Shortage of contrast dye affects patients in Alberta

EDMONTON – More than 7,000 Albertans have had their imaging procedures delayed due to a global shortage of contrast dye, and there are growing concerns about the impact on patients as supply issues drag on. The dye is used in roughly half of the CT scans performed in Alberta, and it helps make blood vessels and organs more visible.

The shortage was sparked when one of Canada’s main suppliers of the contrast material – GE Healthcare – had to shutter its production plant in Shanghai due to COVID-19 lockdowns. While the plant has since re-opened, supply problems continue. According to Alberta Health Services approximately 7,200 patients have had their imaging procedures postponed over the last six weeks, and the shortage is expected to continue for several months with 1,200 patients being impacted weekly.

“It’s just another delay on top of all the other delays in the system,” said Dr. Tony Gomes (pictured), section president for general surgery with the Alberta Medical Association.

According to Gomes, elective CT scans are being postponed by at least two months.

While many people can wait there are concerns some seemingly less urgent patients may suffer. “The problem is that there’s a small percentage of patients who are having routine investigations, routine CAT scans, and a small percentage of those patients are going to actually have a bad diagnosis,” he said. “Things may be found that we look at and wish we’d found before.”

The dye shortage is impacting care in emergency rooms now too, Gomes said. Doctors are trying to conserve the contrast dye for the sickest patients by doing scans without it or resorting to other tests altogether when they can. “There is certainly concern that we’re doing lower quality [CT scans] rather than higher quality ones, and there’s some concerns that we’re using alternative tests like ultrasounds … when actually that might be less than optimal,” Gomes said. “We see patients in the emergency department where we have to decide if an ultrasound is good enough for a diagnosis of something in their abdomen. So, sometimes we may be operating with less information than we actually would like to have about the patient’s condition.”

That includes problems such as appendicitis, according to Gomes, and could complicate care or even lead to unnecessary surgery.

Alberta Health Services said the most urgent patients are not having their imaging procedures delayed. “We continue our mitigation strategies while ensuring that we image our urgent and emergent patients,” spokesperson Kerry Williamson said in a statement emailed to CBC News. “AHS will do everything possible to ensure all deferred patients are imaged in a timely manner when our supply is stabilized.”

Gomes, who is based in Lethbridge, is particularly concerned about cancer patients who he worries could eventually face delays for diagnostic scans.

“If it progresses to the point where we see real delays with cancer staging then we’re going to see patients potentially having poorer outcomes with their surgery because the surgery will be delayed as we’re waiting for the CAT scans to get done before being able to operate on them.”

Calgary-based family physician Dr. Christine Luelo hasn’t yet had patients postponed due to the contrast dye shortage, but she said it highlights the need to think critically about what procedures are needed.

“I’ve been really thinking about when I’m ordering a test, ‘Is this going to need contrast. Do I need this test? Is there another test I can do instead?’ And I think that’s the lesson coming out of the pandemic as well. Are we doing these things because we can or because we really need the test?” she said.

It’s not a new idea, Luelo added, noting there is an ongoing nation-wide campaign aimed at raising awareness about reducing unnecessary testing. Any kind of postponement, though, can be very difficult for patients, she said.

“Anytime something’s delayed it’s significant. And for each one patient it’s significant for them. There’s a lot of anxiety around, ‘What’s that test going to show? How’s that going to change the trajectory of my disease?’”

AHS said it had been increasing its imaging capacity in the months prior to start of the shortage, and it is now filling those spots with patients who don’t need contrast dye. It’s currently sending 15 per cent fewer patients for CT scans on average during a two-week period than it did last year, and two per cent less than in 2018-2019.

The contrast dye shortage is expected to last several more months.