The Environmental Cost of Contrast Media: New Medicare Data Reveals a Growing Challenge for Radiology

A growing body of research is drawing attention to an often overlooked issue in diagnostic imaging: the environmental impact of contrast media. New findings published in JAMA Network Open show that contrast agents used in CT and MRI imaging place a significant and measurable burden on ecosystems, prompting experts to call for stronger contrast stewardship across the healthcare system.

How much contrast is being used in the Medicare population?

The study examined contrast utilization among Medicare beneficiaries between 2011 and 2024. Over this 13-year period, patients in this population received an estimated 13.5 billion milliliters of contrast media. Most of this volume came from iodinated contrast used in CT scans, while gadolinium-based contrast agents accounted for around five percent of total use. Researchers noted that this reflects only the Medicare fee-for-service population. The true national volume is significantly higher when including Medicare Advantage and commercial insurance.

Why are experts concerned?

Contrast agents do not fully break down in the human body. After administration, they enter wastewater systems, where they can persist and accumulate in rivers, lakes, and drinking water supplies. Both iodine and gadolinium are non-renewable resources, and ongoing exposure raises legitimate concerns about long-term ecological impact. Florence Doo, MD, MA, the study’s lead author, emphasized that understanding the specific imaging exams responsible for the greatest contrast burden is essential for developing sustainable stewardship strategies.

What did the researchers analyze?

The team used Medicare Part B fee-for-service claims from 2011 to 2024 to assess exam volume, contrast type, dosing levels, and changes in utilization related to major events such as the COVID-19 pandemic. The dataset covered 169.3 million contrast-enhanced imaging studies across 82 CPT codes. CT imaging of the abdomen and pelvis generated the largest amount of iodinated contrast at more than 4.4 billion milliliters, while MRI of the brain accounted for roughly 221 million milliliters of gadolinium-based contrast during the same period.

How has contrast use changed over time?

The study found consistent growth in contrast use beginning in 2014. Between 2014 and 2019, iodinated contrast use increased by more than five percent per year, and gadolinium use rose by three and a half percent annually. Usage declined sharply during 2020 due to the pandemic, then rebounded quickly in 2021 and stabilized by 2024. A small subset of procedures accounted for the vast majority of usage, with six CT exams responsible for most iodinated contrast and seven MRI exams driving the majority of gadolinium use.

What solutions are experts proposing?

The authors identified several opportunities for the imaging community to reduce unnecessary contrast use and limit environmental impact. Reducing inappropriate or duplicative imaging can make an immediate difference, as can adopting weight-based dosing to avoid excessive administration. More efficient vial management can reduce waste. The researchers also highlighted promising innovations on the horizon. Artificial intelligence may eventually support virtual contrast imaging that replicates enhancement without the need for physical contrast agents. Biodegradable contrast agents and expanded use of ultrasound microbubble technologies are also being explored as potential long-term solutions. Although still under development, these approaches could reduce chemical waste, improve sustainability, and lower patient exposure.

Why this matters for imaging centers

The environmental impact of contrast media is becoming an important operational and ethical consideration in radiology. Understanding where contrast is used most heavily helps imaging centers identify opportunities to adjust protocols without compromising diagnostic accuracy. As lower-dose agents and novel alternatives emerge, radiology teams will also need reliable supervision models, consistent communication pathways, and strong pediatric and adult safety protocols to maintain high-quality care.

How Tether Supervision supports contrast stewardship and safer workflows

Tether Supervision plays an important role in helping imaging centers adapt to modern contrast stewardship demands. Through real-time radiologist oversight during contrast administration, Tether supports technologists and on-site teams and ensures immediate access to expert guidance during adverse reactions. The platform’s scale also provides meaningful experience. With more than 85 imaging centers relying on Tether and over 45,000 hours of supervised contrast exams completed, the organization has developed one of the most robust virtual supervision networks in the United States. This expertise helps imaging teams standardize their contrast protocols, reduce avoidable repeat imaging, and stay aligned with CMS and ACR supervision requirements while also supporting the long-term shift toward safer and more sustainable contrast use.

Looking ahead

Radiology is entering a period in which contrast stewardship, environmental responsibility, and patient safety increasingly intersect. The Medicare data make it clear that contrast use has grown at a scale large enough to warrant national attention. With better information and emerging technologies, imaging providers can take meaningful steps toward reducing waste while maintaining diagnostic performance. Tether Supervision continues to support this transition by providing the oversight, consistency, and clinical guidance needed to adapt safely to new contrast practices.

Read the full study on the JAMA Network: here.