Going Green
By Lauren Swisher
Radiology Today
Vol. 25 No. 8 P. 22
Sustainable practices are sprouting within the field of radiology.
Sustainability in radiology can mean many different things to many different radiologists. It can encompass environmental factors, financial concerns, or even personal energy levels or burnout. For people like Reed Omary, MD, MS, a professor of radiology in the department of radiology at Vanderbilt University Medical Center in Nashville, sustainability entails reducing waste and being good stewards both environmentally and in the workforce. The International Energy Agency declared the world to be in its first global energy crisis in 2022, and the Lancet Countdown report of that same year claimed climate change threatens human health worldwide. Climate change occurs due to an increase in CO2 and greenhouse gases that become trapped in the upper atmosphere of the earth, causing changes in temperature and weather patterns.
While health care is expected to treat many adverse effects of climate change— such as, but not limited to, respiratory and cardiovascular disease; asthma; allergies; food-, water-, and heat-related illnesses; and mental health—health care is also a major contributor to climate change. The global footprint of the health care sector collectively accounts for an estimated 4% to 8.5% of global CO2 emissions and exceeds that of major economies such as the United Kingdom, France, or Germany. Within health care, medical imaging contributes substantially to global greenhouse gas emissions. Many radiologists and interventional radiologists are working towards reducing greenhouse gas emissions in their practices, and this requires collaboration between colleagues, patients, and vendors, among other steps.
Taking Root
In the world of research, several projects and studies have taken root. A recent study published in the American Journal of Roentgenology monitored the energy output of an IR suite, neurointerventional suite, and radiology fluoroscopy unit; two cardiology laboratories over a four-week period; and two urology fluoroscopy units over a two-week period. Historically, the energy demand of imaging systems has been estimated based on specifications provided by manufacturers, rather than estimated in-house. The study found that energy consumption while systems were not being used, were off, or were in idle states accounted for 60.3% of projected total energy consumption. The study also found that a hypothetical operational adjustment to switch systems from idle to off overnight and on weekends would potentially reduce energy consumption of 144,640 kWh, carbon emissions of 18.6 MtCO2eq, and electricity costs of $37,896, annually.
A separate study found that shutting off 29 computers and 25 PACS stations overnight saves 51 tons of CO2 emissions per year, up to $7,253 in savings. In addition, powering down one CT unit during nonoperational hours can save 14,000 kWh per year. For some practices, shutting down systems overnight is standard, but for others, it’s not. Like other sustainable practices, they vary from hospital to hospital.
Northwell Health in New York has measured and evaluated its own electricity usage with a meter bought on Amazon. The meter was plugged into workstation monitors and power strips. For a month, the baseline energy usage was recorded. The next month, energy usage was recorded after putting monitors to sleep after an hour of activity. Such a project allowed a large facility such as Northwell to evaluate its energy consumption and needs and communicate its findings to the rest of Northwell’s departments and hospitals.
At Tisch Hospital-NYU Langone Health, an IR department conducted a life cycle assessment to assess the amount of greenhouse gas emissions in single-use supplies, anesthetics, and the electricity used in procedures over the course of five days. They found that greenhouse gases emitted a carbon dioxide equivalent of 23,500 kg, which is equal to driving a vehicle around 60,000 miles. After further assessment, they discovered the greatest source of emissions came from the energy used to power the HVAC system, 20% to 30% of greenhouse gas emissions came from the HVAC system during off hours. The second greatest source of their emissions came from the production and transportation of singleuse surgical supplies.
“The best, most beneficial outcome of the study was that we raised awareness on a topic that very, very few interventional radiologists are thinking about or had been thinking about,” says Jonathan Gross, MD, an interventional radiologist at Texas Children’s Hospital and Baylor College of Medicine. Texas Children’s Hospital, as well as several other IR practices, have created supply packs for different procedures. These packs include the single-use supplies likely needed for specific procedures that the packs target, to reduce the use of unnecessary single-use supplies. With these packs, instead of preparing a set of all supplies available, including supplies not needed or necessary for a procedure, a department can opt to use a pack specifically targeted towards a procedure without the need to open and discard unnecessary supplies.
Top-Down Initiative
Many in the radiology field feel that a culture shift needs to occur in order for sustainable practices to become the standard. Changes need commitment from leadership down to workers. While climate change and its dangers have been known, the health care system has been slow to make systemic changes. Omary says there are three different ways to make a difference in health care with sustainability: design sustainable medicine with patients, educate and bring awareness to the health care workforce, and provide resources and time for health care to reduce the amount of waste that occurs in the system.
“In addition to our education, we can include sustainability in our guidelines.” Gross says. “If there are a range of different studies that we can perform for a particular clinical scenario, let’s include sustainability. Certain modalities emit fewer greenhouse gas emissions and contribute less to climate change. Let’s prioritize those over CT and MT studies, which we know are far more energy intense than X-ray or ultrasound.”
What hospitals and facilities can do is evaluate their own sustainability and develop initiatives based on their assessments. “I would have a direct ask for interventional radiologists, and that is to evaluate the environmental footprint of the products that are used, and where products have similar outcomes and prices, to choose the one with a smaller environmental footprint,” Omary says.
A product can be assessed at the beginning of its life cycle based on material selection, manufacturing location, energy source, transport, and labor. Such assessments could include the carbon footprint of materials used in the manufacturing of the product. Items and questions to think about in terms of sustainability include equipment and supplies. For equipment, things such as imaging equipment or smaller devices such as monitors or blood pressure cuffs. Does the company have an Environmental, Social, and Governance commitment? Are they Energy Star rated, or something similar? Are they made from recycled materials? Do HVAC, lights, screens, and equipment need to be on 24/7? Can you turn them off when not in use or put them on timers or sleep mode? Can you change from fluorescent to LED light bulbs?
For supplies, is the packaging efficient? Can the components, packaging, and drapes be recycled? Excess packaging increases pollution and adds an increase of carbon emissions to the product’s volume. Are you using single-use items or items that can be reused? For example, are you providing fabric gowns instead of paper gowns or sending surgical trays back to central sterile instead of using single-use surgical trays? An example of a recycling and reuse project is at the University of Vermont, where the wrappings from sterile items are recycled into plastic bits, then turned into bed pans and emesis basins. Can you create custom packs, and are the items in those packs necessary for the procedure? There are both little and big changes everyone can make if a little more attention is paid to how a lifestyle and practice both at work and at home contribute to a carbon footprint.
Green Future
Challenges in adopting sustainable practices lie in education, business, and outreach. In the business realm, enthusiasm “The more we can recognize that the way we practiced in the past is not necessarily going to be the way we practice in the future—if we start thinking about how we want to practice interventional radiology differently in the future, that will continue to keep us in the most cutting-edge position within medicine.” —Reed Omary, MD, MS, a professor of radiology in the department of radiology at Vanderbilt University Medical Center in Nashville needs to be built in order for sustainability to be implemented. “Very often, when speaking with leadership, leading with cost gets their attention. Then, if you could say, ‘It also achieves your goal of carbon neutrality—it’s good for PR’, it’s just like the icing on the cake that can build enthusiasm for projects,” says Drew Caplin, MD, the program director for the integrated and independent interventional radiology residency programs and an associate program director for the diagnostic radiology residency program at the Zucker School of Medicine at Hofstra/Northwell.
A 2023 paper, “Climate Change and Radiology: Impetus for Change and a Toolkit for Action,” proposes radiologists work with vendors to achieve carbon neutrality. Through direct collaboration, radiologists and vendors can create sustainable, user-centered solutions and criteria. Working with vendors can help reduce waste and incorporate sustainable initiatives into practice. Radiologists can also influence vendors to improve sustainability and prioritize energy efficiency. Collaboration with building facilities and design teams can help with waste heat management and recovery by redirecting generated heat from scanner operations. Additionally, the implementation of AI and remote reporting may reduce unnecessary scanning by leading to higher diagnostic accuracy, shorter examination times, and a reduction in patient travel. Enthusiasm can be built on the peer-topeer level by implementing rewards for reaching sustainable goals.
For education and outreach, the challenges have one common goal: awareness. “The hurdle we are facing is just the fact that most people aren’t aware of how we are contributing or how our practices are contributing to climate change. But once people are educated, once we talk to people about changing our practices— I think most people are very, very open to that,” Gross says. Despite hurdles towards changes, there is a growing movement to make health care more sustainable. There has been a growing awareness, cited in the increased number of research articles and studies on the topic, as well as a number of radiology societies that have sustainability working groups. Practices can become certified in sustainable health care from the Joint Commission, sign a pledge with the Department of Health and Human Services, and collaborate with the National Academy of Medicine on sustainable practices within their organization. In fact, more than 100 health care systems have joined the Department of Health and Human Services’ pledge to achieve net zero emissions by 2050.
“The more we can recognize that the way we practiced in the past is not necessarily going to be the way we practice in the future—if we start thinking about how we want to practice interventional radiology differently in the future, that will continue to keep us in the most cutting-edge position within medicine,” Omary says.
Sustainability has a hopeful future in medicine. With many people collaborating on research, ideas, and plans to change practices on individual, local, and global scale. “We recognize that climate change is happening and that it’s affecting all of us and certainly will affect our children and our children’s children’s children. Most people are very concerned and want to do what they can to address climate change and to minimize their impact,” Gross says.
— Lauren Swisher is an editorial assistant at Great Valley Publishing.
