Disinfection byproducts of iopamidol, iohexol, diatrizoate and their distinct acute toxicity on Scenedesmus sp., Daphnia magna and Danio rerio.

The COVID-19 pandemic resulted in increasing the usage of iodinated contrast media (ICM), and thus an increase in the prevalence of ICM-contaminated wastewater. While ICM is generally safe, this has the potential to be problematic because as medical wastewater is treated and disinfected, various ICM-derived disinfection byproducts (DBPs) may be generated and released into the environment. However, little information was available about whether ICM-derived DBPs are toxic to aquatic organisms. In this study, the degradation of three typical ICM (iopamidol, iohexol, diatrizoate) at initial concentration of 10 µM and 100 µM in chlorination and peracetic acid without or with NH4+ was investigated, and the potential acute toxicity of treated disinfected water containing potential ICM-derived DBPs on Daphnia magna, Scenedesmus sp. and Danio rerio was tested. The degradation results suggested that only iopamidol was significantly degraded (level of degradation >98%) by chlorination, and the degradation rate of iohexol and diatrizoate were significantly increased in chlorination with NH4+. All three ICM were not degraded in peracetic acid. The toxicity analysis results indicate that only the disinfected water of iopamidol and iohexol by chlorination with NH4+ were toxic to at least one aquatic organism. These results highlighted that the potential ecological risk of ICM-contained medical wastewater by chlorination with NH4+ should not be neglected, and peracetic acid may be an environment-friendly alternative for the disinfection of wastewater containing ICM.

International Iohexol Shortage: Alternative Contrast Agents and Imaging Procedures for the Urologist.

INTRODUCTION: In April 2022, GE Healthcare announced a COVID-19-related interruption in iohexol manufacturing, leading to an international iodinated contrast shortage. The shortage greatly impacted urological practice, highlighting the value of alternative contrast agents and imaging/procedure alternatives. These alternatives are reviewed in this work. METHODS: A review of existing literature describing the use of alternative contrast agents, alternative imaging procedures, and contrast conservation strategies in urological care was performed using the PubMed database. The review was not performed systematically. RESULTS: Older iodinated contrast agents such as ioxaglate and diatrizoate can replace iohexol for intravascular imaging in patients without renal impairment. These agents, along with gadolinium-based agents such as Gadavist, have been used intraluminally for urological procedures and diagnostic imaging. Several lesser-known imaging and procedure alternatives are described and include air contrast pyelography, contrast-enhanced ultrasound, voiding urosonography, and low tube voltage CT urography. Conservation strategies include contrast dose reductions and use of contrast management devices for contrast vial splitting. CONCLUSIONS: The COVID-19-related iohexol shortage caused significant hardship for urological care internationally, leading to delayed contrasted imaging studies and urological procedures. Alternative contrast agents, imaging/procedure alternatives, and conservation strategies are reviewed in this work with the goal of equipping the urologist to mitigate the current iodinated contrast shortage and to prepare in the event of a future shortage.

Navigating Supply Chain Disruptions of Iodinated Contrast Agent for Neuroimaging and How Business Intelligence Can Help the Decision Process.

A recent coronavirus disease 2019-related shutdown of the main production facility of iohexol in China has led to massive shortages of iodinated contrast material across the globe. This shortage has also jeopardized neuroimaging. In this article, we describe remedies to reduce iodinated contrast material use for stroke imaging, which is its primary use in neuroimaging, that we have implemented in our hospital network.

Short-, Mid-, and Long-term Strategies to Manage the Shortage of Iohexol.

The recent iohexol shortage has precipitated disruptions in a pharmaceutical supply chain critical to radiologic imaging and has impacted global availability of iodinated contrast media (ICM). The shortage has created a national crisis in radiology departments, curtailing their ability to provide health care to patients who need contrast-enhanced examinations. Radiology departments are familiar with crisis management after more than 2 years of clinical and operational disruptions associated with the COVID-19 pandemic. The iohexol and subsequent ICM shortage has short-term (weeks), midterm (months), and long-term (years) implications. The purpose of this report is to provide strategies for dealing with the shortage in the near term and to discuss long-term issues and potential solutions to supply chain problems impacting radiology departments.