The Environmental Impact of Medical Imaging Agents and the Roadmap to Sustainable Medical Imaging

Medical imaging agents, i.e., contrast agents for magnetic resonance imaging (MRI) and radiopharmaceuticals, play a vital role in the diagnosis of diseases. Yet, they mostly contain harmful and non-biodegradable substances, such as per- and polyfluoroalkyl substances (PFAS), heavy metals or radionuclides. As a result of their increasing clinical use, these agents are entering various water bodies and soil, posing risks to environment and human health. Here, the environmental effects of the application of imaging agents are outlined for the major imaging modalities, and the respective chemistry of the contrast agents with environmental implications is linked. Recommendations are introduced for the design and application of contrast agents: the 3Cs of imaging agents: control, change, and combine; and recent approaches for more sustainable imaging strategies are highlighted. This combination of measures should engage an open discussion, inspire solutions to reduce pollution by imaging agents, and increase awareness for the impact of toxic waste related to imaging agents.