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Current and Emerging Perspectives on Contrast Media in Radiology


In a recent video interview series, Dushyant Sahani, M.D., discussed the critical role of contrast media in diagnostic imaging, lessons learned from the contrast media shortage, key considerations with generic agents and currently unmet needs with contrast agents.

“Contrast media is so integral to the value (that) imaging technique adds,” noted Dushyant Sahani, M.D., in a recent video interview series with Joseph Cavallo, M.D., M.B.A.

For computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography computed tomography (PET/CT), Dr. Sahani said contrast media is utilized in the majority of these exams for cardiovascular imaging and oncology imaging in emergency departments.

“I would say that 70 to 80 percent of these exams would not be as effective if we did not use these good contrast media that we have available in the arsenal,” noted Dr. Sahani, a professor and chair of radiology at the University of Washington.

Dr. Sahani added that contrast agents are critical in advanced imaging. Without the use of the fluorodeoxyglucose (FDG) tracer in PET/CT imaging, Dr. Sahani said there is no capability for hybrid or physiologic imaging.

Pointing out a “much younger” global workforce in radiology, Dr. Sahani noted that contrast media helps level the playing field of experience in providing diagnostic support to referring providers and facilitating optimal outcomes for patients.

“Contrast media lends that clarity on those images. If you take contrast media out of a lot of these techniques, (you) will see tremendous variability in how care is delivered (and) challenges with diagnosis and misdiagnosis,” emphasized Dr. Sahani. “(You will also see that) the reliance on imaging techniques will drop substantially.

The recent contrast media shortage also illustrated the dependence that radiologists and health care in general have on contrast media to facilitate timely diagnosis and treatment decisions for patients. While Dr. Sahani recalled the use of imaging bulk packs to reduce contrast media waste and increased utilization of multi-energy and spectral CT to reduce contrast dosing, continued monitoring and diversification of contrast media were key lessons.

“You need to be proactive in terms of checking your supplies, you need to be diversified where your supplies are coming from, and you need to have a great relationship with your vendors. Those relationships really are on display when you need their assistance,” noted Dr. Sahani.

The diversification of imaging contrast agents has also been increasingly prioritized with the surge of imaging volume in the wake of the COVID-19 pandemic.

“If you look at what COVID (-19) has done to health care practices, there is a bigger emphasis on operation, which is not only efficiency but also cost. All these factors will play a bigger role in decision-making in terms of the choice of contrast media and the contracts and how each practice would like to bring on … generic agents or not,” added Dr. Sahani.

There are still unmet needs with contrast agents. Dr. Sahani suggested that alternatives to iodinated contrast media may enhance the capabilities of advanced imaging techniques.

“On the CT side, we have seen so much progress (with) image acquisition and reconstruction with spectral CT, and now photon- counting CT, but the real value of these techniques is with new contrast agents,” claimed Dr. Sahani. “ … We want different type of agents, different molecules (that) can be discriminated with using advanced CT techniques. Then we can envision the full potential of these advanced techniques.”

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