“Every drop counts,” was the take-home message from a plenary session on eco-friendly best practices held March 1 at ECR 2025.
Linda Moy, MD, from NYU Langone Health in New York outlined several ways that radiologists working with MRI can take proactive steps toward environmentally friendly practices and limit water pollution.
“Just as we devote ourselves to the care of our patients, we must bring that same dedication to the care of our world,” Moy said. “It’s clear to all of us that action is no longer optional; it’s essential.”
Linda Moy, MD, explains at ECR 2025 how gadolinium waste from contrast agents exacerbates water pollution. She offered several suggestions to limit or even eliminate the use of gadolinium-based contrast agents in favor of more energy-efficient MR imaging methods.
Moy, who serves as editor in chief of the journal Radiology, specializes in breast imaging. The RSNA and European Society of Radiology (ESR), along with nine other radiology societies, published a position statement in February calling for radiologists worldwide to cooperate and share ideas for mitigating the field's environmental impact.
Her ECR talk touched upon how MRI facilities can take steps such as using lower-power scanning, using less materials that are single-use and disposable, and limiting the use of gadolinium-based contrast agents (GBCAs).
“When we invest in sustainable MRI, we invest in the future of radiology and the planet,” she said.
Gadolinium waste
The use of gadolinium has come under scrutiny in recent years, with its impact on the environment being one concern medical professionals have.
“For all of us, contrast media is vital to our work. But its environmental footprint is undeniable,” Moy said.
She said that since 1988, about 500 million doses of GBCAs have been administered around the world. And each year, medical professionals perform around 50 million MRI scans using these agents.
Most drops of gadolinium in these agents enter the environmental ecosystem. However, water treatment plants meanwhile cannot filter out heavy metals like gadolinium and the material doesn’t break down. In trace amounts, gadolinium may be found on surface water, in drinking water, and in soft drinks. This also means animals that live in the sea are impacted, with previous reports finding that the health of fish, urchins, and mollusks are negatively affected.
“This isn’t a localized issue,” Moy said. “It’s a global challenge that demands our urgent attention.”
To reduce GCBA use, Moy suggested that facilities take the following actions:
- Use multidose injectors. This could reduce contrast waste by 73% and plastic waste by 93%, Moy said. She also suggested this results in an average annual savings of nearly half a million dollars per year and a reduction of 41 seconds per scan.
- Use newer gadolinium contrast agents with a higher T1 relaxivity. Moy said this makes MRI scans appear brighter and cuts the needed level of contrast dosage and level of contrast excretion in half.
- Form partnerships with recycling programs. This can help manage unused contrast media and leftover residues, preventing these agents from entering water systems.
- Have patients be involved. Moy cited the success of the 2023 Greenwater Study, which showed that patients are willing to stay an extra half-hour after their MRI scans to have their urine collected and disposed of in nonpublic wastewater systems.
- Use contrast agents containing manganese or iron rather than gadolinium.
AI meanwhile can help by creating synthetic or virtual postprocessing images, which simulate contrast enhancement. This means using little to no contrast, which Moy said is beneficial to both patients and ecosystems.
“I do believe the synthetic images are quite comparable to the images where contrast was administered,” she said.
Finally, Moy said that emerging MRI imaging sequences can be improved upon for the goal of faster scanning times, which can help avoid unnecessary contrast use.
Plastic waste
Like many other medical specialties, radiology also produces plastic waste via single-use, disposable materials like gloves and syringes, which ends up in the oceans.
Moy said that 400 million tons of plastic waste are produced globally every year, with only 9% of that being recycled. And biodegradable plastics do not break down since the cold temperatures in deeper waters prevent polymer breakdown.
Moy also said that radiologists can advocate for sustainable product designs with reduced packaging waste. Partnerships with vendors can also forge the development of reusable imaging components and prioritize eco-friendly materials, she added.
Radiologists can also use biodegradable gloves and other materials that degrade more efficiently in landfills.
“It’s clear to me that even small changes can ripple out into significant impacts,” Moy said.
Shifting to lower power, saving water
Moy highlighted that water scarcity is a pressing issue today. Imaging departments can use efficient cooling systems by sharing cooling infrastructure between multiple scanners, she said.
Departments can also implement systems where water can be recycled and reused whenever possible and conduct water audits to identify conservation opportunities.
“Water, like contrast media, is precious. Let’s treat it that way,” Moy said.
MRI scanners meanwhile could be developed with eco-friendly materials designed to last longer than conventional scanner parts and to consume less energy. Vendors can also include end-of-life plans for their equipment, ensuring that materials are recycled rather than discarded.
Other steps like using low-field MRI systems and improved coil designs could reduce energy consumption without sacrificing image quality.
For all of this to be successful, Moy said collaboration between radiologists, vendors, policymakers, and academia is needed.
“I feel hopeful. Radiology has always been a field of transformation, driven by innovation, solving problems, and saving lives,” Moy said. “Now, it’s time to extend that transformation to the planet itself.”
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