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Metabolically inert and excreted in urine, treatment plants (WWTP) have difficulty removing CM from wastewater and CM increasingly emerge as environmental contaminants. This study evaluates the effect of urine-collection bag (UCB) distribution on corresponding CM load in WWTP influent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This prospective observational multicenter study includes patients scheduled for contrast-material-enhanced computed tomography (iodine-CM) or magnetic resonance imaging (gadolinium-CM) at an academic and a regional hospital. At each centre, data were collected over a 3-week control-period and a 3-week intervention-period with standard-clinical-care UCB distribution (4pp). Control and intervention were compared for cumulative iodine- and gadolinium-CM-loads in WWTP influent using linear regression analysis, corrected for administered CM. Compliance was evaluated in interviews with consenting patients; results were used to estimate achievable UCB-distribution effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      UCB were distributed to 69.1% (1188\/1719) eligible patients, and had a statistically significant effect on WWTP influent CM-loads: intervention versus control \u221217.4% iopromide [F(1,37)\u2009=\u200954.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.60;\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.966]; \u221214.8% ioversol [F(1,37)\u2009=\u2009154.5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.82;\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.989]; \u22127.2% gadolinium at the academic hospital [F(1,37)\u2009=\u200943.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.54,\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.967]; \u221233.2% gadolinium at the regional hospital [F(1,37)\u2009=\u20091.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.296,\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.03]. Interviews were conducted with 47.0% (558\/1188) patients: 92.1% (514\/558) reported using UCB, and they used 89.2% (1834\/2056) of the UCB they were provided with. Compliance-based estimates were: achievable compliance 29.9% to 43.6%, interceptable CM 26.7% to 38.9%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>UCB distribution had a significant but small impact on reducing wastewater CM-loads. Compliance data overestimate UCB-distribution effect, which underscores the importance of wastewater measurements when evaluating mitigation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Contrast materials (CM) increasingly emerge as environmental contaminants; because treatment plants are currently unable to remove CM from wastewater, the effects of urine-collection-bag distribution are evaluated<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Standard-care urine-collection-bag distribution after CT and MRI led to small but significant CM-load reductions in wastewater; compliance data, however, led to sizeable overestimation of (achievable) effects<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Urine-collection bag distribution had a significant but small impact on reducing contrast materials in wastewater. Most studies only include compliance data, but results show these overestimate impact, underscoring the importance of contrast-load measurements when evaluating mitigation strategies<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11984-5","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T16:50:08Z","timestamp":1760719808000},"page":"2353-2366","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of distributing urine-collection bags on contrast-material load in wastewater"],"prefix":"10.1007","volume":"36","author":[{"given":"Ben J. 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