Sustainable iodine contrast media for a healthy future (SUSTAINED): a global survey of practice

To investigate healthcare professionals' knowledge, attitudes, and practices (KAPs) of the environmental impact and sustainability of iodinated contrast media (ICM).

A cross-sectional web-based survey was distributed to members of professional societies and advertised via social media between June and December 2024. The questionnaire covered themes including sustainability attitudes, reduction strategies, waste management, patient awareness, and institutional policies. Data were analysed using descriptive statistics, chi-square tests, and analysis of variance (ANOVA).

231 respondents from 44 countries completed the survey, primarily diagnostic radiographers (59%) and radiologists (38%). Most respondents (60%) reported that their institutions had sustainable ICM policies, and there was a significant association between institutional size and alignment with sustainability goals $\left(X^2=14.2,p=0.003\right)$ . Adoption of reduction strategies such as protocol optimisation, saline chasers, and multi-patient systems varied significantly across institutions $\left(X^2=18.5,p=0.001\right)$ , with younger professionals (25-44 years) more engaged $\left(ANOVA,F=5.62,p=0.001\right)$ . Respondents reported waste management practices being inconsistently applied, with 26% of respondents reporting "never engaging" $\left(X^2=19.6,p<0.001\right)$ . Patient awareness was perceived as low, 47% "strongly disagreeing" that patients understood the environmental impact of ICM use $\left(X^2=16.9,p=0.002\right)$ . Variability in KAPs across European countries was minimal $\left(s^2=0.0068\right)$ .

This survey highlights widespread professional awareness of ICM sustainability issues but reveals variability in institutional practices, limited patient awareness, and inconsistent waste management. Findings emphasise the importance of stronger institutional policies, targeted education, and international collaboration to promote sustainable ICM use.

Question How do healthcare professionals perceive and implement sustainable practices in the use of iodinated contrast media (ICM) within clinical practice? Findings While many institutions endorse sustainability, notable gaps exist in waste management, patient and practitioner education, and consistency of reduction strategies. Critical relevance statement Strengthening institutional frameworks and professional and patient engagement can enhance sustainable ICM use, safeguard resources, and mitigate environmental impact.