Iopamidol (IPM), as a typical recalcitrant emerging pollutant and precursor of iodinated disinfection by-products (I-DBPs), is unsuccessfully removed by conventional wastewater treatment processes. This study comprehensively evaluated the ozone/peracetic acid (O
3/PAA) process for IPM degradation, focusing on degradation kinetics, environmental impacts,
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Iopamidol (IPM), as a typical recalcitrant emerging pollutant and precursor of iodinated disinfection by-products (I-DBPs), is unsuccessfully removed by conventional wastewater treatment processes. This study comprehensively evaluated the ozone/peracetic acid (O
3/PAA) process for IPM degradation, focusing on degradation kinetics, environmental impacts, transformation products, ecotoxicity, disinfection byproducts (DBPs), and microbial inactivation. The O
3/PAA system synergistically activates PAA via O
3 to generate hydroxyl radicals (
•OH) and organic radicals (CH
3COO
• and CH
3CO(O)O
•), achieving an IPM degradation rate constant of 0.10 min
−1, which was significantly higher than individual O
3 or PAA treatments. The degradation efficiency of IPM in the O
3/PAA system exhibited a positive correlation with solution pH, achieving a maximum degradation rate constant of 0.23 min
−1 under alkaline conditions (pH 9.0). Furthermore, the process demonstrated strong resistance to interference from coexisting anions, maintaining robust IPM removal efficiency in the presence of common aqueous matrix constituents. Furthermore, quenching experiments revealed
•OH dominated IPM degradation in O
3/PAA system, while the direct oxidation by O
3 and R-O
• played secondary roles. Additionally, based on transformation products (TPs) identification and ECOSAR predictions, the primary degradation pathways were elucidated and the potential ecotoxicity of TPs was systematically assessed. DBPs analysis after chlorination revealed that the O
3/PAA (2.5:3) system achieved the lowest total DBPs concentration (99.88 μg/L), representing a 71.5% reduction compared to PAA alone. Amongst, dichloroacetamide (DCAM) dominated the DBPs profile, comprising > 60% of total species. Furthermore, the O
3/PAA process achieved rapid 5–6 log reductions of
E. coli. and
S. aureus within 3 min. These results highlight the dual advantages of O
3/PAA in effective disinfection and byproduct control, supporting its application in sustainable wastewater treatment.
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