The GREENWATER study: patients’ green sensitivity and potential recovery of injected contrast agents

Objectives

The environmental footprint of iodinated contrast agents (ICAs) and gadolinium-based contrast agents (GBCAs) is noteworthy. This study assesses: (1) patients’ “green sensitivity” as measured by their acceptance in a sustainability study and (2) the resulting potential reduction of contrast residuals in wastewater.

Materials and methods

After ethical approval, participants scheduled for administration of ICAs or GBCAs for diagnostic purposes were enrolled in this prospective observational study from July 2022 to October 2023. They were asked to prolong their hospital stay by up to 60 min to collect their first urine in dedicated canisters, thereby measuring the recovery rates of ICAs and GBCAs as found/theoretical ratio of concentrations. Mann–Whitney U, χ² tests, and multivariable regression analysis were used.

Results

Patients scheduled for contrast-enhanced CT or MRI (n = 455) were screened; 422 (92.7%) accepted to participate. We enrolled 212 patients administered with ICAs and 210 administered with GBCAs. The median recovery rate was 51.2% (interquartile range 29.2–77.9%) for ICAs and 12.9% (9.0–19.3%) for GBCAs. At multivariable analysis, a significant effect of patient age (ICAs, p = 0.001; GBCAs, p = 0.014), urine volume (p < 0.001 for both), and time interval from contrast administration to urine collection (p < 0.001 for both) on recovery rates was found for both contrast agents; injected contrast volume (p = 0.046) and saline flushing usage (p = 0.008) showed a significant effect only for ICAs.

Conclusion

The high patient enrollment compliance (93%) and potential recovery rates of 51% (ICAs) and 13% (GBCAs) play in favor of sustainable practices in reducing the environmental footprint of contrast agents.

Key Points

Question How many patients are willing to extend their stay in radiology by up to 60 min to help reduce the environmental impact of contrast agents?

Findings Over 90% of screened patients agreed to extend their stay by up to 60 min and collect their urine in dedicated containers.

Clinical relevance Patients demonstrated a high willingness to cooperate in reducing the environmental impact of contrast agents, allowing for a potential recovery of approximately 51% for iodinated and 13% for gadolinium-based contrast agents.

Graphical Abstract