Enhancing Sustainability in Contrast Media Use: Knowledge, Implementation and Training for Radiologic Technologists

Abstract

Iodinated contrast media (ICM) are vital for computed tomography and other diagnostic imaging, but their use raises concerns about environmental contamination, dependence on limited iodine resources, rising costs, and supply-chain risks. Radiologic technologists are central to contrast preparation, administration, and protocol implementation. However, there is limited evidence on their knowledge and practices regarding sustainable contrast use in low- and middle-income countries. This study aims to assess knowledge, self-reported practices, training exposure, institutional support, and perceived barriers to sustainable contrast media use among radiologic technologists in Nepal. A cross-sectional online survey was administered to Nepal Health Professional Council–registered radiologic technologists employed in government, teaching, and private imaging facilities. The structured questionnaire evaluated knowledge and awareness, contrast-related practices, training exposure, institutional provisions, environmental considerations, and perceived barriers. Knowledge was defined as the correct identification of weight-based contrast dosing as a sustainable practice. A composite practice score (0–3) assessed renal function evaluation, use of weight-based dosing, and involvement in contrast selection. Data were analyzed using descriptive statistics and chi-square tests. Of 205 respondents, 92.2% demonstrated good knowledge and 82.9% reported good practice (11.2% moderate, 5.9% poor). Renal function assessment prior to contrast administration (97.6%) and weight-based dosing (94.6%) were commonly reported, and 84.4% were involved in selecting contrast type and dose. Awareness that contrast media can pollute water resources was 76.1%, and support for eco-friendly institutional policies was 92.2%. However, only 16.6% had received training on contrast sustainability and 29.3% reported an institutional disposal protocol, despite 91.7% expressing willingness to attend training. Previous training was associated with knowledge (p = 0.046) but not practice (p = 0.259). Radiologic technologists in Nepal show high knowledge and generally favorable self-reported practices in sustainable contrast media use, despite limited formal training and inconsistent institutional support. Targeted education, practical guidelines, and stronger organizational systems may support the adoption of more sustainable, environmentally responsible imaging services.