For radiologists iodinated contrast media are essential for diagnostic and interventional procedures. The growing number of CT scans has led to a substantial increase in the use of iodinated contrast media (ICM). As a result, ICMs are increasingly found in surface and drinking water sources with emerging evidence that ICM breakdown products are toxic (1). Commonly used drinking water purification techniques are not sufficiently effective in removing ICM. In some cases this results in the formation of toxic iodinated disinfection by-products. Therefore, iodinated contrast media poses a problem for drinking water preparation that has yet to be solved.

Our objectives are:

To investigate which measures can be taken in the Netherlands for reducing the environmental impact of excreted contrast media in surface and drinking water.

To indicate that the...

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Description of methods about the Dutch chain approach. In the Netherlands we analysed different measures to reduce the environmental impact of excreted contrast media in surface and drinking water.  

The initiative began with the Ministry of Infrastructure and Water Management with the setting up of a national work group. The finding of possible solutions to this problem is now with the major stakeholders – the health sector and water management companies.

We identified the following policies and measures in the Netherlands for reducing the environmental impact of excreted contrast media in surface and drinking water.

Governmental policies

Reducing pharmaceutical residues in water: a chain approach. A national approach jointly launched by the government, the healthcare sector and the (drinking) water sector

The first step towards tackling the problem was getting the various sectors involved to work together. This issue can only be solved through a joint approach, involving measures in the healthcare, pharmaceutical and water treatment sectors. From this, 'the chain approach' document emerged (2,3).  

The second step was to articulate a joint vision; an overarching goal. The joint goal of this approach...

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The environmental impact of iodinated contrast media is an important issue. In the Netherlands, a broad range of action perspectives have been initiated. It started with the national approach jointly launched by the government, the healthcare sector and the (drinking) water sector. This approach has created awareness, started conversations and new initiatives among various stakeholders, such as drinking water companies and health professionals.

Meanwhile, there are many green/environmental teams both in hospitals and overarching at a national level. The number of presentations given at Dutch local and national conferences has risen in the past two years. The Work Group on Sustainability within the Dutch Society for Radiology, has distributed tips and tricks to optimize the utilization and collection of contrast media residues and gives information about the...

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