Computerised Tomography (CT) scan is one of the most common medical imaging performed in healthcare, Each year, 300 million CT scans are performed globally. Of which, around 180M include use of radiocontrast media (RCM). Contrast Enhanced CTs (CECT) create a significant environmental impact, namely: 42,000 tonnes of single use packaging, 900 Tonnes of surgical steel (needles), 90,000 tonnes of plastic tubing and 150,000,000 kWh in energy consumption. These generate on average 9.2 kg of CO2/ scan. In addition, CECTs generates 200,000 tonnes of iodine contamination in water/yr. This is a recognised form of ‘pharmaceutical pollution’. CECTs may also harm patients: needle insertion, toxicity of iodinated RCMs to kidneys (potentially kidney failure) and allergic reactions, which in some cases can be life-threatening. Healthcare systems are responsible for the 4.4% CO2 global emissions (2 Giga tonnes/yr). Of this, ~3 Mega tonnes/yr are generated from CECTs. The EU has declared its NetZero targets of by 2050 through the European Green Deal. We showed feasibility that artificial intelligence (AI, deep learning methods) can extract high level information from non-contrast CT scans and synthesise contrast ‘digitally’. This avoids the need to administer RCM for CECTs. We seek to develop and validate 5 uses cases of CT ’Digital Contrast’ during this Horizon award. By implementing ‘Digital Contrast’ for scans globally, we aim to reduce 30% of the CO2e and iodine RCM waste generated from CECTs by 2033. NetZeroAICT has a grand vision to define a reference framework for scalable development of AI health tools for a future of sustainable health systems. This builds on our prior efforts of AICT consortium, which was established to make CT imaging safer, more efficient, more equitable and more sustainable. NetZeroAICT will accelerate the EU’s trajectory towards NetZero and advance EU’s globally recognized leadership position on Healthcare sustainability.

Atrial fibrillation (AF), the most common arrhythmia, accounts for 1/3rd of Cardiovascular expenses, with over 10 millions affected in Europe. In addition to significant impact on quality of life, AF exposes patients to stroke, heart failure, dementia and death. AF is the most commonly ablated arrhythmia. The Pulmonary Vein Isolation (PVI) is the cornerstone of AF ablation, preventing recurrences, especially in patients with paroxysmal AF. Catheter ablation of AF uses either radio-frequency (RF) or cryothermal (cryo) energy. Common to these thermal energy sources is their reliance on time-dependent conductive heating/cooling and the fact that these modalities ablate all tissue types indiscriminately. The ablation procedure remains long, requires skills and expertise, and has a limited success rate, mostly because of non-durable lesions after PVI implying frequent redo procedures. And these energies are associated with rare but severe complications due to their thermal nature. The goal of BEAT AF is to disrupt AF ablation by achieving durable PVI with permanent, coalescent and transmural ablation lesions using Pulsed Electric Field (PEF) energy. PEF is non-thermal and creates nanoscale pores in cell membranes. Cardiac cells are highly sensitive to PEF unlike phrenic and oesophageal cells. BEAT AF aims to demonstrate that PEF ablation is faster, more effective and safer (tissue selectivity) than RF or cryo ablation. For this purpose, two distinct randomized clinical trials will be conducted: 1) to provide first comparative evidence of the superiority of PEF over RF on the rate of 1-year recurrence for paroxysmal AF, and 2) to provide first evidence of potential efficacy of PEF on the rate of 1-year clinical recurrence for persistent AF. The BEAT AF consortium gathers 9 European renowned clinical centres (France, Czech Republic, Germany, Austria, Belgium) to set the ground for large trials and contribute to decrease the huge burden of AF in Europe.