Embedding Sustainability Into the Imaging and Care of Patients with Cancer
New roadmap urges radiology teams to cut emissions without compromising care
As radiology weighs its climate footprint, a new “Roadmap 2030” proposes nine steps imaging and interventional practices can take by 2030 to mitigate the environmental impact of cancer imaging and treatment.
A review featured in Radiology: Imaging Cancer by Benjamin Northrup, MD, and his team suggests that sustainability in cancer imaging encompasses much more than just radiology’s usual emphasis on electricity consumption.
“Most sustainability efforts in radiology focus primarily on energy usage. But when it comes to oncologic imaging and cancer treatment, the range of considerations expands significantly,” explained Dr. Northrup, an associate professor of radiology at the Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis.
Among the threats posed by climate change, an increased risk of cancer is not typically top of mind. But experts around the globe are beginning to assess the unique ways in which imaging of patients with cancer impacts the environment—and vice versa.
The roadmap reflects growing attention to that two-way relationship and the need for clearer sustainability priorities in cancer imaging and treatment.
The Climate Change-Cancer Link
Climate change and cancer are locked in a vicious circle: the risk of cancer increases with exposure to environmental pollutants, while increased cancer rates lead to an increased use of imaging and image-guided treatments, which can in turn negatively impact the environment.
Dr. Northrup and his colleagues cited studies showing that climate change directly increases skin cancer risk and how air pollution—driven by fossil fuel combustion—can penetrate deep into the respiratory tract, causing lung cancer. Climate-related severe weather adds another layer of risk, potentially worsening outcomes by delaying and disrupting care.
“While the sustainability of cancer imaging and interventions is a ‘young field’ of research, we know it consumes significant energy. It also generates waste from interventional procedures, radiation oncology, nuclear medicine and the growing field of theranostics.”
— BENJAMIN NORTHRUP, MD
Oncology care generates toxins that can potentially affect patients and healthcare workers, including the incineration of chemotherapy agents, imaging contrast agents, including both iodine and gadolinium, released into the water supply, and the use of sterilization agents.
While healthcare accounts for up to 10% of US greenhouse gas (GHG) emissions, medical imaging itself accounts for nearly 1% of the world’s carbon footprint.
The primary sources of radiology-produced GHGs include electricity and the supply chain. However, the level of GHG emissions related to oncologic diagnostics and treatments are mostly unmeasured beyond external beam radiation, which has reduced its CO2 emissions through hypofractionated radiation therapy (RT).
“While the sustainability of cancer imaging and interventions is a ‘young field’ of research, we know it consumes significant energy,” Dr. Northrup said. “It also generates waste from interventional procedures, radiation oncology, nuclear medicine and the growing field of theranostics.”
A 2030 Plan for Cleaner Cancer Care
“Roadmap 2030” groups actions into near-term operational changes, longer-term equipment and supply chain shifts, and research priorities needed to create benchmarks and measure progress.
The authors call for practices to build sustainability principles into operations and medical education. These include development and application of lower-impact technology, expansion of green laboratories and funding research to strengthen the evidence base, and a push for policy changes that support decarbonization.
Easy wins within Roadmap 2030 include reducing energy use and tightening waste management. Dr. Northrup and colleagues recommend purchasing refurbished equipment, which can help radiology practices cut carbon emissions and costs simultaneously.
“In terms of low-hanging fruit, some of the easiest and biggest impact actions to improve sustainability are shutting down imaging equipment and computers overnight,” said co-author Kate Hanneman, MD, MPH, from the Department of Medical Imaging at the Temerty Faculty of Medicine, University of Toronto and University Health Network in Toronto. “We also recommend automating low-power modes between scans, going into low-power mode between examinations, and shutting down CT scanners and MRIs overnight when possible.”
More complex issues tackled by Roadmap 2030 include managing hazardous materials, reducing the use of single-use plastics and properly recycling them, and manufacturing imaging systems designed to last longer—each of which requires collaboration with vendors.
“We’re beginning to see a greater commitment from radiology equipment manufacturers to make CT and MRI units that are more efficient and last longer, and to manufacture sealed MRI systems that reduce helium waste,” Dr. Northrup said. “For other sustainability initiatives, it will come down to vendor and institutional investment in research and development of reusable materials and more efficient equipment. Hospitals should be willing to take an upfront risk and buy newer, sometimes more expensive equipment with the hope the investment will pay off.”
Roadmap 2030 also includes longer-term, collaborative efforts to generate additional research, including life cycle assessments (LCAs) and other metrics that will provide benchmarks for evaluating sustainability initiatives.
“Despite oncology’s large share of NIH funding, there are very few comprehensive LCAs in radiology,” Dr. Northrup said. “RSNA is the natural place to incubate this work and to incorporate sustainability into cancer imaging and cancer research more broadly.”
Dr. Northrup said that linking robust data on sustainability initiatives to real cost savings, especially amid rapidly escalating Medicare costs, should help pave the way for policy and regulatory changes.
Although there are many steps radiology practices can take to make oncological care more sustainable while simultaneously reducing costs, Drs. Northrup and Hanneman emphasized that the quality of care must not be compromised. “The goal is not only to reduce environmental harm and financial toxicity, but to improve cancer outcomes,” Dr. Northrup concluded.
For More Information
Access the Radiology: Imaging Cancer study, “Embedding Sustainability into the Imaging and Care of Patients with Cancer.”
Read previous RSNA News stories on sustainability in radiology: