The Iodine Opportunity for Sustainable Radiology: Quantifying Supply-Chain Strategies to Cut Contrast's Carbon and...

The aim of this study was to estimate the economic and environmental reduction potential of iodinated contrast media (ICM)-saving strategies by examining supply-chain data (from iodine extraction through administration) to inform a decision-making framework that can be tailored to local institutional priorities.

A 100-mL polymer vial of ICM was set as the standard reference case for baseline comparison. To evaluate cost and emissions impacts, four ICM reduction strategies were modeled relative to this standard reference case baseline: vial optimization, hardware or software (artificial intelligence-enabled) dose reduction, and multidose vial and injector systems. This analysis was then translated into a decision-making framework for radiologists to compare ICM strategies by cost, emissions, and operational feasibility.

The supply chain life cycle of a 100-mL iodinated contrast vial produces 1,029 g CO₂ equivalent, primarily from iodine extraction and clinical use. ICM-saving strategies varied widely in emissions reduction, ranging from 12% to 50% nationally. Economically, a 125% tariff could inflate national ICM-related costs to $11.9 billion, and the ICM reduction strategy of artificial intelligence-enhanced ICM systems could lower this expenditure to $2.7 billion. Institutional analysis reveals that the ICM savings from high-capital up-front investment strategies can offset their initial costs, highlighting important trade-offs for implementation decision making.

ICM is a major and modifiable contributor to health care carbon emissions. Depending on the ICM reduction strategy used, emissions can be reduced by up to 53% and ICM-related costs by up to 50%. To guide implementation, the authors developed a decision-making framework that categorizes strategies on the basis of environmental benefit, cost, and operational feasibility, enabling radiology leaders to align sustainability goals with institutional priorities.