Nadja Kadom, MD
Director for Quality, Department of Radiology, Children’s Healthcare of Atlanta
Interim Director for Quality, Department of Radiology and Imaging Sciences, Emory Healthcare
Professor, Emory University School of Medicine
Living more sustainably has been on my mind recently, and I think other radiologists may be similarly interested. As radiologists, we play a crucial role in diagnosing and treating patients, and I strongly believe that we can do even more.
Radiology, being an essential component of modern health care, has an environmental impact, particularly in terms of energy consumption and waste generation. However, I also believe that there are opportunities for positive change. By adopting sustainable practices in our radiology departments, we can reduce our ecological footprint and contribute to a healthier planet.
As Dr. Julia H. Schoen noted in her own InPractice primer, “greener” imaging begins at home [1], so I would love to discuss potential initiatives that radiologists could undertake together, starting with our use of iodinated contrast media (ICM). Accumulating as residual waste in the vials and tubing of patients who receive them, ICM can be released into the sewage system. Although ICMs are of low toxicity, they may transform into other chemicals when undergoing wastewater treatment and/or water purification [2]. These byproducts pose risks for aquatic environments, as well as our drinking water.
Following the shortages of iodinated contrast agents during the COVID pandemic, many radiology practices had to adopt new best practices for decreasing use and waste of iodinated IV contrast [3]. So, with supply chain disruptions resolving and inventory returning, why not adjust contrast volume for each patient based on body weight, lean body mass, or body surface? Certain imaging techniques can allow reduced IV contrast volumes, currently mostly used for patients with renal disease: low-kV techniques, dual-energy scanning with reconstruction of low-keV images, and contrast boost technique for CT angiography.
Using multi-patient injection systems for bottle sizes up to 500 milliliters can make IV contrast administration even more efficient by individualizing the amount of contrast material injected without increasing contrast waste. True, this may require some planning ahead of the imaging day to do so efficiently.
Changing habits is difficult, but do you switch the lights off when you leave a room in your home? How about at work? It’s tough to remember every time, I know. We often feel like a big, concerted effort is necessary to change one single bad habit, and it remains unclear whether such a small contribution can really make a difference.
Hang in there! The 1% rule of marginal gains is the simple idea that big goals can be achieved through incremental steps. No need for making big changes overnight. Instead, let’s aim for small daily improvements.
The three “r”s of sustainability—reduce, reuse, recycle—definitely do translate to our specialty, and there are a few low-hanging fruits worth our consideration. Remember, adopting environmentally friendly practices can also save money, and rethinking how we administer ICM is a feasible first step.
References
- Schoen JL, Thiel CL, Gross JS. ARRS InPractice website. ARRSInPractice.org/climate-change-radiology-primer. Accessed May 16, 2024
- Dekker HM, Stroomberg GJ, Prokop M. Tackling the increasing contamination of the water supply by iodinated contrast media. Insights Imaging 2022 Feb 24; 13:30. doi: 10.1186/s13244-022-01175-x
- EHR Interventions for Contrast Media Shortage Impact CT Utilization. ARRS InPractice website. ARRSInPractice.org/ehr-interventions-for-contrast-media-shortage-impact-ct-utilization. Accessed May 16, 2024