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Environmental sustainability in neurointerventional procedures: a waste audit
  1. Pey Ling Shum1,
  2. Hong Kuan Kok2,3,
  3. Julian Maingard3,4,
  4. Mark Schembri5,
  5. Ramon Martin Francisco Bañez4,
  6. Vivienne Van Damme5,
  7. Christen Barras6,7,
  8. Lee-Anne Slater4,
  9. Winston Chong4,
  10. Ronil V Chandra4,
  11. Ashu Jhamb8,
  12. Mark Brooks5,9,
  13. Hamed Asadi3,4,5,9
  1. 1Monash Health, Clayton, Victoria, Australia
  2. 2Interventional Radiology Service, Department of Radiology, Northern Health, Epping, Victoria, Australia
  3. 3School of Medicine, Deakin University Faculty of Health Medicine Nursing and Behavioural Sciences, Geelong, Victoria, Australia
  4. 4Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
  5. 5Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
  6. 6Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  7. 7South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
  8. 8Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
  9. 9Stroke Division, Florey Institute of Neuroscience and Mental Health – Austin Campus, Heidelberg, Victoria, Australia
  1. Correspondence to Dr Pey Ling Shum, Monash Health, Clayton, VIC 3168, Australia; peylingshum{at}


Background Operating rooms contribute between 20% to 70% of hospital waste. This study aimed to evaluate the waste burden of neurointerventional procedures performed in a radiology department, identify areas for waste reduction, and motivate new greening initiatives.

Methods We performed a waste audit of 17 neurointerventional procedures at a tertiary-referral center over a 3-month period. Waste was categorized into five streams: general waste, clinical waste, recyclable plastic, recyclable paper, and sharps. Our radiology department started recycling soft plastics from 13 December 2019. Hence, an additional recyclable soft plastic waste stream was added from this time point. The weight of each waste stream was measured using a digital weighing scale.

Results We measured the waste from seven cerebral digital subtraction angiograms (DSA), six mechanical thrombectomies (MT), two aneurysm-coiling procedures, one coiling with tumour embolization, and one dural arteriovenous fistula embolization procedure. In total, the 17 procedures generated 135.3 kg of waste: 85.5 kg (63.2%) clinical waste, 28.0 kg (20.7%) general waste, 14.7 kg (10.9%) recyclable paper, 3.5 kg (2.6%) recyclable plastic, 2.2 kg (1.6%) recyclable soft plastic, and 1.4 kg (1.0%) of sharps. An average of 8 kg of waste was generated per case. Coiling cases produced the greatest waste burden (13.1 kg), followed by embolization (10.3 kg), MT (8.8 kg), and DSA procedures (5.1 kg).

Conclusion Neurointerventional procedures generate a substantial amount of waste, an average of 8 kg per case. Targeted initiatives such as engaging with suppliers to revise procedure packs and reduce packaging, digitizing paper instructions, opening devices only when necessary, implementing additional recycling programs, and appropriate waste segregation have the potential to reduce the environmental impact of our specialty.

  • angiography
  • arteriovenous malformation
  • coil
  • intervention
  • thrombectomy

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  • Contributors Study concepts/study design, all authors; data acquisition or data analysis/interpretation, PLS, VVD; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agree to ensure any questions related to the work are appropriately resolved, all authors.

  • Funding This study was not supported by any funding.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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