Inadequate Supply of ICM in 2022: Was it a Harbinger? Were the Lessons Learned?

In the tumultuous year of 2022, a global supply chain disruption for iodinated contrast media (ICM) shook the medical world. This essential component, accounting for 65% of global contrast media use, was particularly affected by COVID-19 lockdowns, leading to a nationwide shortage in the United States.

Between March and June, hospitals' existing inventories depleted, leaving a significant gap in the supply of ICM. The U.S., which performs 48% of its CT scans requiring iodinated contrast each year, was hit hard by this shortage.

However, this crisis served as a wake-up call for hospitals to take proactive measures. One such example is GE HealthCare (GEHC), which added a $30 million production line at its Cork, Ireland, facility, signed a multiyear agreement in Chile for raw iodine, announced an $80 million expansion to its Lindesnes, Norway, facility, and invested a further $138 million in the Cork facility after the crisis.

The disruption was particularly affecting GE HealthCare's Shanghai facility, which supplies 80% of GEHC's iodinated contrast and more than half of all iodinated contrast supplied to the U.S. Other key global iodinated contrast manufacturers include Bracco, Bayer Healthcare, and Guerbet.

To navigate this challenging period, hospitals implemented several strategies. Establishing clear protocols to communicate the status of contrast availability became crucial, including tracking ICM use across departments and facilities and conducting daily "huddles" and weekly briefings.

Managing ICM use and decreasing the imaging exams that require it can result in reduced patients' radiation exposure and contrast dose reactions, and improved department workflows. Reduction of contrast volume while maintaining diagnostic quality can be achieved through the use of lower kVp, dual energy CT, and photon-counting CT.

Some hospitals reported a reduction of emergency department contrast-enhanced CT exams of 85% during the crisis. Maximizing utilization of available contrast and reducing waste can be done by managing multidose ICM vials and automated injectors.

The shortage was also caused by a depletion of available workforce due to COVID quarantines and illness, global shipping delays, and an inability of other manufacturers to quickly increase production of ICMs.

New Zealand, which manages procurement of essential medicines for the entire country, was less affected by ICM shortages, requiring its hospitals to hold at least a two-month supply of critical drugs.

Looking ahead, it's essential to assess the long-term effects of the 2022 ICM shortage. This includes missed diagnoses from delayed imaging, workflow, and resources impacted by the crisis, any higher costs for using alternative imaging modalities, and the role of AI in a situation like this one.

The global contrast media market was $7.2 billion in 2024 and is expected to increase to $12.9 billion in 2034. The lessons learned from the 2022 crisis will undoubtedly shape the future of ICM management, ensuring a more resilient and efficient healthcare system.