How Much Did the Recent Contrast Shortages Affect Otolaryngologists?

Dr. Mohyuddin does, however, share Dr. Hansen’s view that CT scans do have an edge in imaging certain bony tissues. In such cases, “CT scans may be a bit better at delineating frank cortical bone involvement or erosion,” she said. “But an MRI is helpful as well in this setting— for example, when we look at bone marrow enhancement. An MRI can complement and be synergistic with a CT scan, and in some cases may be superior to a CT scan for a particular type of disease pathology.”

There’s also the option of ordering a CT scan without contrast for certain procedures, which will still yield useful information on bony tissue involvement to guide surgery, Dr. Mohyuddin noted. “If, for example, you are concerned about blood supply or arterial circulation, where there may be vessels feeding a tumor, you could probably still identify that information with an MRI,” she said. “I think one can work around the restrictions of not having contrast when you’re looking at particular types of tissue interfaces.”

Are there instances where a CT scan backlog could negatively impact practice? “In isolated cases, perhaps,” Dr. Mohyuddin said. CT angiograms, she explained, require a significant amount of iodinated contrast media and are useful for visualizing arterial and venous circulation in head and neck tumors. “If you had to do a preoperative CT scan with an angiography, the contrast iodinated contrast is going to be more heavily utilized,” she said. “That could be a restriction in terms of obtaining an appropriate analysis of your patient.”

Ultrasound imaging is another alternative to CT scans that is of great value for identifying various head and neck masses, Dr. Mohyuddin said. “It has very little morbidity, is readily available, and is quite capable of visualizing lymph nodes and thyroid nodules, among other structures,” she stressed. “And, depending on your ultrasonographer and your radiologist, the ability to read ultrasounds should be more widely available than for other imaging modalities. If you’re in a bind due to contrast shortages, or you’re in an environment where you have limited resources, don’t leave ultrasound on the sidelines.”

Contrast Shortages and Otolaryngology Practices

Douglas D. Reh, MD, the director of clinical research at the Centers for Advanced ENT Care, LLC, with locations in Baltimore and Hunt Valley, Md., is another example of a practitioner who was able to successfully navigate the iodinated scan shortage. He also sees value in being ready for the next shortfall.