The shortage, in brief
In April 2022, a COVID-19 lockdown shut down GE Healthcare's manufacturing plant in Shanghai, the source of the majority of the company's iodinated contrast media. GE warned customers to expect an 80% reduction in supply of Omnipaque, one of the most widely used contrast agents in US radiology, for several weeks. Hospitals and imaging centers responded by rationing: prioritizing the most urgent contrast-enhanced studies, substituting non-contrast protocols where clinically defensible, and, in some cases, shifting patients to MRI.
That crisis is now three years in the rearview mirror, but it left behind something valuable: a natural experiment. Researchers could compare the same hospitals, the same patient populations, and largely the same clinical presentations before, during, and after a sudden, involuntary constraint on imaging supply — and measure what changed downstream.
What the newest study measured
A study published in Current Problems in Diagnostic Radiology examined electronic health record data from more than 12,000 CT encounters between August 2021 and February 2023 — a window spanning well before, during, and after the shortage. The researchers split that window into four phases: pre-shortage, wash-in (the onset of rationing), rationing (the peak constraint), and post-shortage recovery, then tracked how length of stay, repeat imaging, and downstream costs moved through each phase.
During the shortage phases, 38% to 55% of initial abdominal/pelvis CT exams were performed without contrast, reflecting institutional rationing protocols. The share of patients needing multiple follow-up scans rose too, with a notable spike during the rationing phase — though after the researchers adjusted for patient characteristics and how patients presented to the emergency department, repeat imaging was actually lower during rationing than in the pre- and post-shortage periods. In other words, the raw increase in repeat scans wasn't purely a rationing effect; some of it reflected who was being imaged and why.
Where the cost actually showed up
The more consequential finding wasn't in the radiology department at all. When repeat imaging did occur, it was associated with longer length of stay for both outpatient and inpatient encounters. Median length of stay was also longer among patients who initially received a noncontrast CT compared with those who received contrast on the first scan — the "save time and contrast now" workaround came with a delay cost later.
Total healthcare spending within two months of the initial imaging encounter was higher during the shortage phases, driven largely by additional imaging and longer stays. Notably, imaging utilization and length-of-stay measures drifted back toward pre-shortage levels once contrast supply recovered — but costs stayed elevated in the short term. The authors concluded that "the clinical and economic effects of contrast-conservation strategies are complex and should be evaluated using both imaging utilization and downstream resource-use measures" — a reminder that a supply constraint doesn't stay contained to the department where it originates.
A second, independent cohort found the same pattern
A separate retrospective study in the Western Journal of Emergency Medicine reached a consistent conclusion from a different dataset. Researchers compared 11,044 adult CT patients across six Prisma Health emergency departments in June–July 2019 versus June–July 2022. Contrast use in CT scans fell from 93% before the shortage to 45% during it — and emergency department length of stay showed a statistically significant increase during the shortage period (p = 0.04). Thirty-day mortality held steady at 2.8% in both periods, so the shortage wasn't a mortality story. It was a throughput and cost story: two hospital systems, two different time windows, the same directional result on length of stay.
The lesson isn't really about contrast
Strip away the specific commodity and what's left is a general pattern: constrain one link in the imaging chain, and the system compensates in ways that generate cost somewhere else. In 2022, the constrained link was contrast supply. Clinicians substituted unenhanced scans, some of those scans needed to be repeated with contrast once supply allowed, and the added visits and longer stays outweighed whatever time or material the workaround saved.
Imaging capacity has more than one bottleneck, though. Contrast supply is a constraint on the scan. Radiologist reporting bandwidth is a constraint on the answer — and when reads back up, the same substitution logic tends to play out: referrers order additional studies to compensate for uncertainty, patients wait longer for a result that changes their disposition, and length of stay and downstream costs absorb the delay, just as they did when contrast ran short.
Two supply constraints, one pattern
| Dimension | Contrast-supply shortage (2022) | Reporting-capacity backlog |
|---|---|---|
| What's constrained | Iodinated contrast media | Radiologist read/sign bandwidth |
| Common workaround | Unenhanced scan, alternative modality | Wait for next available read, outside overflow read |
| Downstream effect measured | More repeat scans, longer stays | Delayed disposition, repeat/duplicate orders |
| Cost pattern found | Total 2-month costs higher during shortage | Same logic applies wherever turnaround slips |
Where xAID fits
Contrast supply is a manufacturing problem outside any single hospital's control. Reporting capacity isn't — it's a bottleneck that AI-assisted CT reporting is built to widen. xAID's foundation-model reporting produces a structured draft in minutes rather than hours, with in-house radiologist review on every preliminary and the report delivered ready-to-sign, so a backlog in reads doesn't have to turn into the same delay-driven cost pattern this research documents in contrast rationing.
Frequently asked questions
What happened during the 2022 CT contrast shortage?
A COVID-19 lockdown at GE Healthcare's Shanghai manufacturing plant in April 2022 cut production of Omnipaque, a widely used iodinated contrast agent, triggering an estimated 80% reduction in supply for several weeks. Hospitals rationed contrast, prioritizing the most urgent studies and shifting many routine CT exams to unenhanced protocols.
Did the contrast shortage actually raise healthcare costs?
Yes. A 2026 study in Current Problems in Diagnostic Radiology analyzed more than 12,000 CT encounters from August 2021 to February 2023 and found that total costs within two months of an initial imaging encounter were higher during the shortage, driven largely by additional repeat imaging and longer stays. Costs stayed elevated in the short term even after contrast supply and imaging patterns returned toward pre-shortage levels.
Did length of stay increase during the contrast shortage?
Two independent studies point the same direction. The Current Problems in Diagnostic Radiology analysis found that repeat imaging and initial unenhanced CT scans were both associated with longer stays. A separate retrospective study of 11,044 emergency department patients at six Prisma Health hospitals found a statistically significant increase in ED length of stay during the 2022 shortage compared with the same months in 2019.
What does the contrast shortage show about capacity constraints in imaging?
It shows that constraining any single step in the imaging chain — contrast supply, scanner time, or report turnaround — creates downstream costs that show up elsewhere: more repeat studies, longer stays, and higher total spending. Reporting capacity is a less visible version of the same constraint: when radiologist bandwidth to read and sign studies backs up, the same pattern of delay, rework, and elevated downstream cost tends to follow.
Source: van den Broek-Altenburg et al., "Effect of Iodinated Contrast Shortage on Repeat CT Imaging and ED Spending: a Retrospective Analysis," Current Problems in Diagnostic Radiology (2026), DOI: 10.1067/j.cpradiol.2026.09.006, as reported by Radiology Business; Bellew et al., "Consequences of the 2022 Intravenous Contrast Shortage on Emergency Department Care: A Retrospective Study," Western Journal of Emergency Medicine (2026), DOI: 10.5811/westjem.62947; background on the shortage's origin from Tu, Miller & Forman, NEJM (2022). Figures are rounded as reported.