Zanardo Moreno, Ambrogi Federico, Asmundo Luigi, Cardani Rosanna, Cirillo Giulia, Colarieti Anna, Cozzi Andrea, Cressoni Massimo, Dambra Isabella, Di Leo Giovanni, Monti Caterina B, Nicotera Leonardo, Pomati Francesco, Renna Laura V, Secchi Francesco, Versuraro Marco, Vitali Paolo, Sardanelli Francesco
Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Laboratory of Biostatistics and Data Management, Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Eur Radiol. 2025 Mar;35(3):1205-1214. doi: 10.1007/s00330-024-11150-3. Epub 2024 Oct 31.
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.
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, χ tests, and multivariable regression analysis were used.
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.
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.
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.
碘化造影剂（ICAs）和钆基造影剂（GBCAs）的环境足迹值得关注。本研究评估：（1）通过患者在一项可持续性研究中的接受程度衡量的患者“绿色敏感度”，以及（2）由此可能减少废水中造影剂残留量的情况。
在获得伦理批准后，2022年7月至2023年10月期间，将计划接受ICAs或GBCAs用于诊断目的的参与者纳入这项前瞻性观察研究。要求他们将住院时间延长最多60分钟，以便在专用容器中收集首次尿液，从而测量ICAs和GBCAs的回收率（实际浓度/理论浓度之比）。使用了曼-惠特尼U检验、χ检验和多变量回归分析。
筛查了计划接受增强CT或MRI检查的患者（n = 455）；422名（92.7%）同意参与。我们纳入了212名接受ICAs注射的患者和210名接受GBCAs注射的患者。ICAs的中位回收率为51.2%（四分位间距29.2 - 77.9%），GBCAs为12.9%（9.0 - 19.3%）。在多变量分析中，发现患者年龄（ICAs，p = 0.001；GBCAs，p = 0.014）、尿量（两者均p < 0.001）以及从注射造影剂到收集尿液的时间间隔（两者均p < 0.001）对两种造影剂的回收率均有显著影响；注射造影剂体积（p = 0.046）和生理盐水冲洗的使用情况（p = 0.008）仅对ICAs有显著影响。
患者的高参与依从性（93%）以及51%（ICAs）和13%（GBCAs）的潜在回收率有利于在减少造影剂环境足迹方面采取可持续做法。
问题有多少患者愿意将在放射科的停留时间延长最多60分钟以帮助减少造影剂的环境影响？研究结果超过90%的筛查患者同意将停留时间延长最多60分钟，并在专用容器中收集尿液。临床意义患者在减少造影剂环境影响方面表现出很高的合作意愿，碘化造影剂的潜在回收率约为51%，钆基造影剂为13%。
