The effects of climate change and environmental disaster are no longer confined to news headlines or speculation. Take, for example, this week’s air quality advisory in Madison – the result of smoke from Canadian wildfires. These realities emphasize the need to prioritize sustainability in medical practice.
Currently, the American healthcare industry consumes close to 10% of the total commercial energy used in the United States and accounts for about 8% of national carbon emissions. Of the 14,000 tons of waste generated in the United States’ health care facilities each year, upwards of 25% is plastic – most of which is not recycled.
“As radiologists and stewards to future medical healthcare generations, it’s critical to not only increase awareness about hospital waste but make impactful and relatively swift changes to our current practices,” says Giuseppe Toia, MD. “Green radiology is an effective way to implement such change into our daily work life and I believe it should be part of every department’s mission.”
Contrast-enhanced CT scans comprise a significant proportion of modern-day imaging practice. Shortly after Dr. Toia’s start at UW in August 2021, the Department invested in a few multiuse-syringeless CT injectors (MUSI). In the typical contrast-enhanced CT exam workflow iodinated intravenous contrast is packaged in single-use plastic vials and injected via single-use syringe-based injectors. Using multiple smaller-volume vials generates significant waste of plastic, contrast, saline – and even time.
“We hypothesized that such a technology, if implemented correctly, should provide improved CT technologist workflow efficiencies while cutting down on waste,” explains Dr. Toia. The possible savings could be substantial, especially for a large medical enterprise like UW Health.
To test that hypothesis, Dr. Toia assembled a team that included medical physicist Timothy Szczykutowicz, PhD, fellow radiologist Meghan Lubner, MD, technologists Carrie Bartels, Rachel Bladorn, and Kelsey Schluter, engineering undergraduates Zita Brown and Dominic Dovalis, and Medical Physics PhD alumnus Sean Rose.
“This project is a combined effort between all the listed authors,” says Dr. Toia, referencing the recent article in Academic Radiology. “It could not come to fruition without the contributions of them all.”
The team measured and compared consumable waste over a 4-month period and time spent by 15 CT technologists (using either single-use injectors or MUSI) over three clinical workdays. Their findings are striking: With MUSI, contrast, plastic, and total waste were reduced by 100%, 84.5% and 77.6%, respectively. In addition, technologists spent 40.5 seconds less per exam. At a medical institution like UW, the savings add up fast.
“On average, we scan between 30 to 45 patients on a single scanner during a typical workday,” says Dr. Toia. “For a 30-patient workday, this would equate to 101.3-minute time savings per scanner over a 5-day workweek.” As technologists become more accustomed to the new injector, they may become even more efficient.
Reducing contrast usage isn’t just good for the environment. As a result of the Covid-19 pandemic, mass production of iohexol – the iodinated contrast product occupying the majority of market size – came to a halt. At UW, the new injectors allowed clinical service to proceed efficiently despite a limited supply of contrast.
This technology will be permanently integrated into the CT workflow at UW. In fact, the CT leadership team has budgeted to release the remainder of our existing single-use syringe-based CT injectors in the next few years.
For now, the article has the field’s attention, with coverage by Aunt Minnie and Health Imaging. UW hopes to be a leader in the implementation of sustainable practices in radiology.
“Ominous news stories about irreversible temperature averages and melting artic glaciers may make many feel hopeless about starting new green initiatives, but small changes add up, especially if most of our population participates,” says Dr. Toia.