EcoRad: Why Sustainable Radiology Can Also Boost the Bottom Line
A combined focus on the ecology and economics of radiology can improve patient care, profitability and planetary health
Many radiologists are interested in sustainable radiology, but perceived economic barriers often get in the way of broader adoption, according to Benjamin Northrup, MD, associate professor of radiology at the Mallinckrodt Institute of Radiology in St. Louis.
Dr. Northrup is lead author of an article in BJR Open that challenges the idea that these barriers present insurmountable obstacles.
He and his coauthors coined the term “EcoRad” to emphasize the shared “eco” root of ecology and economics, highlighting how the two align. The term also reflects a wide range of departmental initiatives that deliver both ecologic and economic benefits.
“The practical point of EcoRad is simple,” explained co-author Reed A. Omary, MD, MS, a professor of radiology and biomedical engineering at Vanderbilt University in Nashville. “Reducing waste often lowers costs, improves efficiency and strengthens patient care. Put another way: high-quality radiology practices have the least waste.”
However, the persistence of these perceived barriers is often driven by cognitive bias, the authors note.
Understanding the interplay of ecology and economics is key to avoiding roadblocks such as status quo bias, in which radiology leaders might prefer the status quo because it feels safer and requires less cognitive or financial investment.
Bias can also show up as the sunk cost fallacy, Dr. Northrup noted, when institutions continue using inefficient equipment or workflows because they have already invested heavily in them. “In doing so, we may overlook ongoing hidden costs—both financial and environmental—that can exceed the cost of pivoting,” he said.
Prioritizing short-term profit and growth over long-term gains is another barrier, according to co-author Kate Hanneman, MD, MPH, vice chair and associate professor in the Department of Medical Imaging at the Temerty Faculty of Medicine, University of Toronto and University Health Network in Toronto, and deputy lead of sustainability at the University Health Network’s Joint Department of Medical Imaging at Toronto General Hospital.
“One of the biggest barriers to sustainable radiology is the belief that it costs more,” Dr. Hanneman said. “Biases persist because they make sustainable choices feel expensive when this is not necessarily true. The way through is to make the hidden value visible.”
Once leaders see that the responsible option is usually the financially sound one, the resistance tends to fade, she said.
Starting on the Road to Sustainability
How does an institution adopt an EcoRad approach?
“Start by measuring,” Dr. Hanneman said. “Looking at emissions by imaging modality, we found that a small number of modalities account for most of a department’s footprint, so knowing your own numbers tells you exactly where to focus.”
Tools such as life cycle assessment can quantify environmental and financial advantages side-by-side, she added. “Reducing energy use on MRI, for example, lowers both emissions and costs while expanding imaging capacity,” Dr. Hanneman said.
Efficiency improvements are often the fastest path to sustainability, Dr. Northrup noted. “Reducing unnecessary imaging, optimizing workflows to reduce patient travel and increase patient throughput and switching off monitors at night are not only good for the planet, but they also have the potential to help alleviate the current workforce shortage and reduce burnout while lowering overhead costs, increasing patient safety and bettering the patient experience.”
Beyond these immediate steps, broader frameworks can support long-term change. The authors point to “Green Lean Six Sigma,” a framework to improve operational efficiency by optimizing resource use, patient outcomes and profitability. They further recommended “green budgeting,” which tracks both the direct financial and indirect environmental costs related to energy use, resource depletion and waste generation.
Value-based care can further reinforce these efforts by aligning financial incentives with patient outcomes, sustainability and efficiency, the authors note.
Dr. Hanneman emphasized keeping patients at the center of this work. “A lot of sustainability conversations start with carbon, but I believe that a health-centered framework is essential because reducing radiology's environmental impact and improving patient care are inseparable,” she said. “The feedback loop makes that concrete. Sustainable radiology is better for patients and for the planet.”
Dr. Northrup urged radiologists to embrace EcoRad’s “triple bottom line.”
“All three components are important, but there is an order of importance: patient, planet, profits,” he said. “Although the economic component is listed last, improvements in patient care and environmental sustainability will in turn yield economic benefits for radiology practices.”
“Radiology has a significant influence on the environmental impact and economic outcomes of hospital systems, because medical imaging is a prominent source of emissions and radiology is a major profit center for most systems,” Dr. Northrup said. “Our specialty is well-positioned to be a leader in the circular economy and to partner with industry to design imaging equipment and supplies with sustainability in mind.”
For More Information
Access the BJR Open article, “EcoRad: Sustainable Radiology and the Ecology of Economics.”
Read RSNA News stories on sustainability in radiology: