Anthropogenic gadolinium in freshwater and drinking water systems

Anthropogenic impact of rare earth elements on groundwater and surface water in the watershed of the largest freshwater lake in China

Limited knowledge exists regarding the potential risks associated with anthropogenic release of rare earth elements (REEs) in the environment. This study aimed to investigate REE signatures in the watershed Poyang Lake, the largest freshwater lake in China. Samples of surface water, wastewater, and groundwater were collected from five rivers discharging into the lake. Results revealed wastewater from wastewater treatment plants contained total REE concentrations from 231 to 904 μg/L, exceeding those found in surface water (0.4 to 1.3 μg/L) and groundwater (0.5 to 416 μg/L). Samples with elevated REE were found in Ca-Mg-Cl/SO4 type waters and exhibited an 18OD deviation from local meteoric water line. Wastewater exhibited a higher positive Gd anomaly compared to surface water and groundwater, attributed to anthropogenic input of Gd (Gdanth). The determined Gdanth concentration ranged from 0.04 to 0.21 μg/L, and from 0.06 to 0.37 μg/L, accounting for 4 % to 21 % and 49 % to 84 % of total Gd concentrations in groundwater and surface water, respectively. Gdanth concentration in wastewater (0.19 to 0.43 μg/L) remained constant in effluent after wastewater treatment. Surface water displayed relatively complex normalized REE patterns influenced by anthropogenic activities and natural processes (weathering and complexation), while groundwater exhibited heavy REEs enrichment, due to carbonate solution complexation. Additionally, Gdanth concentration showed a positive correlation with ΣREE, Pb, Ni, and Co concentrations in groundwater, indicating a good pollution tracing potential. Health risk assessment using the hazard quotient (HQ) suggested higher HQGd values in groundwater compared to surface water. Residents in the eastern part of Poyang Lake were found to face higher risks associated with Gd in groundwater compared to the western part, with infants and children at greater risk than adult males and females. These findings offer valuable insights into environmental behavior and health risks of REEs in aquatic systems impacted by human activities.

Anthropogenic gadolinium contaminations in the marine environment and its ecological implications

Due to the widespread application in medicine and industry of anthropogenic gadolinium (Gdanth), the widespread of Gd anomaly in surface water has leading to disruption of the natural Gd geochemical cycle. However, challenges related to the identification and quantification of Gdanth, assessment of its impacts on marine ecosystems, and exploration of strategies for mitigating its adverse effects still exist. Meanwhile, as the major source of the Gdanth, the environmental geochemical behavior of Gd-based contrast agents (GBCAs), which are used in medical diagnostics in magnetic resonance imaging (MRI), are still poorly understood. In this review, we 1) analyzed Gd anomalies in samples from published literature worldwide, confirmed their prevalence (81.25% for sea and lake water, 72.73% for river water), 2) demonstrated that the third-order polynomial method is the preferred approach for the detection of Gdanth in surface seawater, 3) outlined the species and applications of Gdanth and its impacts on marine environment, 4) explored the process of GBCAs influx into the ocean and demonstrated the concentration of Gdanth in coral samples was mainly affected by terrestrial input GBCAs (63.75%) through Pearson correlation analysis and principle component analysis, 5) proposed effective management strategies for GBCAs at all stages from production to release into the ocean, 6) formulated an expectation for future research on marine Gdanth.

Tracing Gadolinium levels throughout wastewater treatment: Insights from a yearly assessment in northern Spain

Gadolinium (Gd) is a rare earth element (REE) used in the formulation of contrast agents for Magnetic Resonance Imaging (MRI) due to its paramagnetic properties. The growth in population and the improved quality of the healthcare systems over the last years, has promoted the use of MRI as an effective diagnostic tool thus increasing the consumption of gadolinium and its release into the wastewater treatment network. Therefore, the tracking and quantification of this metal in sewage treatment plants and water bodies, is of paramount importance since there are currently no specific rare earth treatment technologies installed in WWTPs, and consequently gadolinium is finally discharged into the environment. In this work, the presence of gadolinium and all other rare earth elements was monitored during a year in three WWTPs in northern Spain (Vuelta Ostrera and San Román in Cantabria and Galindo in País Vasco). These WWTPs are located close to urban centres with hospitals where MRI tests are performed. By tracing Gd throughout the wastewater treatment facilities, its presence was confirmed in water streams, in the order of ng per litter, and in sludge and ashes, in the order of mg per kilogram. A significant human influence was observed, with Gd anomaly values between 3.14 and 79.2 and anthropogenic Gd percentages above 90 %. The presence of Gd in water streams is affected by the sampling period due to the variations of the activity periods of the hospitals nearby the treatment plants. On the contrary, its content in sludge and ashes remains almost constant along the year. The concentration of this metal found in the ashes opens the door to its possible recovery together with other critical raw materials in the context of the circular economy.

Sustainable radiology departments: A European survey to explore radiographers' perceptions of environmental and energy sustainability issues

INTRODUCTION

The environmental impact of radiology and radiotherapy activities is influenced by the energy consumption of equipment, the life cycle of consumables, waste generation, and CO2 emissions caused by staff travel. This study aims to investigate radiographers' perception and knowledge of environmental sustainability issues.

METHODS

An online survey was created and distributed to European radiographers and therapeutic radiographers. The survey questions (n = 43) include demographic data; questions on their perceptions and actions regarding environmental sustainability in healthcare, energy consumption, emissions from staff travel, waste generation from radiological procedures; the role of radiographers in addressing sustainability issues within their departments.

RESULTS

A total of 253 responses were collected from 27 European countries. About their perception on sustainability issues, most participants considered environmental sustainability in healthcare as very important. According to 63.6% (n = 161) of respondents, the energy consumption of radiological equipment is the major source of environmental footprints from radiology activities. Additionally, 44.7% (n = 113) believe that conducting diagnostic examinations remotely could reduce environmental footprints from staff commuting About their actions at workplace, over 70% (n = 192) reported turning off devices after use. Attention to waste recycling is high, but limited to paper, plastic and glass. Contrast agents recycling procedures are implemented by 13% (n = 33). The absence or unawareness of environmental sustainability procedures in the workplace was reported by 66% (n = 167). Radiographers could play an active role in environmental sustainability programs for 243 (96.1%) participants.

CONCLUSION

This study provides a comprehensive overview of European radiographers' knowledge and perceptions concerning environmental sustainability issues. While radiographers recognize the importance of a green radiology department, significant gaps remain in their understanding of eco-friendly initiatives in radiology units' activities.

IMPLICATION FOR PRACTICE

Enhancing radiographers' skills with sustainability expertise could promote a greener culture within radiology departments.

Intramolecular Hydrogen Bonding Based CEST MRI Contrast Agents As an Emerging Design Strategy: A Mini-Review

Intramolecular hydrogen bonding-based chemical exchange saturation transfer magnetic resonance imaging (CEST MRI) contrast agents represent an innovative design strategy aiming to overcome limitations in diamagnetic CEST (diaCEST) MRI contrast agent specificity and also those associated with traditional metal-based MRI contrast agents. Ward and Balaban's proposal of small diamagnetic compounds marked a paradigm shift in contrast-based radiologic research, inspiring extensive investigations since 2000. These contrast agents leverage labile hydrogen bonds, serving as chemical exchange sites to induce saturation of water. The selective manipulation of radiofrequency (RF) allows for optimized signal contrast in soft tissue, with a significant signal amplification even at low probe concentrations, mitigating concerns about dose-dependent toxicities. This mini-review delves into the evolution of CEST MRI, its classification, and the strategic design principles of synthetic small molecules containing intramolecular hydrogen bonds. With a focus on applications and potential clinical relevance, the authors highlight the promising role of intramolecular hydrogen bonding-based CEST MRI in diverse medical contexts, especially renal imaging and pH mapping, paving the way for enhanced molecular imaging capabilities. Ongoing research endeavors aim to further optimize and expand the utility of these contrast agents, underscoring their transformative potential in clinical diagnostics and imaging.

Occurrence of rare earth elements in umbilical cord serum and association with thyroid hormones and birth outcomes in newborns

Rare earth elements (REEs) are emerging contaminants that are increasingly used in high technology products. However, limited information is available regarding exposure to REEs and associated health effects in neonates. This study aimed to investigate the association between REE concentrations and thyroid hormone levels, as well as birth outcomes in 109 newborns in Beijing, China. We measured the concentrations of 16 REEs and thyroid hormones in umbilical cord serum. To assess the impact of exposure to individual REEs and REE mixtures on thyroid hormone levels and birth outcomes, we employed univariate linear regression, least absolute shrinkage and selection operator (LASSO), and weighted quantile sum (WQS) models. We detected 14 REEs at high rates (92.6%-100%), with yttrium exhibiting the highest median (interquartile range) concentration [43.94 (0.33-172.55) ng/mL], followed by scandium [3.64 (0.46-11.15) ng/mL]. Univariate analyses showed that per logarithmic (ln)-unit change of neodymium (Nd) and samarium (Sm) was associated with 0.039 [95% confidence interval (CI): 0.001, 0.007] and 0.031 (95% CI: 0.003, 0.060) increases in free thyroxine (FT4) levels, respectively. Moreover, 14 REEs exhibited significant associations with triiodothyronine (T3) levels, resulting in increases ranging from 0.066 to 0.307. Elevated concentrations of terbium (Tb) [per ln-unit change: -0.021 (95% CI: -0.041, -0.01)] and lutetium (Lu) [-0.023 (95% CI: -0.043, -0.002)] were inversely correlated with birth length in newborns. A further multiple exposure analysis employing the LASSO model identified Sm, Nd, Y, Sc, and Lu as critical factors influencing FT4 and T3 levels. Additionally, WQS analyses showed positive associations between exposure to a mixture of 14 REEs and FT4 (P = 0.046), T3 (P < 0.001), and birth length (P = 0.049). These findings suggest that in utero exposure to REEs might disrupt thyroid hormone homeostasis and impact intrauterine growth. Further studies are warranted to validate these findings and elucidate the underlying mechanisms.

Promoting sustainability activities in clinical radiography practice and education in resource-limited countries: A discussion paper

OBJECTIVE

Urgent global action is required to combat climate change, with radiographers poised to play a significant role in reducing healthcare's environmental impact. This paper explores radiography-related activities and factors in resource-limited departments contributing to the carbon footprint and proposes strategies for mitigation. The rationale is to discuss the literature regarding these contributing factors and to raise awareness about how to promote sustainability activities in clinical radiography practice and education in resource-limited countries.

KEY FINDINGS

The radiography-related activities and factors contributing to the carbon footprint in resource-limited countries include the use of old equipment and energy inefficiency, insufficient clean energy to power equipment, long-distance commuting for radiological examinations, high film usage and waste, inadequate training and research on sustainable practices, as well as limited policies to drive support for sustainability. Addressing these issues requires a multifaceted approach. Firstly, financial assistance and partnerships are needed to adopt eco-friendly technologies and clean energy sources to power equipment, thus tackling issues related to old equipment and energy inefficiency. Transitioning to digital radiography can mitigate the environmental impact of high film usage and waste, while collaboration between governments, healthcare organisations, and international stakeholders can improve access to radiological services, reducing long-distance commuting. Additionally, promoting education programmes and research efforts in sustainability will empower radiographers with the knowledge to practice sustainably, complemented by clear policies such as green imaging practices to guide and incentivise the adoption of sustainable practices. These integrated solutions can significantly reduce the carbon footprint of radiography activities in resource-limited settings while enhancing healthcare delivery.

CONCLUSION

Radiography-related activities and factors in resource-limited departments contributing to the carbon footprint are multifaceted but can be addressed through concerted efforts.

IMPLICATIONS FOR PRACTICE

Addressing the challenges posed by old equipment, energy inefficiency, high film usage, and inadequate training through collaborative efforts and robust policy implementation is essential for promoting sustainable radiography practices in resource-limited countries. Radiographers in these countries need to be aware of these factors contributing to the carbon footprint and begin to work with the relevant stakeholders to mitigate them. Furthermore, there is a need for them to engage in education programmes and research efforts in sustainability to empower them with the right knowledge and understanding to practice sustainably.

Assessing teratogenic risks of gadolinium in freshwater environments: Implications for environmental health

Gadolinium (Gd) is among the rare earth elements extensively utilized in both industrial and medical applications. The latter application appears to contribute to the rise in Gd levels in aquatic ecosystems, as it is excreted via urine from patients undergoing MRI scans and often not captured by wastewater treatment systems. The potential environmental and biological hazards posed by gadolinium exposure are still under investigation. This study aimed to assess the teratogenic risk posed by a gadolinium chelate on the freshwater cnidarian Hydra vulgaris. The experimental design evaluated the impact of pure Gadodiamide (25 μg/l, 50 μg/l, 100 μg/l, 500 μg/l) and its commercial counterpart compound (Omniscan®; 100 μg/l, 500 μg/l, 782.7 mg/l) at varying concentrations using the Teratogenic Risk Index (TRI). Here we showed a moderate risk (Class III of TRI) following exposure to both tested formulations at concentrations ≥ 100 μg/l. Given the potential for similar concentrations in aquatic environments, particularly near wastewater discharge points, a teratogenic risk assessment using the Hydra regeneration assay was conducted on environmental samples collected from three rivers (Tiber, Almone, and Sacco) in Central Italy. Additionally, chemical analysis of field samples was performed using ICP-MS. Analysis of freshwater samples revealed low Gd concentrations (≤ 0.1 μg/l), despite localized increases near domestic and/or industrial wastewater discharge sites. Although teratogenic risk in environmental samples ranged from high (Class IV of TRI) to negligible (Class I of TRI), the low Gd concentrations, particularly when compared to higher levels of other contaminants like arsenic and heavy metals, preclude establishing a direct cause-effect relationship between Gd and observed teratogenic risks in environmental samples. Nevertheless, the teratogenic risks observed in laboratory tests warrant further investigation.

Radiomics-based detection of acute myocardial infarction on noncontrast enhanced midventricular short-axis cine CMR images

Cardiac magnetic resonance cine images are primarily used to evaluate functional consequences, whereas limited information is extracted from the noncontrast pixel-wise myocardial signal intensity pattern. In this study we want to assess whether characterizing this inherent contrast pattern of noncontrast-enhanced short axis (SAX) cine images via radiomics is sufficient to distinguish subjects with acute myocardial infarction (AMI) from controls. Cine balanced steady-state free-precession images acquired at 1.5 T from 99 AMI and 49 control patients were included. First, radiomic feature extraction of the left ventricular myocardium of end-diastolic (ED) and end-systolic (ES) frames was performed based on automated (AUTO) or manually corrected (MAN) segmentations. Next, top features were selected based on optimal classification results using a support vector machine (SVM) approach. The classification performances of the four radiomics models (using AUTO or MAN segmented ED or ES images), were measured by AUC, classification accuracy (CA), F1-score, sensitivity and specificity. The most accurate model was found when combining the features RunLengthNonUniformity, ClusterShade and Median obtained from the manually segmented ES images (CA = 0.846, F1 score = 0.847). ED analysis performed worse than ES, with lower CA and F1 scores (0.769 and 0.770, respectively). Manual correction of automated contours resulted in similar model features as the automated segmentations and did not improve classification results. A radiomics analysis can capture the inherent contrast in noncontrast mid-ventricular SAX cine images to distinguishing AMI from healthy subjects. The ES radiomics model was more accurate than the ED model. Manual correction of the autosegmentation did not provide significant classification improvements.

Comparison of 3T MR arthrography and 3T MRI in intra-articular hip pathology: a cost-analysis

BACKGROUND

MR arthrography (MRA) has previously been the radiological gold standard for investigating labral and chondral lesions of the hip joint. In recent years, 3T MRI has demonstrated comparable accuracy, being adopted as the first-line imaging investigation in many institutions.

AIMS

We compare the associated increased cost and radiation dose of the fluoroscopic component of the MRA compared to MRI.

METHODS

In this retrospective review over 2 years, 120 patients (mean age 27.3 years ± 13.2, range 8-67) underwent 3T MRA or non-contrast 3T MRI. Three musculoskeletal radiologists reported the data independently. Primary objectives included cost-comparison between each and radiation dose of the fluoroscopic component of the MRA. Secondary objectives included comparing detection of pathology involving the acetabular labrum, femoral cartilage, and acetabular cartilage.

RESULTS

Then, 58 (48%) underwent 3T MRA and 62 (52%) patients underwent 3T MRI. The added cost of the fluoroscopic injection prior to MRA was €116.31/patient, equating to €7211.22 savings/year. MRA was associated with a small radiation dose of 0.003 mSv.

CONCLUSIONS

Transitioning from 3T MRA to 3T MRI in the investigation of intra-articular hip pathology increases cost savings and reduces radiation dose.

Diffusion probabilistic versus generative adversarial models to reduce contrast agent dose in breast MRI

BACKGROUND

To compare denoising diffusion probabilistic models (DDPM) and generative adversarial networks (GAN) for recovering contrast-enhanced breast magnetic resonance imaging (MRI) subtraction images from virtual low-dose subtraction images.

METHODS

Retrospective, ethically approved study. DDPM- and GAN-reconstructed single-slice subtraction images of 50 breasts with enhancing lesions were compared to original ones at three dose levels (25%, 10%, 5%) using quantitative measures and radiologic evaluations. Two radiologists stated their preference based on the reconstruction quality and scored the lesion conspicuity as compared to the original, blinded to the model. Fifty lesion-free maximum intensity projections were evaluated for the presence of false-positives. Results were compared between models and dose levels, using generalized linear mixed models.

RESULTS

At 5% dose, both radiologists preferred the GAN-generated images, whereas at 25% dose, both radiologists preferred the DDPM-generated images. Median lesion conspicuity scores did not differ between GAN and DDPM at 25% dose (5 versus 5, p = 1.000) and 10% dose (4 versus 4, p = 1.000). At 5% dose, both readers assigned higher conspicuity to the GAN than to the DDPM (3 versus 2, p = 0.007). In the lesion-free examinations, DDPM and GAN showed no differences in the false-positive rate at 5% (15% versus 22%), 10% (10% versus 6%), and 25% (6% versus 4%) (p = 1.000).

CONCLUSIONS

Both GAN and DDPM yielded promising results in low-dose image reconstruction. However, neither of them showed superior results over the other model for all dose levels and evaluation metrics. Further development is needed to counteract false-positives.

RELEVANCE STATEMENT

For MRI-based breast cancer screening, reducing the contrast agent dose is desirable. Diffusion probabilistic models and generative adversarial networks were capable of retrospectively enhancing the signal of low-dose images. Hence, they may supplement imaging with reduced doses in the future.

KEY POINTS

• Deep learning may help recover signal in low-dose contrast-enhanced breast MRI. • Two models (DDPM and GAN) were trained at different dose levels. • Radiologists preferred DDPM at 25%, and GAN images at 5% dose. • Lesion conspicuity between DDPM and GAN was similar, except at 5% dose. • GAN and DDPM yield promising results in low-dose image reconstruction.

Green radiology: How to develop sustainable radiology

The phenomenon of global warming due to the increased emission of greenhouse gases makes it necessary to raise public awareness about the importance of promoting sustainable practices. The field of radiology is not an exception, as it consumes a large amount of energy and resources to operate equipment and generate images. Green radiology is a sustainable, innovative, and responsible approach in radiology practice that focuses on minimizing the negative environmental effects of the technologies and procedures used in radiology. Its primary goal is to reduce the carbon, water and ecological footprint in our services based on four strategic pillars: decreasing energy, water, and helium usage; properly recycling and/or disposing of waste and residues (including contrast media); minimizing the environmental impact of ionizing radiation; and promoting eco-friendly radiology practices.

Environmental Sustainability and MRI: Challenges, Opportunities, and a Call for Action

The environmental impact of magnetic resonance imaging (MRI) has recently come into focus. This includes its enormous demand for electricity compared to other imaging modalities and contamination of water bodies with anthropogenic gadolinium related to contrast administration. Given the pressing threat of climate change, addressing these challenges to improve the environmental sustainability of MRI is imperative. The purpose of this review is to discuss the challenges, opportunities, and the need for action to reduce the environmental impact of MRI and prepare for the effects of climate change. The approaches outlined are categorized as strategies to reduce greenhouse gas (GHG) emissions from MRI during production and use phases, approaches to reduce the environmental impact of MRI including the preservation of finite resources, and development of adaption plans to prepare for the impact of climate change. Co-benefits of these strategies are emphasized including lower GHG emission and reduced cost along with improved heath and patient satisfaction. Although MRI is energy-intensive, there are many steps that can be taken now to improve the environmental sustainability of MRI and prepare for the effects of climate change. On-going research, technical development, and collaboration with industry partners are needed to achieve further reductions in MRI-related GHG emissions and to decrease the reliance on finite resources. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.

Go Green in Neuroradiology: towards reducing the environmental impact of its practice

Raising public awareness about the relevance of supporting sustainable practices is required owing to the phenomena of global warming caused by the rising production of greenhouse gases. The healthcare sector generates a relevant proportion of the total carbon emissions in developed countries, and radiology is estimated to be a major contributor to this carbon footprint. Neuroradiology markedly contributes to this negative environmental effect, as this radiological subspecialty generates a high proportion of diagnostic and interventional imaging procedures, the majority of them requiring high energy-intensive equipment. Therefore, neuroradiologists and neuroradiological departments are especially responsible for implementing decisions and initiatives able to reduce the unfavourable environmental effects of their activities, by focusing on four strategic pillars-reducing energy, water, and helium use; properly recycling and/or disposing of waste and residues (including contrast media); encouraging environmentally friendly behaviour; and reducing the effects of ionizing radiation on the environment. The purpose of this article is to alert neuroradiologists about their environmental responsibilities and to analyse the most productive strategic axes, goals, and lines of action that contribute to reducing the environmental impact associated with their professional activities.

Contrast Media-driven Anthropogenic Gadolinium: Knowns and Unknowns

Gadolinium-based contrast agents (GBCAs) have augmented the capabilities of MRI, which has led to their widespread and increasing use in radiology practice. GBCAs are introduced into the environment through disposal of unused product and elimination after intravenous injection, both primarily via liquid dispersion into the environment. This human introduction of gadolinium into the environment, referred to as anthropogenic gadolinium, is associated with the detection of gadolinium in water systems, raising concerns for potential adverse impact and prompting certain mitigation actions. This article summarizes the existing knowledge and problem scope, conveys the relevant underlying chemical principles of chelate dissociation, and offers an inferred perspective that the magnitude of the problem is most unlikely to cause human harm. The merits and limitations regarding possible mitigation tactics, such as collecting urine after GBCA administration, use of lower-dose high-relaxivity macrocyclic GBCAs, and the option for virtual contrast-enhanced examinations, will be discussed. Finally, the potential for monitoring gadolinium uptake in bone will be presented, and recommendations for future research will be offered. © RSNA, 2024 See also the article by Ibrahim et al in this issue. See also the article by McKee et al in this issue.

α-Aryl substituted GdDOTA derivatives, the perfect contrast agents for MRI?

Enhancing the performance of Gd3+ chelates as relaxation agents for MRI has the potential to lower doses, improving safety and mitigating the environmental impact on our surface waters. More than three decades of research into manipulating the properties of Gd3+ have failed to develop a chelate that simultaneously optimizes all relevant parameters and affords maximal relaxivity. Introducing aryl substituents into the α-position of the pendant arms of a GdDOTA chelate affords chelates that, for the first time, simultaneously optimize all physico-chemical properties. Slowing tumbling by binding to human serum albumin affords a relaxivity of 110 ± 5 mM-1 s-1, close to the maximum possible. As discrete chelates, these α-aryl substituted GdDOTA chelates exhibit relaxivities that are 2-3 times higher than those of currently used agents, even at the higher fields (1.5 & 3.0 T) used in modern clinical MRI.

Associations of maternal urinary rare earth elements individually and in mixtures with neonatal size at birth

Prenatal rare earth elements (REEs) exposure is linked to unfavorable health consequences. Epidemiologic research on repeated measurements of REEs during gestation correlated with fetal growth is exiguous. Until now, few studies have characterized exposure characteristics of REEs in pregnant women. We aimed to ascertain the characteristics and predictors of REEs exposure over three trimesters among pregnant women and examine the possible effects of prenatal REEs exposure on size at birth. Urinary REEs concentrations exhibited considerable within-subject variation with intraclass correlation coefficients ranging from 0.16 to 0.58. Maternal age, household income, gestational weight gain, passive smoking during pregnancy, parity, and neonatal gender were associated with maternal urinary REEs concentrations. Elevated maternal urinary holmium and thulium concentrations in the 3rd trimester were significantly related to reductions in birth weight. Weighted quantile sum (WQS) regression model identified that urinary REEs mixture in the 3rd trimester were negatively related to birth weight (WQSREEs β = -26.22; 95% confidence interval [CI]: -47.62, -4.82), with holmium (40%) and thulium (24%) receiving the highest weights. Male infants received the most weight (>50%) related to decreased birth weight. This study revealed a significant association between individual and mixture REE exposure in late pregnancy with a reduction in birth weight.

Multivalent Fluorinated Nanorings for On-Cell 19F NMR

The design of imaging agents with a high fluorine content is necessary for overcoming the challenges of low sensitivity in 19F magnetic resonance imaging (MRI)-based molecular imaging. Chemically self-assembled nanorings (CSANs) provide a strategy to increase the fluorine content through multivalent display. We previously reported an 19F NMR-based imaging tracer, in which case a CSAN-compatible epidermal growth factor receptor (EGFR)-targeting protein E1-dimeric dihydrofolate (E1-DD) was bioconjugated to a highly fluorinated peptide. Despite good 19F NMR performance in aqueous solutions, a limited signal was observed in cell-based 19F NMR using this monomeric construct, motivating further design. Here, we design several new E1-DD proteins bioconjugated to peptides of different fluorine contents. Flow cytometry analysis was used to assess the effect of variable fluorinated peptide sequences on the cellular binding characteristics. Structure-optimized protein, RTC-3, displayed an optimal spectral performance with high affinity and specificity for EGFR-overexpressing cells. To further improve the fluorine content, we next engineered monomeric RTC-3 into CSAN, η-RTC-3. With an approximate eightfold increase in the fluorine content, multivalent η-RTC-3 maintained high cellular specificity and optimal 19F NMR spectral behavior. Importantly, the first cell-based 19F NMR spectra of η-RTC-3 were obtained bound to EGFR-expressing A431 cells, showing a significant amplification in the signal. This new design illustrated the potential of multivalent fluorinated CSANs for future 19F MRI molecular imaging applications.

Effects of gadolinium (Gd) and a Gd-based contrast agent (GBCA) on early life stages of zebrafish (Danio rerio)

Gadolinium (Gd) is one of the rare earth elements (REY) and is widely used in magnetic resonance imaging (MRI) contrast agents. Anthropogenic Gd enrichment has frequently been found in wastewater treatment plant effluents in industrialised countries, rising concerns regarding effects on aquatic biota. This study investigates the acute toxicity and sublethal effects of Gd in two forms, as inorganic salt (GdCl3) and as Gd-based contrast agent (GBCA), on early life stages of zebrafish (Danio rerio). Nominal exposure concentrations ranged from 3 to 3000 μg L-1, with an exposure duration of 96 h. None of the two tested compounds were acutely toxic to embryos and larvae. Similarly, we did not observe any effects on larval development and locomotive behaviour. However, we found significant changes in the brain activity of larvae exposed to the highest concentrations of GdCl3 and the GBCA. Our findings show that Gd can have sublethal effects on developing fish at lower concentrations than reported previously, highlighting the necessity of investigating the long-term fate and effects of GBCAs released into the aquatic environment.

A Comprehensive Overview of the Efficacy and Safety of Gadopiclenol: A New Contrast Agent for MRI of the CNS and Body

ABSTRACT

This review describes the pharmacokinetics, efficacy, and safety of gadopiclenol, a new macrocyclic gadolinium-based contrast agent (GBCA) recently approved by the Food and Drug Administration at the dose of 0.05 mmol/kg. Gadopiclenol is a high relaxivity contrast agent that shares similar pharmacokinetic characteristics with other macrocyclic GBCAs, including a predominant renal excretion. In pediatric patients aged 2-17 years, the pharmacokinetic parameters (assessed through a population pharmacokinetics model) were comparable to those observed in adults, indicating no need for age-based dose adjustment. For contrast-enhanced magnetic resonance imaging (MRI) of the central nervous system (CNS) and body indications, gadopiclenol at 0.05 mmol/kg was shown to be noninferior to gadobutrol at 0.1 mmol/kg in terms of 3 lesion visualization parameters (ie, lesion border delineation, internal morphology, and contrast enhancement). Moreover, for contrast-enhanced MRI of the CNS, compared with gadobenate dimeglumine at 0.1 mmol/kg, gadopiclenol exhibited superior contrast-to-noise ratio at 0.1 mmol/kg and comparable contrast-to-noise ratio at 0.05 mmol/kg. A pooled safety analysis of 1047 participants showed a favorable safety profile for gadopiclenol. Comparative studies showed that the incidence and nature of adverse drug reactions with gadopiclenol were comparable to those observed with other GBCAs. Importantly, no significant safety concerns were identified in pediatric and elderly patients, as well as in patients with renal impairment. Overall, these findings support the clinical utility and safety of gadopiclenol for MRI in adult and pediatric patients aged 2 years and older in CNS and body indications.

MRI Gadolinium-Based Contrast Media: Meeting Radiological, Clinical, and Environmental Needs

Gadolinium-based contrast agents (GBCAs) are routinely used in magnetic resonance imaging (MRI). They are essential for choosing the most appropriate medical or surgical strategy for patients with serious pathologies, particularly in oncologic, inflammatory, and cardiovascular diseases. However, GBCAs have been associated with an increased risk of nephrogenic systemic fibrosis in patients with renal failure, as well as the possibility of deposition in the brain, bones, and other organs, even in patients with normal renal function. Research is underway to reduce the quantity of gadolinium injected, without compromising image quality and diagnosis. The next generation of GBCAs will enable a reduction in the gadolinium dose administered. Gadopiclenol is the first of this new generation of GBCAs, with high relaxivity, thus having the potential to reduce the gadolinium dose while maintaining good in vivo stability due to its macrocyclic structure. High-stability and high-relaxivity GBCAs will be one of the solutions for reducing the dose of gadolinium to be administered in clinical practice, while the development of new technologies, including optimization of MRI acquisitions, new contrast mechanisms, and artificial intelligence may help reduce the need for GBCAs. Future solutions may involve a combination of next-generation GBCAs and image-processing techniques to optimize diagnosis and treatment planning while minimizing exposure to gadolinium. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.

Gadolinium Effects on Liposome Fluidity and Size Depend on the Headgroup and Side Chain Structure of Key Mammalian Brain Lipids

The lanthanide metal gadolinium has been used in the healthcare industry as a paramagnetic contrast agent for years. Gadolinium deposition in brain tissue and kidneys has been reported following gadolinium-based contrast agent administration to patients undergoing MRI. This study demonstrates the detrimental effects of gadolinium exposure at the level of the cell membrane. Biophysical analysis using fluorescence spectroscopy and dynamic light scattering illustrates differential interactions of gadolinium ions with key classes of brain membrane lipids, including phosphatidylcholines and sphingomyelins, as well as brain polar extracts and biomimetic brain model membranes. Electrostatic attraction to negatively charged lipids like phosphatidylserine facilitates metal complexation but zwitterionic phosphatidylcholine and sphingomyelin interaction was also significant, leading to membrane rigidification and increases in liposome size. Effects were stronger for fully saturated over monounsaturated acyl chains. The metal targets key lipid classes of brain membranes and these biophysical changes could be very detrimental in biological membranes, suggesting that the potential negative impact of gadolinium contrast agents will require more scientific attention.

The new era hypothesis of coastal degradation: G(s) elements-gallium, gadolinium, and germanium

Mining of precious metals contributes to environmental pollution, especially in coastal areas, and conventional treatment methods are not always effective in removing metal contaminants. Some of these metals, such as gadolinium, germanium and gallium, have caused increasing concern worldwide, as little is known about their current concentrations in the aquatic environment and their biological significance. Therefore, the aim of this study was to determine for the first time the variation of average G(s) concentrations (gallium, gadolinium and germanium) by month/season/site differences along the coast of Istanbul. The ecological risk index was calculated to assess the contamination of seawater and to serve as a diagnostic tool for the mitigation of water pollution. The average distribution G(s) in seawater was in the following order: Ga > Gd > Ge. In addition, the potential ecological risk in the sampling areas ranged from 68 to 1049. Of the three metals, Gd poses the highest ecological risk (grade III). In the spatial distribution of ecological risks, Gd mainly originated from discharges from wastewater treatment plants. Therefore, the sources of the anthropogenic Gd anomaly in wastewater should be identified, as this indicates the possibility of human exposure to potentially harmful anthropogenic compounds.

Ameliorative effect of natural floating island as fish aggregating devices on heavy metals distribution in a freshwater wetland

Growing human population and climate change are leading reasons for water quality deterioration globally; and ecologically important waterbodies including freshwater wetlands are in a vulnerable state due to increasing concentrations of pollutants like heavy metals. Given the declining health of these valuable resources, the present study was conducted to evaluate the effect of natural floating island in the form of fish aggregating devices (FADs) made of native weed mass on the distribution of heavy metals in the abiotic and bio compartments of a freshwater wetland. Lower concentrations of surface water heavy metals were observed inside the FADs with a reduction of 73.91%, 65.22% and 40.57-49.16% for Cd, Pb and other metals (viz. Co, Cr, Cu, Ni and Zn), respectively as compared to outside FAD. These led to 14.72-55.39% reduction in the heavy metal pollution indices inside the FAD surface water. The fish species inside the FADs were also found less contaminated (24.07-25.07% reduction) with lower health risk indices. The study signifies the valuable contribution of natural floating island as FADs in ameliorating the effect of heavy metals pollution emphasizing the tremendous role of the natural floating islands in sustainable maintenance of freshwater wetlands for better human health and livelihood.

Gadolinium accumulation and its biochemical effects in Mytilus galloprovincialis under a scenario of global warming

Electrical and electronic equipment reaching the end of its useful life is currently being disposed of at such an alarmingly high pace that raises environmental concerns. Together with other potentially dangerous compounds, electronic waste contains the rare-earth element gadolinium (Gd), which has already been reported in aquatic systems. Additionally, the vulnerability of aquatic species to this element may also be modified when climate change related factors, like increase in temperature, are taken into consideration. Thus, the present study aimed to evaluate the toxicity of Gd under a scenario of increased temperature in Mytilus galloprovincialis mussels. A multi-biomarker approach and Gd bioaccumulation were assessed in mussels exposed for 28 days to 0 and 10 μg/L of Gd at two temperatures (control - 17 °C; increased - 22 °C). Results confirmed that temperature had a strong influence on the bioaccumulation of Gd. Moreover, mussels exposed to Gd alone reduced their metabolism, possibly to prevent further accumulation, and despite catalase and glutathione S-transferases were activated, cellular damage seen as increased lipid peroxidation was not avoided. Under enhanced temperature, cellular damage in Gd-exposed mussels was even greater, as defense mechanisms were not activated, possibly due to heat stress. In fact, with increased temperature alone, organisms experienced a general metabolic depression, particularly evidenced in defense enzymes, similar to the results obtained under Gd-exposure. Overall, this study underlines the importance of conducting environmental risk assessment taking into consideration anticipated climate change scenarios and exposures to emerging contaminants at relevant environmental concentrations.

Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice

INTRODUCTION

Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research.

METHODS

A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings.

RESULTS

A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel.

CONCLUSIONS

Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare.

IMPLICATIONS FOR PRACTICE

Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.

Artificial Intelligence to Reduce or Eliminate the Need for Gadolinium-Based Contrast Agents in Brain and Cardiac MRI: A Literature Review

ABSTRACT

Brain and cardiac MRIs are fundamental noninvasive imaging tools, which can provide important clinical information and can be performed without or with gadolinium-based contrast agents (GBCAs), depending on the clinical indication. It is currently a topic of debate whether it would be feasible to extract information such as standard gadolinium-enhanced MRI while injecting either less or no GBCAs. Artificial intelligence (AI) is a great source of innovation in medical imaging and has been explored as a method to synthesize virtual contrast MR images, potentially yielding similar diagnostic performance without the need to administer GBCAs. If possible, there would be significant benefits, including reduction of costs, acquisition time, and environmental impact with respect to conventional contrast-enhanced MRI examinations. Given its promise, we believe additional research is needed to increase the evidence to make these AI solutions feasible, reliable, and robust enough to be integrated into the clinical framework. Here, we review recent AI studies aimed at reducing or replacing gadolinium in brain and cardiac imaging while maintaining diagnostic image quality.

Where does the gadolinium go? A review into the excretion and retention of intravenous gadolinium

Gadolinium-based contrast agents (GBCAs) are commonly used in medical imaging. Most intravenously (IV) administered gadolinium is excreted via the kidneys, and pathological retention in renal failure leading to nephrogenic systemic fibrosis (NSF) is well described. More recently, retention of gadolinium in the body in the absence of renal disease has been identified, with unknown clinical consequences. Many patients are aware of this, either through the media or via comprehensive consent documentation. Some internet sites, without hard evidence, have suggested a constellation of possible symptoms associated with GBCA retention. Recent experience with patients ascribing symptoms to a contrast-enhanced MRI examination prompted this review of the fate of injected GBCA after MRI study, and of information available to patients online regarding gadolinium retention.

Image quality assessment using deep learning in high b-value diffusion-weighted breast MRI

The objective of this IRB approved retrospective study was to apply deep learning to identify magnetic resonance imaging (MRI) artifacts on maximum intensity projections (MIP) of the breast, which were derived from diffusion weighted imaging (DWI) protocols. The dataset consisted of 1309 clinically indicated breast MRI examinations of 1158 individuals (median age [IQR]: 50 years [16.75 years]) acquired between March 2017 and June 2020, in which a DWI sequence with a high b-value equal to 1500 s/mm2 was acquired. From these, 2D MIP images were computed and the left and right breast were cropped out as regions of interest (ROI). The presence of MRI image artifacts on the ROIs was rated by three independent observers. Artifact prevalence in the dataset was 37% (961 out of 2618 images). A DenseNet was trained with a fivefold cross-validation to identify artifacts on these images. In an independent holdout test dataset (n = 350 images) artifacts were detected by the neural network with an area under the precision-recall curve of 0.921 and a positive predictive value of 0.981. Our results show that a deep learning algorithm is capable to identify MRI artifacts in breast DWI-derived MIPs, which could help to improve quality assurance approaches for DWI sequences of breast examinations in the future.

Phytoremediation, recovery and toxic effects of ionic gadolinium using the free-floating plant Lemna gibba

The biosorption and recovery of ionic gadolinium (Gd) from contaminated water by the free-floating duckweed Lemna gibba was studied. The highest non-toxic concentration range was determined as (6.7 mg L^-1). The concentration of Gd in the medium and in the plant biomass was monitored and a mass balance was established. Tissue Gd concentration of Lemna increased with increasing Gd concentration of the medium. The bioconcentration factor was up to 1134 and in nontoxic concentrations up to 2.5 g kg^-1 Gd tissue concentration was reached. Lemna ash contained 23.2 g Gd kg^-1. Gd removal efficiency from the medium was 95%, however, only 17-37% of the initial Gd content of the medium accumulated in Lemna biomass, an average of 5% remained in the water, and 60-79% was calculated as a precipitate. Gadolinium-exposed Lemna plants released ionic Gd into the nutrient solution when they were transferred to a Gd-free medium. The experimental results revealed that in constructed wetlands, L. gibba is able to remove ionic Gd from the water and can be suitable for bioremediation and recovery purposes.

Relationship between gadolinium-based MRI contrast agent consumption and anthropogenic gadolinium in the influent of a wastewater treatment plant

Gadolinium-based contrast agents (GBCAs) used in magnetic resonance imaging (MRI) are highly resistant in the environment. They pass through wastewater treatment plants (WWTPs) unhindered escaping degradation. Although GBCAs are subjects of intensive research, we recognized that a quantitative approach to the mass balance of gadolinium, based on known input and output data, is missing. The administered amount of Gd as GBCAs, the number of out- and inpatients and the concentration of rare earth elements (REEs) in wastewater were monitored for 45 days in a medium sized city (ca. 203,000 inhabitants) with two MRI centres. An advection-dispersion type model was established to describe the transport of Gd in the wastewater system. The model calculates with patient locality, excretion kinetics of Gd and the yield of wastewater. The estimated and measured daily amount of anthropogenic gadolinium released to the WWTP were compared. GBCAs (Omniscan and Dotarem) were administered to 1008 patients representing a total of 700 ± 1 g Gd. The amount of total Gd entering the WWTP was 531 ± 2 g, of which the anthropogenic contribution (i.e. GBCAs) was 261 ± 6 g (49 ± 1 % of the total Gd) during the sampling campaign. Local residents and inpatients should fully release Gd in the city, but outpatients only partially. Overall, 37 ± 1 % of the total administered Gd was recovered in the wastewater, so the remaining 63 ± 1 % of administered Gd is expected to be dispensed outside of the sewer system. Our approach enables to better understand the dispersion of GBCAs originated Gd in an urban environment.

Reduction of Gadolinium-Based Contrast Agents in MRI Using Convolutional Neural Networks and Different Input Protocols: Limited Interchangeability of Synthesized Sequences With Original Full-Dose Images Despite Excellent Quantitative Performance

OBJECTIVES

The purpose of this study was to implement a state-of-the-art convolutional neural network used to synthesize artificial T1-weighted (T1w) full-dose images from corresponding noncontrast and low-dose images (using various settings of input sequences) and test its performance on a patient population acquired prospectively.

MATERIALS AND METHODS

In this monocentric, institutional review board-approved study, a total of 138 participants were included who received an adapted imaging protocol with acquisition of a T1w low dose after administration of 10% of the standard dose and acquisition of a T1w full dose after administration of the remaining 90% of the standard dose of a gadolinium-containing contrast agent. A total of 83 participants formed the training sample (51.7 ± 16.5 years, 36 women), 25 the validation sample (55.3 ± 16.4 years, 11 women), and 30 the test sample (55.0 ± 15.0 years, 9 women). Four input settings were differentiated: only the T1w noncontrast and T1w low-dose images (standard setting), only the T1w noncontrast and T1w low-dose images with a prolonged postinjection time of 5 minutes (5-minute setting), multiple noncontrast sequences (T1w, T2w, diffusion) and the T1w low-dose images (extended setting), and only noncontrast sequences (T1w, T2w, diffusion) were used (zero-dose setting). For each setting, a deep neural network was trained to synthesize artificial T1w full-dose images, which were assessed on the test sample using an objective evaluation based on quantitative metrics and a subjective evaluation through a reader-based study. Three readers scored the overall image quality, the interchangeability in regard to the clinical conclusion compared with the true T1w full-dose sequence, the contrast enhancement of lesions, and their conformity to the respective references in the true T1w full dose.

RESULTS

Quantitative analysis of the artificial T1w full-dose images of the standard setting provided a peak signal-to-noise ratio of 33.39 ± 0.62 (corresponding to an average improvement of the low-dose sequences of 5.2 dB) and a structural similarity index measure of 0.938 ± 0.005. In the 4-fold cross-validation, the extended setting yielded similar performance to the standard setting in terms of peak signal-to-noise ratio ( P = 0.20), but a slight improvement in structural similarity index measure ( P < 0.0001). For all settings, the reader study found comparable overall image quality between the original and artificial T1w full-dose images. The proportion of scans scored as fully or mostly interchangeable was 55%, 58%, 43%, and 3% and the average counts of false positives per case were 0.42 ± 0.83, 0.34 ± 0.71, 0.82 ± 1.15, and 2.00 ± 1.07 for the standard, 5-minute, extended, and zero-dose setting, respectively. Using a 5-point Likert scale (0 to 4, 0 being the worst), all settings of synthesized full-dose images showed significantly poorer contrast enhancement of lesions compared with the original full-dose sequence (difference of average degree of contrast enhancement-standard: -0.97 ± 0.83, P = <0.001; 5-minute: -0.93 ± 0.91, P = <0.001; extended: -0.96 ± 0.97, P = <0.001; zero-dose: -2.39 ± 1.14, P = <0.001). The average scores of conformity of the lesions compared with the original full-dose sequence were 2.25 ± 1.21, 2.22 ± 1.27, 2.24 ± 1.25, and 0.73 ± 0.93 for the standard, 5-minute, extended, and zero-dose setting, respectively.

CONCLUSIONS

The tested deep learning algorithm for synthesis of artificial T1w full-dose sequences based on images after administration of only 10% of the standard dose of a gadolinium-based contrast agent showed very good quantitative performance. Despite good image quality in all settings, both false-negative and false-positive signals resulted in significantly limited interchangeability of the synthesized sequences with the original full-dose sequences.

Reducing contrast agent residuals in hospital wastewater: the GREENWATER study protocol

The potential enviromental impact of iodinated (ICAs) and gadolinium-based contrast agents (GBCAs) have recently come under scrutiny, considering the current nonselective wastewater treatment. However, their rapid excretion after intravenous administration could allow their potential recovery by targeting hospital sewage. The GREENWATER study aims to appraise the effective quantities of ICAs and GBCAs retrievable from patients' urine collected after computed tomography (CT) and magnetic resonance imaging (MRI) exams, selecting ICA/GBCA per-patient urinary excretion and patients' acceptance rate as study endpoints. Within a prospective, observational, single-centre, 1-year framework, we will enrol outpatients aged ≥ 18 years, scheduled to perform contrast-enhanced CT or MRI, willing to collect post-examination urine in dedicated canisters by prolonging their hospital stay to 1 h after injection. Collected urine will be processed and partially stored in the institutional biobank. Patient-based analysis will be performed for the first 100 CT and 100 MRI patients, and then, all analyses will be conducted on the pooled urinary sample. Quantification of urinary iodine and gadolinium will be performed with spectroscopy after oxidative digestion. The evaluation of the acceptance rate will assess the "environmental awareness" of patients and will aid to model how procedures to reduce ICA/GBCA enviromental impact could be adapted in different settings. Key points • Enviromental impact of iodinated and gadolinium-based contrast agents represents a growing point of attention.• Current wastewater treatment is unable to retrieve and recycle contrast agents.• Prolonging hospital stay may allow contrast agents retrieval from patients' urine.• The GREENWATER study will assess the effectively retrievable contrast agents' quantities.• The enrolment acceptance rate will allow to evaluate patients' "green sensitivity".

Investigation of anthropogenic gadolinium in tap water of polish cities: Gdańsk, Kraków, Warszawa, and Wrocław

In urban areas where tap water is often produced by a purification of water supplied from a river bank filtration, a significant fraction of gadolinium (Gd) total pool is of an anthropogenic origin. It happens because Gd-based contrast agents used in Magnetic Resonance Imaging (MRI) are not removed during wastewater treatment and they are discharged to the environment and returned to the water cycle. Despite the growing number of MRI examinations worldwide, little is known about the anthropogenic Gd in Polish surface water as well as drinking water. The aim of this pilot study was to gain information about the occurrence of emergent pollution as Gd in potable water available for inhabitants of Polish municipal areas. Tap water samples from Gdańsk, Kraków, Wrocław and Warszawa were analyzed by an inductively coupled plasma quadrupole mass spectrometry after their preconcentration by a seaFAST-pico chromatographic system. In this study, the sum of REE was in the range registered in the drinking waters of European urban regions (usually below 100 ng/L). The highest values of the sum of REE total concentrations were observed in the tap water samples collected in Warszawa (37.7 ng/L) and Wrocław (35.9 ng/L and 32.9 ng/L), where water supplies originate from the Wisła River and Oława River, respectively. The highest total Gd concentration was observed in the tap water of Warszawa city where the anthropogenic Gd fraction represented about 90% of the total Gd. The lowest values of the sum REE were registered in tap waters of Gdańsk (sum of REE below 2.2 ng/L) with up to 17% of the anthropogenic Gd. Thus, our study showed the occurrence of the anthropogenic Gd in all analyzed tap waters.

Intracellular bioaccumulation of the rare earth element Gadolinium in ciliate cells resulting in biogenic particle formation and excretion

Ciliates are abundant unicellular organisms capable of resisting high concentrations of metal ions in the environment caused by various anthropogenic activities. Understanding the cellular pathways involved in resistance to and detoxification of elements is required to predict the impact of ciliates on environmental element cycles. Here, we investigated the so far unknown process of tolerance, cellular uptake and bioaccumulation of the emerging rare earth element gadolinium (Gd) in the common ciliate Tetrahymena pyriformis. Gd treatment results in the intracellular formation and excretion of biogenic Gd-containing particles. This cellular process effectively removes dissolved Gd from the organic growth medium by 53.37% within 72 h. Based on light and electron microscopic observations, we postulate a detoxification pathway: Cells take up toxic Gd³⁺ ions from the medium by endocytosis, process them into stable Gd-containing particles within food vacuoles, and exocytose them. Stable biogenic particles can be isolated, which are relatively homogeneous and have a diameter of about 3 µm. They consist of the elements Gd, C, O, P, Na, Mg, K, and Ca. These findings broaden the view of metal ion accumulation by protists and are of relevance to understand environmental elemental cycles and may inspire approaches for metal recovery or bioremediation.

Clinical validation of the basophil activation test in immediate hypersensitivity reactions to gadolinium-based contrast agents

Gadolinium based contrast agents (GBCAs) are safe compounds globally used in magnetic resonance imaging (MRI). However, in last years it has been detected an increase of immediate hypersensitivity reactions (IHRs) to them. Diagnosis of IHRs to GBCAs is based on clinical symptoms, skin tests (STs) and drug provocation test (DPT). But DPTs are not without risks, thus it is important to implement an in vitro alternative method such as the basophil activation test (BAT). We described the clinical validation of the BAT using ROC curves from a control population formed by 40 healthy individuals without previous reactions to any contrast agents and 5 patients suffering from IHRs to GBCAs. Four patients presented IHRs to gadoteric acid (GA) as the culprit agent and another one to gadobutrol (G). Basophil reactivity was measured in percentage of CD63 expression and in stimulation index (SI). The optimal cut-off with the highest sensitivity (S) and specificity (E) for the GA was of 4.6% at 1:100 dilution (S = 80% and E = 85%; AUC = 0.880, p = 0.006). For the SI with GA, the cut-off of highest sensitivity and specificity was of 2.79 at 1:100 dilution (S = 80% and E = 100%; AUC = 0.920, p = 0.002). Sensitivity did not show differences between STs regarding the BAT (p < 0.05). Moreover, the BAT was able to detect one case with IHR to GA which had negative STs. Therefore, the BAT is a useful method in diagnosis of IHRs to GBCAs.

European fluxes of medical gadolinium to the ocean: A model based on healthcare databases

Marine ecosystems are exposed to a multitude of stresses, including emerging metals as Rare Earth Elements. The management of these emerging contaminants represents a significant environmental issue. For the past three decades, the increasing medical use of gadolinium-based contrast agents (GBCAs) has contributed to their widespread dispersion in hydrosystems, raising concerns for ocean conservation. In order to control GBCA contamination pathways, a better understanding of the cycle of these elements is needed, based on the reliable characterization of fluxes from watersheds. Our study proposes an unprecedented annual flux model for anthropogenic gadolinium (Gd_anth) based on GBCA consumption, demographics and medical uses. This model enabled the mapping of Gd_anth fluxes for 48 European countries. The results show that 43 % of Gd_anth is exported to the Atlantic Ocean, 24 % to the Black Sea, 23 % to the Mediterranean Sea and 9 % to the Baltic Sea. Together, Germany, France and Italy contribute 40 % of Europe's annual flux. Our study was therefore able to identify the current and future major contributors to Gd_anth flux in Europe and identify abrupt changes related to the COVID-19 pandemic.

A Novel Protein for the Bioremediation of Gadolinium Waste

Several hundreds of tons of gadolinium-based contrast agents (GBCAs) are being dumped into the environment every year. Although macrocyclic GBCAs exhibit superior stability compared to their linear counterparts, we have found that the structural integrity of chelates are susceptible to ultraviolet light, regardless of configuration. In this study, we present a synthetic protein termed GLamouR that binds and reports gadolinium in an intensiometric manner. We then explore the extraction of gadolinium from GBCA-spiked artificial urine samples and investigate if the low picomolar concentrations reported in gadolinium-contaminated water sources pose a barrier for bioremediation. Based on promising results, we anticipate GLamouR can be used for detecting and mining REEs beyond gadolinium as well and hope to expand the biological toolbox for such applications.

Fate and Trophic Transfer of Rare Earth Elements in a Tropical Estuarine Food Web

We sampled abiotic and food web components in an impacted estuarine system to assess the transfer and fate of rare earth elements (REE). REE (based on dry weight) were measured in sediments, suspended particulate matter (SPM), and organisms from different trophic levels. The highest ∑REE concentrations were measured in sediments (180 ± 4.24 mg kg^-1) and SPM (163 ± 12.6 mg kg^-1). Phytoplankton (45.7 ± 5.31 mg kg^-1), periphyton (51.6 ± 1.81 mg kg^-1), and zooplankton (68.5 ± 1.27 mg kg^-1) are the major sources of exposure and transfer of REE to the food web. REE concentrations were several orders of magnitude lower in bivalves, crustaceans, and fish (6.01 ± 0.11, 1.22 ± 0.18, and 0.059 ± 0.003 mg kg^-1, respectively) than in plankton. The ∑REE declined as a function of the trophic position, as determined by functional feeding groups and δ¹⁵N, indicating that REE were subject to trophic dilution. Our study suggests that the consumption of seafood is unlikely to be an important source of REE for humans. However, given the numerous sources of dietary introduction of REE, they should be monitored for a possible harmful cumulative effect. This study provides new key information on REE's baseline concentrations and trophic transfers and patterns.

Comparison of different analytical methods for speciation of seven gadolinium-based magnetic resonance imaging contrast agents and the applications in wastewater and whole blood

Three methods, high-performance liquid chromatography hyphenated with inductively coupled plasma mass spectrometry, high-performance liquid chromatography-tandem mass spectrometry, and ion chromatography, were compared for simultaneous speciation of seven commercial gadolinium-based contrast agents for magnetic resonance imaging. Optimizations of experimental conditions for individual method were conducted, respectively. Methods of high-performance liquid chromatography hyphenated with inductively coupled plasma mass spectrometry and high-performance liquid chromatography-tandem mass spectrometry showed the capability of speciation for all seven target compounds, whereas ion chromatography was only suitable for three of them when using electronic conductivity detector. The limits of detection and limits of qualification by the three methods were compared, and high-performance liquid chromatography hyphenated with inductively coupled plasma mass spectrometry was found to be the most sensitive one. The limits of detection for seven target compounds by high-performance liquid chromatography hyphenated with inductively coupled plasma mass spectrometry were in the range of 0.15-0.55 pg. Thus, high-performance liquid chromatography hyphenated with inductively coupled plasma mass spectrometry was chosen as the final method and successfully applied to speciation analysis of seven gadolinium-based contrast agents in wastewater and whole blood. Compounds of gadoxetic acid disodium, gadobenate dimeglumine, gadodiamide, and gadobentetate dimeglumine were found in wastewater.

Dissolved rare earth elements in the Pearl River Delta: Using Gd as a tracer of anthropogenic activity from river towards the sea

Growing demands for high-tech uses of rare earth elements (REE) result in their releases into the aquatic environment, but local anthropogenic sources and water chemistry reactions may vary in aquatic systems. In this study, we quantified the yttrium and REEs (REY) in the surface waters of the Pearl River Delta (PRD), Southern China, and investigated their sources and processes controlling the dissolved REY distributions from rivers towards the sea. Spatial variations of dissolved REY concentrations (<0.4 μm) were observed in the surface water due to both natural and anthropogenic sources. Salt-induced flocculation removed colloidal REY from water during estuarine mixing, particularly at low salinity. In contrast, a significant increase of dissolved REY concentration with salinity suggested the occurrence of REY desorption from particles during estuarine mixing. The PAAS-normalized REE patterns (i.e., filtrates <0.4 μm and <3 kDa) showed a significant light REE (LREE) depletion relative to heavy REE (HREE) in dissolved fractions, indicating reactive LREE adsorption onto particles. Positive Gd anomalies in most waters revealed significant impacts from human activities, such as effluents from wastewater treatment plants in the PRD. In particular, the anthropogenic Gd contributed 90 % of the total dissolved Gd along the Pearl River and was conservatively mixed with saltwater in the estuary via the Humen outlet. Positive Sm anomalies were also observed in the PRD, indicating other point sources related to industrial activity. With the increase of urbanization and high demand for green technology, the REY anomalies could be a good indicator of human activities on assessing their fluxes and impacts on the aquatic systems.

Climate Change, Carbon Dioxide Emissions, and Medical Imaging Contribution

Human activities have raised the atmosphere's carbon dioxide (CO₂) content by 50% in less than 200 years and by 10% in the last 15 years. Climate change is a great threat and presents a unique opportunity to protect cardiovascular health in the next decades. CO₂ equivalent emission is the most convenient unit for measuring the greenhouse gas footprint corresponding to ecological cost. Medical imaging contributes significantly to the CO₂ emissions responsible for climate change, yet current medical guidelines ignore the carbon cost. Among the common cardiac imaging techniques, CO₂ emissions are lowest for transthoracic echocardiography (0.5-2 kg per exam), increase 10-fold for cardiac computed tomography angiography, and 100-fold for cardiac magnetic resonance. A conservative estimate of 10 billion medical examinations per year worldwide implies that medical imaging accounts for approximately 1% of the overall carbon footprint. In 2016, CO₂ emissions from magnetic resonance imaging and computed tomography, calculated in 120 countries, accounted for 0.77% of global emissions. A significant portion of global greenhouse gas emissions is attributed to health care, which ranges from 4% in the United Kingdom to 10% in the United States. Assessment of carbon cost should be a part of the cost-benefit balance in medical imaging.

Technology-critical elements in Rhine sediments - A case study on occurrence and spatial distribution

Despite their presence in almost every technical device, little is known about the occurrence, distribution, and fate of technology-critical elements (TCEs) within the environment. Due to high economic demands and short product lifespans as well as low recycling rates, many TCEs appear to become emerging contaminants. Within the scope of this work, 57 sediment samples from the German part of the Rhine river, as well as various tributaries, were collected to study the occurrence and distribution of TCEs. This specific catchment area has consistently been subjected to strong anthropogenic influences over the last century. Hierarchical cluster analysis, as well as principal component analysis were used to gain first insights into the spatial distribution and possible sources of TCEs along the Rhine. Obtained mass fractions in conjunction with corresponding geoaccumulation indices (I_geo) provide first indications of a possible enrichment along the Rhine for the TCEs of interest (Ga, Ge, Nb, In, Te, rare earth elements, and Ta). Especially the mass fractions of Zn, Ge, In, La, Sm, and Gd exhibit significant anthropogenic inputs. For stations characterized by high Ge and In mass fractions, element fingerprints imply possible atmospheric deposition stemming from e.g. combustion processes. Distinct anomalies of La and Sm most likely originate from discharges located at the city of Worms into the Upper Rhine. Statistical analysis of all analyzed 55 elemental mass fractions revealed similar behavior of TCEs compared to classical heavy metals. Diffuse as well as point sources of TCEs are likely. As a result, this study provides further insight into the role of TCEs as potential emerging contaminants in the environment.

Analytical strategies to measure gadolinium as a wastewater marker in surface and groundwater systems

The increasing use of gadolinium (Gd)-based contrast agents in magnetic resonance imaging and the recalcitrant behavior of Gd during municipal wastewater treatment have led to increased concentrations of the tracer in aquatic environments. These anthropogenic Gd emissions to wastewater and, subsequently, to surface and groundwater systems can be exploited to calculate groundwater travel times and mixing ratios, identify wastewater inputs, and calibrate groundwater models. However, analytical complexity, costs, and the time needed to directly measure anthropogenic inputs hinder the practical use of Gd. While direct measurements with inductively coupled plasma-mass spectrometry (ICP-MS) are highly efficient and feasible, only total Gd can be detected with this approach. In unknown hydrogeological systems, the differentiation between total, anthropogenic, and geogenic Gd by interpolating rare earth element patterns requires complex sample pre-treatment and pre-concentration. Direct measurements of Gd can be obtained using anion-exchange chromatography coupled to ICP-MS but the limit of quantification will be higher. Here we provide guidelines for selecting the optimal method for the analysis of Gd as a wastewater tracer in surface-groundwater systems.•The cost-effectiveness of existing analytical strategies to measure Gd when used as a wastewater tracer in surface-groundwater systems is addressed•A novel analytical strategy for direct determination of total Gd is presented.

Radiology Environmental Impact: What Is Known and How Can We Improve?

The healthcare sector generates approximately 10% of the total carbon emissions in the United States. Radiology is thought to be a top contributor to the healthcare carbon footprint due to high energy-consuming devices and waste from interventional procedures. In this article, we provide a background on Radiology's environmental impact, describe why hospitals should add sustainability as a quality measure, and give a framework for radiologists to reduce the carbon footprint through quality improvement and collaboration.

Cell sorting microbeads as novel contrast agent for magnetic resonance imaging

The success of several cell-based therapies and prevalent use of magnetic resonance imaging (MRI) in the clinic has fueled the development of contrast agents for specific cell tracking applications. Safe and efficient labeling of non-phagocytic cell types such as T cells nonetheless remains challenging. We developed a one-stop shop approach where the T cell sorting agent also labels the cells which can subsequently be depicted using non-invasive MRI. We compared the MR signal effects of magnetic-assisted cell sorting microbeads (CD25) to the current preclinical gold standard, ferumoxytol. We investigated in vitro labeling efficiency of regulatory T cells (Tregs) with MRI and histopathologic confirmation. Thereafter, Tregs and T cells were labeled with CD25 microbeads in vitro and delivered via intravenous injection. Liver MRIs pre- and 24 h post-injection were performed to determine in vivo tracking feasibility. We show that CD25 microbeads exhibit T2 signal decay properties similar to other iron oxide contrast agents. CD25 microbeads are readily internalized by Tregs and can be detected by non-invasive MRI with dose dependent T2 signal suppression. Systemically injected labeled Tregs can be detected in the liver 24 h post-injection, contrary to T cell control. Our CD25 microbead-based labeling method is an effective tool for Treg tagging, yielding detectable MR signal change in cell phantoms and in vivo. This novel cellular tracking method will be key in tracking the fate of Tregs in inflammatory pathologies and solid organ transplantation.