The advancement of contrast agents in radiology is significantly influencing the trajectory of medical imaging, integrating cutting-edge technology with sustainable practices. At the European Congress of Radiology, experts explored the key advancements, including strategies for minimising iodine contamination and the introduction of novel hyperpolarised agents. Additionally, the growth of photon counting CT technology was discussed, highlighting its potential to enhance image quality and reduce radiation dose.
Innovation in Sustainability of Contrast Agents
Andrew England, a Senior Lecturer in Medical Imaging at University College Cork and former EFRS President, discussed the sustainability challenges of contrast agents in radiology. He highlighted the rising demand for contrast media, ongoing supply shortages, and environmental concerns, particularly iodine contamination in wastewater. England explored strategies for reducing contrast usage, including weight-based dosing, alternative agents, and AI-generated synthetic imaging. He emphasised the importance of sustainable solutions: "Contrast media supply challenges are likely to continue to grow." Recycling initiatives, such as the Green Water project, could play a critical role in managing contrast agent waste.
New Frontiers with Hyperpolarised Contrast Media in MR Imaging
Ferdia Aidan Gallagher discussed the future of hyperpolarised contrast agents in MRI, highlighting their emerging clinical applications and experimental advancements. He explained that MRI’s strength lies in its ability to identify molecules non-invasively but suffers from low sensitivity. Hyperpolarisation addresses this by significantly enhancing signal detection, with some techniques increasing sensitivity by factors of 10,000 to 100,000.
Gallagher detailed two key technologies: hyperpolarised gases (e.g., xenon-129) and dynamicnuclear polarisation (DNP) with carbon-13-labelled molecules. Hyperpolarised gases are already used in conditions like cystic fibrosis and COPD, allowing detailed imaging of lung function and treatment response. In contrast, DNP is still experimental but shows promise in oncology, enabling real-time tracking of tumour metabolism and early therapy response.
One major application is in tumour stratification, distinguishing aggressive from less aggressive cancers. "We’re here to see the tigers from the pussycats of prostate cancer," he noted. Additionally, early treatment response can be assessed within days, potentially revolutionising patient management.
Gallagher concluded by acknowledging the challenges of cost and specialised equipment but emphasised the transformative potential of hyperpolarised contrast agents in oncology, neurology and cardiology.
Optimising contrast agent utilisation within photon counting CT
Ronald Booij discussed advancements in ultra-high-resolution CT imaging and the benefits of iodinated contrast agents. He highlighted how optimised radiation dosing and photon counting technology enhance image quality while minimising artefacts. "You have ultra-high resolution, and that's of benefit also when using iodinated contrast."
He explained that reducing KAV levels improves contrast but increases blooming artefacts, requiring careful protocol adjustments. While alternative contrast materials like tungsten show promise for improving attenuation and reducing artefacts, they are not yet available for clinical use.
The session concluded with insights on balancing contrast enhancement, artefact reduction, and sustainability in imaging protocols.
As the demand for contrast agents increases, the industry faces critical challenges related to supply chain limitations, ecological sustainability and economic feasibility. Advanced solutions such as AI-driven optimisation strategies, hyperpolarisation techniques and photon-counting CT technology present viable avenues for achieving enhanced efficiency and sustainability in imaging practices.
Source & Image Credit: ECR 2025
