When I had a PET scan in 2000, the radioactive glucose compound was made during the night at a cyclotron in Seattle and flown to Portland for use the next day. Early morning doses were much less radioactive to start than doses to be used later in the day. By the time the afternoon doses were used, they decayed to levels similar to the morning doses. After the image was produced, I volunteered to stay in the scintillator to see if a good image could be produced using a (by then) smaller dose. The results were encouraging. The radioactive glucose was definitely produced on a just-in-time basis!
Nuc Med tech here. We have a fraction of a half-life to use a dose and still be within acceptable dosing levels. For F18,which you received in the glucose for your PET scan, you can go about 30 minutes past the calibration time. For Tc99m, which is in the majority of nuclear medicine radiopharmaceuticals, you can go about 100 minutes past calibration time. Because of the nature of radioactive half-lives, we must operate with just-in-time manufacturing and that can not be changed.
Business schools have been singing the praises of just in time supply chains since the 1980s, always praising Toyota as the prime example. But in the pandemic a lot of business were caught with their pants down because of it. And when you look into it, it's not revolutionary, it's just penny pinching that comes with a low-probably of massive cost. For car manufacturers the chip shortage shut down whole production lines. For the health industry to cost is human and potentially incalculable.
@@SianaGearz *Its still lean production,* they just require their suppliers to maintain a stockpile of two- to six months' worth of microcontroller units, SOC's and other critical microchips under a Business Continuity Plan drafted in the aftermath of the 2011 Tōhoku earthquake-a disaster which revealed the long lead times for IC supply chains and led Toyota to reckon with process bottlenecks likely to emerge from climate destabilisation.
Just In Time was important to Japan due to their shortage of land causing extreme real-estate prices. Literally they could not afford on-site storage. This problem has never existed in western countries. However, in the1980's Japan's economic success led to fad adoption of Japanese methods in the West - Just In Time supply with all the rest, such as the Taguchi Method, Total Quality Method, etc. I remember attending in courses on Japanese methods (forced to attend by my employer) and seriously annoying the teacher by pointing out that these methods were American methods taught to the Japanese during the US occupation when WW2 ended. and that industry in the west had since moved on. And also annoying the teacher by pointing out that Japanese success was not due to using smart business methods, it was due to Japan not spending much on defense, and business collusion that would be regarded as anti-competitive and even illegal in the West. The current problems stem not from penny-pinching as such, it stems because cost per unit falls with increasing size of the automated production. My wife used to work for a large multi-national electronics company. In the 1960's they had factories in nearly every western country, using lots and lots of low skill labour. She went on a factory tour - this one factory was still making cell phones - entirely automatically using robots - for the world market. She asked how much of the production was for our country - she was told "about a week's production'"
Nah, this week in Brazil a Taylor swift fan died during a show from heat stroke because water was fucking expensive and the production had covered ventilation gaps in the stadium so those who had not paid could listen. Human life is quite cheap. Specially in the global south. And accountants and lawyers will be happy to make a spreadsheet
I giggled at your description of MRI scans. I've had them on five separate occasions so far, and four times I've fallen asleep in the machine with the somehow-soothing rhythmic noises. Got pretty close to sleep the fifth time, too.
I work in the Inpatient Pharmacy at a cancer treatment center and we were definitely affected by the shortage of contrast and Omnipaq. Had to go back to the Isovue product until Omnipaq supplies normalized. Really emphasizes how precarious medical supply chains are when you rely solely on a handful of manufacturers worldwide.
I appreciate the work done to find a non painful contrast agent. I was recently treated for follicular lymphoma and a related tumour in my left lung. I have had a few contrast scans since April of 2022 and will need a few more to track the progress of my chemotherapy. Thank you for a look at the people and companies making this possible.
Actually had both iodine and gadolinium based contrasts (at different times) used on me. The iodine was was weird because it created a "warm feeling" as it went through my veins and spread in my body. Not painful, but weird. The gadolinium contrast though, it was like icewater being put into my veins. The "temperature difference" or sensation was enough that I could feel it going from my arm, to my core, down to my legs, and up my neck. I don't think it was actually cold per se, but its interesting that the two compounds produced a similar, but opposite sensation when injected.
Man so weird to see other people know that feeling. So weird, they even warned me but fuck I was sure. That metallic taste and feeling the contrast fluid being pumped in. Great times 🤣🤣🤣
There's a similar problem here in Australia with supply of Ozempic pens. The manufacturer Novo Nordisk claims that the drug molecule is in ample supply, but that the pharmaceutical plastic for prefilled pen devices cannot be manufactured fast enough. We've started to receive other drugs in a similar class in single use vials, Tirzepatide. They've actually discontinued some of their prefilled pens for insulin to increase the amount of Ozempic they can make. No idea if any other countries are having the same problem. Hopefully this pressure will encourage a change to reusable pen devices; the prepilled pens are incredibly wasteful.
don't count on it. the further we are from the supply chain crisis without reforms the less and less chances lessons and changes are learned and implimented
Let me chime in as a dane currently under education in the field. Novo just invested 6 billion in a new facility to produce GLP-1, though it won't be finished before 2029. So yeah, there will be a shortage. Denmark isn't a big country by any means and since the FDA wants Novo's operators in charge of the medicine production to have a 1.5-4.5 year degree there's a huuuge lack of workers. 50% of my class got their apprenticeship at Novo, let that sink in. We have thousands of manufacturing companies yet Novo swallows up 50% of all the operators currently under education and now they're gonna need 800 new educated operators just for their new plant alongside 2.200 other positions. Now that may not sound like much, but theres only around 80.000 people currently unemployed in Denmark, that would be like hiring 4% of the unemployed. What makes matters worse is this new production plant won't be close to one of the three big cities so educated workers are even scarcer. The city in which the plant will reside, already has 25% of it's inhabitants working for Novo; truly is mindboggling.
@@ewilgreen5148 Denmark us part of the open market of EU, half a billion people. There have to be some education, of course, but still 800 operators doesn't sound that many.
Thanks for reviewing this niche topic! This shortage had a large upstream impact and caused major delays in new and combined method imaging research and development across Radiology and Cardiology. As researchers we had to source little bits of contrast left over from clinical procedures (that were already rationed) to eek out progress as possible.
I faced this shortage during my residency in 2022. Now I got to know the actual reason. Thank you for the informative video. We were using more diluted versions of contrast for non-CT scans like RGU, MCU scans and intraop contrast guided access. For scans, we started preferring MR Urograms over contrast CT Urograms. Those 5-6 months were crazy
@@acedeuce Rumour has it, has a year long queue of videos which are available to paying patrons immediately while they get unprivated to the general public on a schedule.
@@SianaGearz didnt realize his patron videos were available actually on UA-cam earlier, thought that they distributed those videos through patreon for early release. I'll definitely consider it more seriously
Perfect timing. I'm currently confined in a hospital and had 2 CT scans to determine what's causing the pain in my upper right abdomen. I thought it was gallstones or appendicitis, but turns out it was lower right lung damage. Dunno what caused it as I am not a smoker or a vaper. I did get a contrast injected in me during my initial whole abdomen scan. However, I was asked if I had seafood allergy. I told them no, then they did a low dose first, then a high dose next. The low dose kinda felt like arthritis on my hand where my syringe was connected. The high dose one had me feeling something warm all over my body. I had to redo the CT scan since they needed to scan my lungs too but they no longer needed to inject me a contrast fluid. Diagnosis was atelectasis with pulmomary fibrosis on the lower right lung. The machine they used was a GE. Can't believe they're still alive for all this years despite them falling out of relevance in the consumer appliance market. They even once had a bank here in the Philippines.
*General Electric survives* as three separate stock-issuing companies: GE Aerospace (mainly jet engines), GE Vernova (power generation and renewable energy) and GE Healthcare (imaging technologies). Interestingly, Philips is another legacy home electronics/appliances/lighting giant that survives as a prominent maker of medical imaging systems.
@@Outlawstar0198 yeah, but is completely invisible in the consumer space. If you're not in the healthcare industry, you won't even know they still exist. The consumer appliance space has been taken over by the Korean giants like LG and Samsung and some other players like Panasonic, Sharp, etc to a lesser degree.
Cost Optimisations. That's why it was Just-In-Time, made one place and shipped another for packaging. Just extreme profit margining with the assumption nothing will go wrong because it hasn't in so long so why waste money on over run, backups, storage costs and all the other costs, we can just so it live and in time to use. Works great, till it doesn't
Interesting that I had no problems getting a CT with contrast in Melbourne after going to emergency in about August 2022 after going blind in my right FOV on both eyes and seeing zig zags with colours come out of them. And it wasn't even anything dangerous in the end, but nurse on call and my local hospital said I should go to the Royal Melbourne hospital in case I was having a stroke.
Also happens when you inyect sodium chloride in 3-5% as an hypertonic solution. When we use those we usually need a central venous line because of pain and burning sensation in patients
If I remember correctly, Canada also had the contrast storage. Seems like we have shortage on everything during covid. We even still have storage on other stuff now.
Also worth noting that many people have metal in their bodies making any MRI potentially fatal, especially if you don't know someone's medical history. They are wonderful machines, but sadly I can't go near one. This makes CT the best option in most cases, obviously. I'm just as grateful that we have made x-ray & CT scans more accurate with less radiation over the years as I am for the chemistry you just described.
Those Shanghai lockdowns really did look brutal. We had some very long lockdowns here in Australia, but they looked like a walk in a park compared to the Chinese ones. I remember that American political commentator Candice Owens went on some tirade about how Australia should be invaded as we've "fallen to communism" by having lockdowns. Truly bizarre stuff.
Was in Běijīng during Zero COVID. Never got as severe as Shànghǎi but still alarming to see entire gated communities randomly further fenced in and guarded, with mandatory swab testing requirements also suddenly changing by the day. During the Shànghǎi lockdowns the food distribution was so uneven and inefficient that some of our colleagues there survived literally only through donations addressed directly to them that our office branch had sent.
Please do videos about healthcare technologies like ct and mrt! Siemens healthineers is using photon counting sensors in their newest ct-Generation. They are based on the use of Cadmium telluride crystals to convert x-ray-photons into electrical signals. I think that sounds like a pretty interesting technology
great video but you forgot one important type of scan that can show functionality. Nuclear Medicine with SPECT/CT and PET/CT scans can also visualize specific organs and functions without iodine. Unfortunately they also face shortage of "contrast agents" from time to time, but that is a topic/video for another time, hopefully!
Does the specific tie-in of GE-Healthcare contrast medium solution to certain CT-Scan machines be related to calibration? Can CT-Scan machines function properly with contrast medium from another manufacturers? What about generic alternatives, aren't the patents expired yet after 40+ years?
The video literally says there are other suppliers. Manufacturing tends to be more efficient and cheaper with a few big factories and minimal stock on hand. And often (though not always) it means the prices go way down that you need to be super efficient to survive though even without that if you are a public for profit company you want to be efficient to make more money. The consequence is when one of them goes down for any reason there are shortages. Making any sort of sterile medical product is something that cannot be scaled up quickly so if no one has spare capacity which is not unusual because spare capacity costs money there are shortages.
@@TheBrain0110 What I was referring to is that if certain model of CT-Scanners required preferably contrast solution made by GE-Healthcare for proper results making the possibility to switch to another supplier less feasible.
There is also a gamma ray emitting isotope with short half-life that can be injected into the veins and give a better quality image. The total radiation the body is exposed to is about the same as a "normal" x-ray scan. The scanner is only a detector, not the source of the radiation. I remember reading about it 15-20 years ago why it made better 3-d pictures but i forgot the details. The only problem/benefit is that those isotopes can not be stored and have to be created before use.
lol dude... gonk gonk gonk...yea preatty much what happened to me... claustrofobia as well, was so distressed when i came out that i passed out in front of the hospital (noone came to check ofcourse lol)
Like to see a video on the new photon counting CT technology. The detectors may be different across vendors, GE seems to favor silicon based while. others (Siemens or Phillips) may prefer cadmium. So a video explaining the detector differences between photon and traditional CT and the actual detector.
@@tcbobb1613 It just getting packaged in China. It is made mainly in Norway where it was discovered so probably a ecosystem there to support it and Ireland probably due to tax
Well, this explains the 16-hour emergency room wait my wife had last year while they hunted for contrast agents from other hospitals. (She was fine; it was indigestion)
JIT for making and acquiring stuff that doesn't matter is a pretty good idea. You don't know how many people are going to buy hairbrushes next month, so as a store and a producer it makes sense to scale orders and production with trends in demand, rather than make enough and have enough hair brushes to meet a high point of theoretical demand. It helps smooth out the curves of the supply chain and ensures nobody eats shit because they have too much stuff to sell. All that being said, I would argue JIT for life saving medical treatments and important goods (Stuff like finished, packaged semiconductors) is an absolutely atrocious idea. Doing that and not hedging your bets by insisting on buying from a diverse set of suppliers is getting on you knees and begging for the worst to happen. The people that are responsible for this clusterfuck should probably be identified and fired before they fuck up something like the supply of antibiotics or components for oxygen concentration machines.
As a business grad, I've never understood and I will never understand JIT manufacturing, it makes no sense, Neither does putting all of your production in one country.
MRI machines are the closest we have come to magic in our everyday lifes explaining them as huge things that make GWANKGWANKGWANK is very much sufficent
It’s not just China as a small number of countries have them too. It’s only in China where no public environmental resistance prevents it from being mined extensively.
@@AndersHalden in Au, but then again we have a stupid government that follows the US starting trade wars, even when it is to our own disadvantage. But I suppose, when the works biggest bully points a big gun at you, you do what you are told.
Hi, it is interesting to see how you use the word "we" as the subject of discoveries... :-). We are all part of the "human family", but we did not together make the discoveries you mentioned. Anyway, the plandemic crisis clearly showed the built in system dependencies.
There was no great compelling labor cost advantage to putting in the packaging factory in Shanghai, when the basic chemical, omnipaque, was being manufactured in Norway/Ireland. As you can probably tell, that is basically a very much automated factory where glass bottles get filled and sterilized and put inside boxes. Perhaps the glass bottles were Made in China, but they could have been made very easily and cheaply in Europe also in an automated factory. Almost certainly, the main reason for the factory was that GE had made a HUGE push to sell their medical diagnostic equipment when trade with China first started opening up in the 1990s - CT scanners especially. I remember hearing that one year, GE sold something like 100 CT scanners to China during that time. This MUST have come with some sort of a quid pro quo with Chinese leaders at the time, because, the Chinese NEVER give you that much business without getting something back in return. And so it was the Omnipaque bottling/packaging factory. GE must have figured this was a very low tech process that China couldn't possibly screw up or want to steal the technology for. Shanghai was chosen as the location for the factory because that was the power base of the Jiang Zemin Shanghai clique, back when he was the President of China from 1993 - 2003. That's when GE was making its big push for huge numbers of sales of medical equipment in China. Unfortunately, when Xi jinping became President, one of his favorite whipping boys became the Jiang Zemin Shanghai clique, and during the COVID epidemic, Shanghai was picked out for especially harsh, no, brutally vicious and inhumanitarian treatment, using the Zero COVID policy as the method of punishment. EVERYTHING in Shanghai got totally locked down, much, much more harshly than in other cities. People were literally welded into their apartments to imprison them in forced quarantine, and some died in an apartment fire as a result of that inhumane policy. And so there you have it. GE had no compelling reason to divert one part, the simplest part, of their Omnique supply chain all the way from Europe to China, other than to suck up to the Jiang Zemin Shanghai clique during a time when they were pushing to sell medical equipment to China. They could have, SHOULD HAVE, put the factory in the US, where so much of the contrast was being sold and used, kind of like Coca Cola has local companies bottle and can their coca cola and distribute it. Instead, they sold out the US Healthcare system to curry favor with Jiang Zemin.
Caveat about CT: the radiation dosage to achieve that quality of imaging is bloody high, as told to me by a radiologist. Depends on part of the body, but a quick google is pretty eye-opening. Ranges from twice to over 20(!) the dosage of an X-ray. Equating to years of natural background radiation. If an MRI is an alternative, I'll take that, even through I'm somewhat claustrophobic. Having had one twice in the last few months, I now have a routine, combined with the nice assistant choosing the right selection in Spotify, where I've managed to actually fall asleep both times! Look mum! No glowing in the dark! 😆
You call it safe but my mother has severe adverse reactions to Iodine so I assume that's not true for her? Also "safe" is a word we really use too much when it comes to medicine... it just means "we haven't found any huge problems with it, and even if we did it's the best we have, so deal with it", but yeah for most people it's probably pretty safe compared to Thorium.
You ask some very good questions about the wisdom of our economic policy makers - I'm not a fan of economists and the havoc they wreak more often than not - I'm looking forward to someone in the know doing an expose on the hows, whys and wherefors of whose bright idea of setting up economic dependence on foreign supply chains and sometime antagonists can be blamed on, and on how to avoid the same in the future.
Foreign is done because your corporate overlords that made that decision wanted to save some pennies. That's it. Yes that means some of the poor people will die. But that is a sacrifice the rich are willing to make.
@@robertadsett5273 Question marks go at the end of sentences, not the beginning. And yes, as has generally been the case governments have partnered with Google and its subsidiary platforms over the course of the pandemic, both advising on these sorts of context boxes, paying for ads, and generally being a nuisancw.
The "Just in time" business model, pioneered by Apple, was widespread throughout all kinds of industries before 2020. Since then, the "Just in time" business model has been recognised for what it is: a dangerous clockwork mechanism whose only purpose is to squeeze some more profit from the industry's logistic operations, thus risking the entire manufacturing output if something goes awry. Everyone has local stock and asynchronous logistics after the lessons of 2020, without excessive impact to profits. Thanks for the great video, Anthony
When I had a PET scan in 2000, the radioactive glucose compound was made during the night at a cyclotron in Seattle and flown to Portland for use the next day. Early morning doses were much less radioactive to start than doses to be used later in the day. By the time the afternoon doses were used, they decayed to levels similar to the morning doses. After the image was produced, I volunteered to stay in the scintillator to see if a good image could be produced using a (by then) smaller dose. The results were encouraging. The radioactive glucose was definitely produced on a just-in-time basis!
Nuc Med tech here. We have a fraction of a half-life to use a dose and still be within acceptable dosing levels. For F18,which you received in the glucose for your PET scan, you can go about 30 minutes past the calibration time. For Tc99m, which is in the majority of nuclear medicine radiopharmaceuticals, you can go about 100 minutes past calibration time. Because of the nature of radioactive half-lives, we must operate with just-in-time manufacturing and that can not be changed.
Business schools have been singing the praises of just in time supply chains since the 1980s, always praising Toyota as the prime example. But in the pandemic a lot of business were caught with their pants down because of it. And when you look into it, it's not revolutionary, it's just penny pinching that comes with a low-probably of massive cost. For car manufacturers the chip shortage shut down whole production lines. For the health industry to cost is human and potentially incalculable.
If you also look at it, you will notice that Toyota moved on from JIT system. To a better one.
Ironic that Toyota ended up among the least affected manufacturers. Presumably they took supply chain security more seriously.
@@SianaGearz
*Its still lean production,* they just require their suppliers to maintain a stockpile of two- to six months' worth of microcontroller units, SOC's and other critical microchips under a Business Continuity Plan drafted in the aftermath of the 2011 Tōhoku earthquake-a disaster which revealed the long lead times for IC supply chains and led Toyota to reckon with process bottlenecks likely to emerge from climate destabilisation.
Just In Time was important to Japan due to their shortage of land causing extreme real-estate prices. Literally they could not afford on-site storage. This problem has never existed in western countries. However, in the1980's Japan's economic success led to fad adoption of Japanese methods in the West - Just In Time supply with all the rest, such as the Taguchi Method, Total Quality Method, etc. I remember attending in courses on Japanese methods (forced to attend by my employer) and seriously annoying the teacher by pointing out that these methods were American methods taught to the Japanese during the US occupation when WW2 ended. and that industry in the west had since moved on.
And also annoying the teacher by pointing out that Japanese success was not due to using smart business methods, it was due to Japan not spending much on defense, and business collusion that would be regarded as anti-competitive and even illegal in the West.
The current problems stem not from penny-pinching as such, it stems because cost per unit falls with increasing size of the automated production. My wife used to work for a large multi-national electronics company. In the 1960's they had factories in nearly every western country, using lots and lots of low skill labour. She went on a factory tour - this one factory was still making cell phones - entirely automatically using robots - for the world market. She asked how much of the production was for our country - she was told "about a week's production'"
Nah, this week in Brazil a Taylor swift fan died during a show from heat stroke because water was fucking expensive and the production had covered ventilation gaps in the stadium so those who had not paid could listen.
Human life is quite cheap. Specially in the global south.
And accountants and lawyers will be happy to make a spreadsheet
I giggled at your description of MRI scans. I've had them on five separate occasions so far, and four times I've fallen asleep in the machine with the somehow-soothing rhythmic noises. Got pretty close to sleep the fifth time, too.
“So yeah, we needed something else…” I laughed aloud. Your videos are both informative and entertaining.
I work in the Inpatient Pharmacy at a cancer treatment center and we were definitely affected by the shortage of contrast and Omnipaq. Had to go back to the Isovue product until Omnipaq supplies normalized. Really emphasizes how precarious medical supply chains are when you rely solely on a handful of manufacturers worldwide.
Thankful for doctors and nurses 🥰
I appreciate the work done to find a non painful contrast agent. I was recently treated for follicular lymphoma and a related tumour in my left lung. I have had a few contrast scans since April of 2022 and will need a few more to track the progress of my chemotherapy.
Thank you for a look at the people and companies making this possible.
Absolutely the best channel on YT, the level of quality is through the roof!
Your friend in Seattle Thanks!
Actually had both iodine and gadolinium based contrasts (at different times) used on me. The iodine was was weird because it created a "warm feeling" as it went through my veins and spread in my body. Not painful, but weird.
The gadolinium contrast though, it was like icewater being put into my veins. The "temperature difference" or sensation was enough that I could feel it going from my arm, to my core, down to my legs, and up my neck. I don't think it was actually cold per se, but its interesting that the two compounds produced a similar, but opposite sensation when injected.
Oh did I pee myself...nar it's just the contrast
Man so weird to see other people know that feeling. So weird, they even warned me but fuck I was sure. That metallic taste and feeling the contrast fluid being pumped in. Great times 🤣🤣🤣
Yes, hot stuff! Or cold, as the case may be....
There's a similar problem here in Australia with supply of Ozempic pens. The manufacturer Novo Nordisk claims that the drug molecule is in ample supply, but that the pharmaceutical plastic for prefilled pen devices cannot be manufactured fast enough. We've started to receive other drugs in a similar class in single use vials, Tirzepatide. They've actually discontinued some of their prefilled pens for insulin to increase the amount of Ozempic they can make. No idea if any other countries are having the same problem. Hopefully this pressure will encourage a change to reusable pen devices; the prepilled pens are incredibly wasteful.
don't count on it. the further we are from the supply chain crisis without reforms the less and less chances lessons and changes are learned and implimented
Let me chime in as a dane currently under education in the field. Novo just invested 6 billion in a new facility to produce GLP-1, though it won't be finished before 2029. So yeah, there will be a shortage. Denmark isn't a big country by any means and since the FDA wants Novo's operators in charge of the medicine production to have a 1.5-4.5 year degree there's a huuuge lack of workers. 50% of my class got their apprenticeship at Novo, let that sink in. We have thousands of manufacturing companies yet Novo swallows up 50% of all the operators currently under education and now they're gonna need 800 new educated operators just for their new plant alongside 2.200 other positions. Now that may not sound like much, but theres only around 80.000 people currently unemployed in Denmark, that would be like hiring 4% of the unemployed. What makes matters worse is this new production plant won't be close to one of the three big cities so educated workers are even scarcer. The city in which the plant will reside, already has 25% of it's inhabitants working for Novo; truly is mindboggling.
@@ewilgreen5148 Denmark us part of the open market of EU, half a billion people. There have to be some education, of course, but still 800 operators doesn't sound that many.
Loved your description of MRI. So accurate!🤣
Yo ! Who are you ? How did you get here 2 months ago
@@ChadPANDA...he supports the show on patreon gets early access
Gong gong gong
The part about MRI had me laughing because its exactly how it goes.
"Oh my god! thorium nitrate" had me in fits 😂😂
Thanks for reviewing this niche topic! This shortage had a large upstream impact and caused major delays in new and combined method imaging research and development across Radiology and Cardiology. As researchers we had to source little bits of contrast left over from clinical procedures (that were already rationed) to eek out progress as possible.
Oh God, given how many CT scans I have had, I am beyond grateful to exist in a time where the contrast isn't painful.
We consider the tonicity of all injections these days. Ideal formulations are isotonic of course
@@lich5655 Now if we could just better rate limit potassium infusions so they don't fucking make your arm feel like it was dipped in lava...
Heavy metal contrast medium: That is the fuel of nightmares.
Current state of development with the contrast medium seems to be perfect.
Iodine compounds was also used as contrast media.
Interesting topic explained clearly. Thanks for your efforts.
@aman_2002 yes. i think this channel is worth supporting
I faced this shortage during my residency in 2022. Now I got to know the actual reason. Thank you for the informative video.
We were using more diluted versions of contrast for non-CT scans like RGU, MCU scans and intraop contrast guided access.
For scans, we started preferring MR Urograms over contrast CT Urograms. Those 5-6 months were crazy
"and oh my god, 10% thorium nitrate" lol had me dying.
Laughed out loud at "OH MY GOD Thorium nitrate."
The fact this has 2 month old comments is blowing my mind....
Wtf is happening
That’ll be patreons getting a preview, which seems fair enough.
@@acedeuce Rumour has it, has a year long queue of videos which are available to paying patrons immediately while they get unprivated to the general public on a schedule.
Maybe some Patreon/bonus-Video, he forgot/didn't plan to make available to the public?🤔
@@SianaGearz didnt realize his patron videos were available actually on UA-cam earlier, thought that they distributed those videos through patreon for early release. I'll definitely consider it more seriously
Thanks for the video and especially the historical overview! The contrast shortage definitely affected Canada too.
Learned so much from this one! Always a pleasure.
I love this channel so much you have no idea
I wont lie, I first learned aboiut the shortage because of Chicago Med's episode on it. Which, honeslty, is very impressive for a medical drama
Perfect timing. I'm currently confined in a hospital and had 2 CT scans to determine what's causing the pain in my upper right abdomen. I thought it was gallstones or appendicitis, but turns out it was lower right lung damage. Dunno what caused it as I am not a smoker or a vaper. I did get a contrast injected in me during my initial whole abdomen scan. However, I was asked if I had seafood allergy. I told them no, then they did a low dose first, then a high dose next. The low dose kinda felt like arthritis on my hand where my syringe was connected. The high dose one had me feeling something warm all over my body. I had to redo the CT scan since they needed to scan my lungs too but they no longer needed to inject me a contrast fluid.
Diagnosis was atelectasis with pulmomary fibrosis on the lower right lung.
The machine they used was a GE. Can't believe they're still alive for all this years despite them falling out of relevance in the consumer appliance market. They even once had a bank here in the Philippines.
*General Electric survives* as three separate stock-issuing companies: GE Aerospace (mainly jet engines), GE Vernova (power generation and renewable energy) and GE Healthcare (imaging technologies). Interestingly, Philips is another legacy home electronics/appliances/lighting giant that survives as a prominent maker of medical imaging systems.
GE Healthcare is HUGE
Jet engines through the joint venture CFM with Safran?
GE was massive back in the day, like Samsung or Sony massive
@@Outlawstar0198 yeah, but is completely invisible in the consumer space. If you're not in the healthcare industry, you won't even know they still exist.
The consumer appliance space has been taken over by the Korean giants like LG and Samsung and some other players like Panasonic, Sharp, etc to a lesser degree.
"A suspension of water, citric acid and oh my god 10% thorium nitrate."
14:06 loved the technical language there 😂
Cost Optimisations. That's why it was Just-In-Time, made one place and shipped another for packaging. Just extreme profit margining with the assumption nothing will go wrong because it hasn't in so long so why waste money on over run, backups, storage costs and all the other costs, we can just so it live and in time to use. Works great, till it doesn't
Yeah it's like living paycheck to paycheck and then boom you got retrenched
Interesting that I had no problems getting a CT with contrast in Melbourne after going to emergency in about August 2022 after going blind in my right FOV on both eyes and seeing zig zags with colours come out of them.
And it wasn't even anything dangerous in the end, but nurse on call and my local hospital said I should go to the Royal Melbourne hospital in case I was having a stroke.
Also happens when you inyect sodium chloride in 3-5% as an hypertonic solution.
When we use those we usually need a central venous line because of pain and burning sensation in patients
If I remember correctly, Canada also had the contrast storage. Seems like we have shortage on everything during covid. We even still have storage on other stuff now.
Just in time supply chains are everywhere your corporate overlords get to own and control.
Also worth noting that many people have metal in their bodies making any MRI potentially fatal, especially if you don't know someone's medical history. They are wonderful machines, but sadly I can't go near one. This makes CT the best option in most cases, obviously. I'm just as grateful that we have made x-ray & CT scans more accurate with less radiation over the years as I am for the chemistry you just described.
Those Shanghai lockdowns really did look brutal. We had some very long lockdowns here in Australia, but they looked like a walk in a park compared to the Chinese ones. I remember that American political commentator Candice Owens went on some tirade about how Australia should be invaded as we've "fallen to communism" by having lockdowns. Truly bizarre stuff.
Was in Běijīng during Zero COVID. Never got as severe as Shànghǎi but still alarming to see entire gated communities randomly further fenced in and guarded, with mandatory swab testing requirements also suddenly changing by the day.
During the Shànghǎi lockdowns the food distribution was so uneven and inefficient that some of our colleagues there survived literally only through donations addressed directly to them that our office branch had sent.
Please do videos about healthcare technologies like ct and mrt!
Siemens healthineers is using photon counting sensors in their newest ct-Generation.
They are based on the use of Cadmium telluride crystals to convert x-ray-photons into electrical signals.
I think that sounds like a pretty interesting technology
great video but you forgot one important type of scan that can show functionality. Nuclear Medicine with SPECT/CT and PET/CT scans can also visualize specific organs and functions without iodine. Unfortunately they also face shortage of "contrast agents" from time to time, but that is a topic/video for another time, hopefully!
This is great! I subscribed
I work in radiology so I remember this 😮
Small correction: Nyegaard was known as Nycomed by the time it merged with Amersham.
Like UA-camr Safiya Nygaard??
There is this company called Richardson Electronics ($RELL) which sells CT tubes to China, was impacted by US law
Does the specific tie-in of GE-Healthcare contrast medium solution to certain CT-Scan machines be related to calibration? Can CT-Scan machines function properly with contrast medium from another manufacturers? What about generic alternatives, aren't the patents expired yet after 40+ years?
The video literally says there are other suppliers. Manufacturing tends to be more efficient and cheaper with a few big factories and minimal stock on hand. And often (though not always) it means the prices go way down that you need to be super efficient to survive though even without that if you are a public for profit company you want to be efficient to make more money. The consequence is when one of them goes down for any reason there are shortages. Making any sort of sterile medical product is something that cannot be scaled up quickly so if no one has spare capacity which is not unusual because spare capacity costs money there are shortages.
@@TheBrain0110 What I was referring to is that if certain model of CT-Scanners required preferably contrast solution made by GE-Healthcare for proper results making the possibility to switch to another supplier less feasible.
There is also a gamma ray emitting isotope with short half-life that can be injected into the veins and give a better quality image. The total radiation the body is exposed to is about the same as a "normal" x-ray scan. The scanner is only a detector, not the source of the radiation. I remember reading about it 15-20 years ago why it made better 3-d pictures but i forgot the details. The only problem/benefit is that those isotopes can not be stored and have to be created before use.
lol dude... gonk gonk gonk...yea preatty much what happened to me... claustrofobia as well, was so distressed when i came out that i passed out in front of the hospital (noone came to check ofcourse lol)
Like to see a video on the new photon counting CT technology. The detectors may be different across vendors, GE seems to favor silicon based while. others (Siemens or Phillips) may prefer cadmium. So a video explaining the detector differences between photon and traditional CT and the actual detector.
If the USA uses 100M doses a year, why is the stuff not made here?
Because it's probably cheaper to get it made in China
@@tcbobb1613 It just getting packaged in China. It is made mainly in Norway where it was discovered so probably a ecosystem there to support it and Ireland probably due to tax
@@anush_agrawalIreland is absolutely due to tax write offs. They’re like Delaware.
Well, this explains the 16-hour emergency room wait my wife had last year while they hunted for contrast agents from other hospitals. (She was fine; it was indigestion)
JIT for making and acquiring stuff that doesn't matter is a pretty good idea. You don't know how many people are going to buy hairbrushes next month, so as a store and a producer it makes sense to scale orders and production with trends in demand, rather than make enough and have enough hair brushes to meet a high point of theoretical demand. It helps smooth out the curves of the supply chain and ensures nobody eats shit because they have too much stuff to sell. All that being said, I would argue JIT for life saving medical treatments and important goods (Stuff like finished, packaged semiconductors) is an absolutely atrocious idea. Doing that and not hedging your bets by insisting on buying from a diverse set of suppliers is getting on you knees and begging for the worst to happen. The people that are responsible for this clusterfuck should probably be identified and fired before they fuck up something like the supply of antibiotics or components for oxygen concentration machines.
As a business grad, I've never understood and I will never understand JIT manufacturing, it makes no sense, Neither does putting all of your production in one country.
Thank God for smart people in the world that come up with these absolutely fantastic ideas to help their fellow man..Thanks for uploading ....
“…And OMG 10% Throrium Nitrate” 😂
MRI machines are the closest we have come to magic in our everyday lifes
explaining them as huge things that make GWANKGWANKGWANK is very much sufficent
Konrad Röntgen discovered "x-rays" not "we"
Finally figured it out: Thorsten Almen looks like Phlox from Enterprise
Thorsten Almen certainly and very deservedly stole the show 😁
What a hero
And, Oh, My, God, Becky... Thorium
why only rareearth element only avaliable at China?
It’s not just China as a small number of countries have them too. It’s only in China where no public environmental resistance prevents it from being mined extensively.
China has bought up most of the world’s rare earth metal mines.
2008 finical crisis changed the way US businesses did things, changed more to JIT vs stock piling to cut cost.
Kind of messed up but it is what it is.
Interesting materials, thank you....
If you think the contrast medium shortage is over, you are living in different world to those who work in healthcare.
In the US?
@@AndersHalden in Au, but then again we have a stupid government that follows the US starting trade wars, even when it is to our own disadvantage. But I suppose, when the works biggest bully points a big gun at you, you do what you are told.
Why is it still all iodine based? There's a whole other row of heavy junk down there to choose from that would absorb x--rays just as well.
Probably because the heavy metals are toxic.
@@SalivatingSteve bismuth tho...
also you could just chelate the ion as is done with gadolinium
Wow great work. If I had the financial background, I would support you.
Hi, it is interesting to see how you use the word "we" as the subject of discoveries... :-). We are all part of the "human family", but we did not together make the discoveries you mentioned. Anyway, the plandemic crisis clearly showed the built in system dependencies.
There was no great compelling labor cost advantage to putting in the packaging factory in Shanghai, when the basic chemical, omnipaque, was being manufactured in Norway/Ireland. As you can probably tell, that is basically a very much automated factory where glass bottles get filled and sterilized and put inside boxes. Perhaps the glass bottles were Made in China, but they could have been made very easily and cheaply in Europe also in an automated factory.
Almost certainly, the main reason for the factory was that GE had made a HUGE push to sell their medical diagnostic equipment when trade with China first started opening up in the 1990s - CT scanners especially. I remember hearing that one year, GE sold something like 100 CT scanners to China during that time. This MUST have come with some sort of a quid pro quo with Chinese leaders at the time, because, the Chinese NEVER give you that much business without getting something back in return.
And so it was the Omnipaque bottling/packaging factory. GE must have figured this was a very low tech process that China couldn't possibly screw up or want to steal the technology for.
Shanghai was chosen as the location for the factory because that was the power base of the Jiang Zemin Shanghai clique, back when he was the President of China from 1993 - 2003. That's when GE was making its big push for huge numbers of sales of medical equipment in China.
Unfortunately, when Xi jinping became President, one of his favorite whipping boys became the Jiang Zemin Shanghai clique, and during the COVID epidemic, Shanghai was picked out for especially harsh, no, brutally vicious and inhumanitarian treatment, using the Zero COVID policy as the method of punishment. EVERYTHING in Shanghai got totally locked down, much, much more harshly than in other cities. People were literally welded into their apartments to imprison them in forced quarantine, and some died in an apartment fire as a result of that inhumane policy.
And so there you have it. GE had no compelling reason to divert one part, the simplest part, of their Omnique supply chain all the way from Europe to China, other than to suck up to the Jiang Zemin Shanghai clique during a time when they were pushing to sell medical equipment to China. They could have, SHOULD HAVE, put the factory in the US, where so much of the contrast was being sold and used, kind of like Coca Cola has local companies bottle and can their coca cola and distribute it. Instead, they sold out the US Healthcare system to curry favor with Jiang Zemin.
Caveat about CT: the radiation dosage to achieve that quality of imaging is bloody high, as told to me by a radiologist. Depends on part of the body, but a quick google is pretty eye-opening. Ranges from twice to over 20(!) the dosage of an X-ray. Equating to years of natural background radiation. If an MRI is an alternative, I'll take that, even through I'm somewhat claustrophobic. Having had one twice in the last few months, I now have a routine, combined with the nice assistant choosing the right selection in Spotify, where I've managed to actually fall asleep both times! Look mum! No glowing in the dark! 😆
Freaking thorium 😂🤪😝
You call it safe but my mother has severe adverse reactions to Iodine so I assume that's not true for her? Also "safe" is a word we really use too much when it comes to medicine... it just means "we haven't found any huge problems with it, and even if we did it's the best we have, so deal with it", but yeah for most people it's probably pretty safe compared to Thorium.
Not painful but definitely makes u feel like your peeing all over yourself lol
Diet nose tick?
LMAO the covid disclaimer
I like the noise. sort of like some Japanese noise /art music from the 2000s.
i love you charles!! haha legend.. i think i'll actually buy some cardano before it flies to the moon soon.
Some times I wonder if I was born through s3x my parents look so innocent especially my mum
You ask some very good questions about the wisdom of our economic policy makers - I'm not a fan of economists and the havoc they wreak more often than not - I'm looking forward to someone in the know doing an expose on the hows, whys and wherefors of whose bright idea of setting up economic dependence on foreign supply chains and sometime antagonists can be blamed on, and on how to avoid the same in the future.
Foreign is done because your corporate overlords that made that decision wanted to save some pennies.
That's it.
Yes that means some of the poor people will die. But that is a sacrifice the rich are willing to make.
well you chose the hard way and not the simple way, so you have various shortages and lack-kings.
Norge!!!!
👍👍👍
Wow, the government of Canada is still paying UA-cam for "Context box" scarlet letters if you mention covid. In 2023. What a grift.
?? Why do you think the government of Canada is paying for it?
@@robertadsett5273 Question marks go at the end of sentences, not the beginning.
And yes, as has generally been the case governments have partnered with Google and its subsidiary platforms over the course of the pandemic, both advising on these sorts of context boxes, paying for ads, and generally being a nuisancw.
@@POVwithRCno government has paid for it, the tech companies just went along with it as part of a global censorship regime that emerged during covid.
Interesting
Lindesnes 🎉
Was Earl Osborne only five years old when developing his stuff?😉
You speak here with all the authority of ChatGPT.
The "Just in time" business model, pioneered by Apple, was widespread throughout all kinds of industries before 2020.
Since then, the "Just in time" business model has been recognised for what it is: a dangerous clockwork mechanism whose only purpose is to squeeze some more profit from the industry's logistic operations, thus risking the entire manufacturing output if something goes awry. Everyone has local stock and asynchronous logistics after the lessons of 2020, without excessive impact to profits.
Thanks for the great video,
Anthony
The "Just in time" model is absolutely not pioneered by Apple. It was pioneered by Toyota.
DiagNOsticks
MRI:GONK GONK GONK
I wont lie, I first learned aboiut the shortage because of Chicago Med's episode on it. Which, honeslty, is very impressive for a medical drama