The Environmental Impact of Iodinated Contrast Media: Strategies for Optimized Use and Recycling

ABSTRACT: Iodinated contrast media (ICM) is an integral and ubiquitous component of modern diagnostic imaging. Although most radiology practices are familiar with ICM administration and physiological excretion, they may be less aware of how much ICM is wasted on a per exam basis. Furthermore, radiologists may not recognize the environmental fate of discarded ICM waste. In an evolving world where medical practices are increasingly cognizant of their environmental footprint and radiology practices are considered high consumers of resources, it behooves the radiology community to understand the ICM lifecycle and ways to mitigate unnecessary waste. This review article explains the origin and environmental fate of discarded ICM, with special focus on wastewater contamination. Secondly, the article focuses on feasible options to both optimize use and decrease consumable waste. Specifically, the article addresses ICM vial size inventory diversification, multi-use ICM vials, syringeless contrast injectors, and the potential for using multi-energy imaging (dual-energy or photon counting CT) to accomplish these goals. Finally, the authors share their institutional experience participating in an ICM recycling program and its current departmental impact.