Evidence map›Paper›PMID 39480535›Full record

Observational studyEuropean radiology2025

The GREENWATER study: patients' green sensitivity and potential recovery of injected contrast agents.

Moreno Zanardo, Federico Ambrogi, Luigi Asmundo, Rosanna Cardani, Giulia Cirillo, Anna Colarieti, Andrea Cozzi, Massimo Cressoni, Isabella Dambra, Giovanni Di Leo and 8 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Review
  3. Observational
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Moreno ZanardoRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy. moreno.zanardo@grupposandonato.it.ORCID http://orcid.org/0000-0001-9640-8534
Federico AmbrogiLaboratory of Biostatistics and Data Management, Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Luigi AsmundoPostgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
Rosanna CardaniBiobank BioCor, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Giulia CirilloRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Anna ColarietiRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Andrea CozziRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Massimo CressoniRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Isabella DambraRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Giovanni Di LeoRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Caterina B MontiPostgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
Leonardo NicoteraDepartment of Radiology, ASST Santi Paolo e Carlo, Milan, Italy.
Francesco PomatiArsChemica S.R.L., Caselle Landi, Italy.
Laura V RennaBiobank BioCor, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Francesco SecchiRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Marco VersuraroBiobank BioCor, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Paolo VitaliRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
Francesco SardanelliRadiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe 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. MATERIALS AND

methodsAfter 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

resultsPatients 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.

conclusionThe 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. KEY POINTS: 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.

Indexed as

Contrast MediaGadoliniumAdultAgedFemaleHumansIodineMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesTomography, X-Ray ComputedWastewaterContrast MediaGadoliniumIodineWastewaterContrast mediaEnvironmental fateGadolinium-based contrast agentsIodinated contrast agentsSustainability

Identifiers

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.