, phase-contrast imaging can be used to measure the flow of cerebrospinal fluid. One of the most common clinical uses is in cardiac valvular flow imaging, at which the data are used to assess the severity of valvular disease and quantify the shunt fraction. Multiple applications of phase-contrast imaging are actively used in clinical practice. The acquisition of diagnostic-quality images requires selection of the correct imaging plane to ensure accurate measurement and selection of the encoding velocity and thus prevent aliasing and achieve the highest signal-to-noise ratio. With use of bipolar gradients, degrees of phase shift are encoded and in turn correlated directly with the velocity of protons. This imaging modality relies on phase data, which are intrinsic to all MRI signals. With phase-contrast imaging, the MRI signal is used to visualize and quantify velocity.
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