Barium Shortage Affecting Radiology Practices

Low global barium availability prevents suppliers from filling orders; pushes radiologists to consider CT scan alternatives or use barium substitutes.

Since last fall, radiology practices and departments nationwide have grappled with a continued shortage of barium agents used in multiple imaging studies. Recent reports indicate the shortage shows no sign of slowing, and several providers say they’ve had to alter their approach to patient care.

According to Bracco Diagnostics Inc., a leading, worldwide barium supplier, barium is in low availability globally. A September 2012 letter to customers from the company announced a significant number of barium requests are on backorder.

“With the continued efforts of our barium suppliers, we are attempting to make all of the key backordered products available as soon as possible,” Tom Ortiz, Bracco director of North America CT business and worldwide product director of oral imaging, said in the letter. “However, at this time, there are procedures for which we are unable to provide products.”

For example, Bracco has not fulfilled orders for small bowel, esophageal, and other CT studies.
Scripps Health in California is among those facilities struggling to meet patient needs with a limited barium supply, said Jeremy Enfinger, lead radiologic technologist at the Scripps Mercy Chula Vista Hospital.

“We got to the point where we had scheduled patients but not enough barium to complete the studies for the day,” he said. “There were several times that we used a courier to deliver supplies from one of our other hospitals within the organization. But, eventually, they stopped allowing us to do that because they had also run out.”

With the future barium supply level still in question, Enfinger postulated the industry might be pushed into using more water-soluble contrast agents to fulfill patient needs.

Based on conversations with Bracco and other barium suppliers, the American College of Radiology (ACR) Committee of Drugs and Contrast Media announced in a Jan. 15 statement that access to barium products isn’t expected to normalize until later this spring. The situation is similar to the recent technetium-99m shortage, and the committee recommended you respond in a similar way.

“Radiology practices may need to take action to continue to provide excellent care to their patients,” the ACR statement said.

To maximize the amount of barium product you have on-hand, the ACR suggested you substitute alternatives for barium products in certain studies, perform studies that don’t require barium, or refer patients for endoscopy. You could also triage barium examinations, scheduling the less urgent ones at a later date.

The Greater New York Hospital Association has also offered guidance to its members for navigating this shortage. You should first review your facility’s product supply to determine how the shortage will impact operations, and place orders for alternative products, if necessary. Identify studies that can be moved to different services, and create a plan for effectively communicating about this problem with patients and referring physicians.