RPS 230 - Building a sustainable future for radiology

Author Block: J. Lydia, F. Abubacker Sulaiman, R. Praveenkumar, M. Nivitha, D. Dharshini, A. Raashid Ibrahim; Chennai/IN
Purpose: Evaluate the environmental impact of radiology services.

Identify policy gaps in promoting sustainable practices in radiology.

Assess awareness and actions related to sustainability among radiology professionals.

Demonstrate practical departmental initiatives toward sustainable radiology practices.
Methods or Background: Literature review of global and regional studies on sustainable radiology practices.

Analysis of existing healthcare policies related to sustainability.

Survey of radiology professionals to assess awareness of sustainable development and adoption of environmentally friendly practices.

Documentation and evaluation of actions implemented in our radiology department, including energy-efficient protocols, waste reduction, and recycling initiatives aimed at future sustainability.
Results or Findings: Survey results revealed moderate awareness among radiology professionals, with varying adoption of sustainable practices. Departmental initiatives led to measurable reductions in energy use and waste. Existing policies are broad and lack modality-specific guidance for radiology.
Conclusion: Radiology can play a key role in healthcare sustainability through awareness, practical initiatives, and policy integration. Structured support at the policy level is essential to standardize and incentivize environmentally responsible practices.
Limitations: None
Funding for this study: No funding was provided
Has your study been approved by an ethics committee? Not applicable
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Author Block: A. Cue Castro, A. Camacho Palomino; Mexico City/MX
Purpose: To evaluate current evidence on the biological and environmental effects of iodinated and gadolinium-based contrast media (CM) and to propose justification and dose-optimization strategies that ensure diagnostic quality while minimizing risks to patients and the environment.
Methods or Background: A comprehensive literature review (PubMed, ESUR, ACR, WHO, 2015–2025) analyzed data on nephrotoxicity, gadolinium deposition, hypersensitivity, and environmental persistence of CM. International guidelines were reviewed to identify best practices in patient risk assessment, indication justification, and imaging protocol optimization.
Results or Findings: Evidence confirms that repeated CM exposure may induce renal and systemic effects in susceptible patients and that gadolinium and iodine residues persist in wastewater, impacting aquatic ecosystems. Personalized dosing (weight- and renal function–based), use of macrocyclic gadolinium chelates and low- or iso-osmolar iodinated agents, and optimized CT/MRI protocols reduce administered doses without compromising diagnostic value. Standardized justification checklists decrease unnecessary contrast use by up to 30–40%.
Conclusion: Rational and justified use of contrast media is essential to balance diagnostic benefit with patient and environmental safety. Radiology departments should integrate contrast monitoring systems, dose optimization protocols, and education programs promoting responsible, evidence-based use of iodinated and gadolinium agents. Professional education should be prioritized to ensure responsible imaging practice.
Limitations: Data heterogeneity and variability in study design limit direct comparison across contrast agents and imaging modalities. Environmental data remain regionally restricted and require broader, multicenter monitoring.
Funding for this study: Own
Has your study been approved by an ethics committee? Not applicable
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Author Block: P. Hehenkamp¹, M. Obmann¹, S. Kamber¹, D. Kraft², M. Loser², E. M. Merkle¹, T. Heye¹, J. Vosshenrich¹; ¹Basel/CH, ²Forchheim/DE
Purpose: To assess the efficiency and operational feasibility of a novel CT power save mode designed to reduce inter-examination energy consumption without affecting clinical workflows.
Methods or Background: CT scanners consume substantial energy during idle periods. While powering down systems has been shown to provide substantial energy, cost, and carbon emission benefits, this is infeasible for short inter-examination intervals. To address this current limitation, one CT scanner (SOMATOM X.ceed; Siemens Healthineers) was equipped with a newly developed power save mode. The scanner’s power draw was prospectively measured over a 28-week period (Nov 2024–Jun 2025). Data was segmented into active, idle and power save states. Energy and emission savings were calculated, and usability and impact on workflow were assessed via a survey of CT technologists.
Results or Findings: Across 124 workdays, the power save mode reduced power draw by 26.8% compared with idle (1.6 ± 0.1 kW vs. 2.1 ± 0.1 kW), yielding a 15.6% reduction in nonproductive and 7.2% reduction in total operational energy use. Nonproductive time accounted for 66.1% of scanner on-hours with the power save mode being active during 58.1% of this time. 19 CT technologists responded to the structured survey. Awareness of the mode’s functionality was high (84%), and 79% of the technologists had manually activated the power save mode at least once. All technologists reported the activation process as “very easy.” Importantly, all technologists (100%) denied any technical issues or workflow disruptions.
Conclusion: A novel rapid-reactivation CT power save mode substantially reduces nonproductive energy consumption during inter-examination idle periods without disrupting clinical workflows, representing a practical step toward a more sustainable operation of CT.
Limitations: Only one specific CT scanner model was investigated. Relative and absolute savings may vary by vendor, model, and practice setting.
Funding for this study: No funding was received for this study
Has your study been approved by an ethics committee? Not applicable
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Author Block: N. Maalouf, F. K. E. Mankertz, J. Berger, F. Raab, J. Herrmann, K. Nikolaou, T. Küstner, S. Afat; Tübingen/DE
Purpose: The purpose of this study is to compare the energy consumption of six Siemens MRI systems and assess the implications for sustainability and cost efficiency.
Methods or Background: Aera, AvantoFit, and Sola (1.5 T) and PrismaFit, Vida, and VidaFit (3 T) scanners were evaluated under routine clinical conditions (6.2024–3.2025). Scan data were sent to the manufacturer for centralized analysis of energy consumption (kWh), power output (kW), and time-normalized power (kW/min). Deviations from the fleet mean were calculated across sequence types, with scan duration used to adjust for time-dependent variability. Scanner model and field strength (1.5 T vs 3 T) were analyzed as determinants of energy efficiency. Performance differences were visualized with deviation plots and radar charts. Statistical analysis used confidence intervals.
Results or Findings: Energy use differed markedly across scanners. VidaFit showed the highest deviations (+66% normalized power, +57% energy) and greatest consumption, while AvantoFit and Vida consumed least (−24% to −31% below mean). Radar analysis confirmed VidaFit as the main outlier, with other models clustering near the fleet average.
Conclusion: Energy use differs across Siemens MRI generations despite similar clinical operation, reflecting hardware and gradient design. Selecting lower-consumption scanners for routine exams can cut costs and reduce carbon footprint. Integrating energy-efficiency metrics into MRI procurement supports sustainable radiology without affecting diagnostic quality.
Limitations: A single-center study may limit generalizability, although the trends remained consistent over several months of monitoring.
Funding for this study: No funding was received.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: IRB approval was obtained.

Author Block: F. Mariotti, A. Borgheresi, A. Agostini, L. Reversi, M. Valenti, A. Giovagnoni; Ancona/IT
Purpose: Magnetic Resonance Imaging (MRI) has high energy demands, raising sustainability concerns in abdominal applications. With growing demand for liver MRI, there is a need to balance diagnostic value with environmental impact. Abbreviated protocols (AMRI) and AI-based acceleration are promising strategies to reduce scan time and electricity use. This study quantifies potential energy and CO₂ savings in upper abdominal MRI while assessing trade-offs between energy neutrality and patient throughput.
Methods or Background: Five literature-based scenarios were modeled: (A) standard multiphasic protocol with contrast (20–30 min, ~20 kWh/exam); (B) abbreviated non-contrast (7–9 min); (C) abbreviated contrast-enhanced (10–12 min); (D) standard with AI-based acceleration (30% scan time reduction); and (E) abbreviated with AI acceleration. Assumptions included an active phase representing 40–60% of total energy, baseline active consumption of 8–12 kWh, and Italian electricity carbon intensity of 0.233 kg CO₂e/kWh (2024). Per-exam savings, annual throughput, and energy neutrality thresholds—the maximum exams within a 114,000 kWh/year budget—were then calculated.
Results or Findings: Compared with the standard protocol, abbreviated non-contrast saved 41–51% of active energy (0.96–1.70 kg CO₂e), abbreviated contrast 70–72% (1.35–2.24), AI ~30% (0.56–0.84), and abbreviated with AI 59–87% (1.23–2.40).
With a 114,000 kWh/year budget, standard protocols allowed ~5,700 exams, abbreviated non-contrast ~7,972, abbreviated contrast ~9,268, AI ~6,705, and abbreviated with AI ~9,819.
Depending on the protocol, between 25% and 72% more liver MRI exams could be performed annually without exceeding the energy budget.
Conclusion: Abbreviated and AI-accelerated liver MRI protocols reduce active energy use by up to 87% and allow thousands of additional exams annually within the same energy budget. Despite trade-offs between diagnostic completeness and efficiency, these strategies support greener radiology, improved productivity, and progress toward sustainable healthcare
Limitations: Theoretical study based on literature-derived data
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
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Author Block: F. Abubacker Sulaiman; Chennai/IN
Purpose: To quantitatively compare the carbon footprint and energy consumption of computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound examinations, and to identify potential strategies for sustainable imaging practice.
Methods or Background: A prospective observational study was conducted over six months in a tertiary care imaging center. A total of 300 diagnostic procedures were analyzed—100 each of CT, MRI, and ultrasound. Energy consumption was measured using integrated power meters on imaging systems and converted to carbon dioxide equivalents (CO₂e) based on local emission factors. Ancillary energy use (HVAC, lighting, computing) was proportionally attributed per examination. Patient throughput and scan duration were factored to calculate per-scan carbon footprint. Data were statistically analyzed using ANOVA and correlation with machine age and utilization.
Results or Findings: Average carbon footprint per examination was CT: 9.2 kg CO₂e, MRI: 17.1 kg CO₂e, and Ultrasound: 0.8 kg CO₂e. MRI demonstrated the highest footprint due to long acquisition times and continuous cooling system requirements, whereas ultrasound showed minimal emissions. Optimization of scan protocols and standby power management reduced CT and MRI footprints by approximately 22% and 18%, respectively. Equipment utilization efficiency showed strong inverse correlation with per-scan carbon footprint (r = –0.78, p < 0.001).
Conclusion: Among cross-sectional imaging modalities, ultrasound remains the most sustainable, while MRI contributes the highest carbon emissions. Implementing energy-efficient hardware, optimized scheduling, and eco-mode settings can significantly mitigate environmental impact in radiology departments.
Limitations: Single-center design, exclusion of contrast media production impact, and regional energy variability may limit generalizability.
Funding for this study: No external funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional ethical committee approval was obtained.

Author Block: S. Morozov, N. Heracleous, B. Rizk, C. Thouly, B. Dufour, O. Novarina; Sion/CH
Purpose: To develop and validate a systematic methodology for evaluating radiologist AI adoption patterns, innovation readiness, and user experience across a multi-site radiology network, providing actionable insights for sustainable AI integration in clinical practice.
Methods or Background: Building on four years of AI implementation since 2021 with 10 AI solutions processing 100,000 exams annually, a comprehensive mixed-methods survey was conducted among 58 radiologists across 20 sites of 3R Swiss Imaging Network in June 2025, achieving 91.4% response rate. The methodology combined quantitative metrics including Net Promoter Score (NPS) analysis for 12 AI solutions, sentiment scoring (1-5 scale), and usage frequency assessment. A composite Innovation Index was calculated incorporating AI adoption rate, usage intensity, technology relevance, and innovation sentiment. Qualitative thematic analysis categorized improvement suggestions. Statistical analysis included Shapiro-Wilk normality testing and Spearman correlations to identify predictors of AI acceptance.
Results or Findings: The group achieved a General Innovation Index of 73/100, positioning it in the "Early Adopter" phase among European radiology networks. AI adoption rate reached 91.4/100 with 53/58 radiologists using AI tools. Usage intensity scored 70.3/100 with 66% reporting frequent AI use. NPS varied dramatically across solutions (range: -55.3 to +86.7). Top performers included X-ray Bone Age estimation (NPS +86.7), Trauma and Orthopedic diagnostics (NPS +65.2). Critical improvement themes emerged: speed/latency (48% of concerns), advanced workflow integration (19%), and reliability issues (11%). Strong correlations were found between trust, quality perception, and clinical confidence (r=0.66-0.68).
Conclusion: This human-centric assessment framework successfully identified innovation profiles, user segments, and systematic barriers to AI adoption. The methodology enables evidence-based change management, targeted interventions, and sustainable innovation strategies in radiology practices.
Limitations: Longitudinal validation needed to confirm predictive value of innovation metrics.
Funding for this study: Institution funded.
Has your study been approved by an ethics committee? Not applicable
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Author Block: H. S. Gewefel¹, M. Amin², S. Khodair², M. Zaher¹, A. Mahmoud²; ¹6th of October City/EG, ²Cairo/EG
Purpose: To assess feasibility and patient acceptance of pragmatic sustainability measures (“green radiology”) in the Women And Fetal Imaging (WAFI) private imaging center in Giza, Egypt.
Methods or Background: Single-center cross-sectional survey of adult women attending mammography and or breast ultrasound at WAFI, the women age was 52.9 ± 13. An online, self-administered questionnaire containing 19 questions was completed by 82 women, capturing their acceptance across a range of domains; (1) energy-conscious scheduling (night/morning slots), (2) digital intake and electronic reports, (3) Heating, Ventilation, and Air Conditioning (HVAC) optimization with preserved comfort, (4) travel consolidation (combining services in one visit), and (5) reassurance about lower-dose X-ray protocols. Survey items were rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). Responses of “agree” or “strongly agree” were classified as indicating acceptance.
Data were analyzed using descriptive statistics and reported as proportions (n/N).
Results or Findings: Eighty-two respondents completed the survey, revealing strong acceptance of green radiology practices across multiple domains. Key findings included high interest in clustered/morning appointments (80%) and a willingness to combine services in one visit (82.9%). Most participants preferred digital intake and reports (79%), with 65.7% finding them easy to use, though a small minority (14.6%) still wanted a situational paper option. Patient comfort and reassurance were also highly rated, with 89% satisfied with HVAC optimization and 86.6% confident in the safety of lower-dose X-ray protocols. Overall care satisfaction was exceptionally high at 97.6%.
Conclusion: Conclusion
Women in a real-world breast imaging unit were highly receptive to sustainability measures. This pilot showed that targeted educational strategies improve women's knowledge and engagement with sustainable radiology practices.
Limitations: This study was performed at a single centre and included a relatively small number of participants.
Funding for this study: Acknowledgements:
This work was granted funding by The European Institute for Biomedical Imaging Research (EIBIR) and The European Society of Radiology (ESR).
Has your study been approved by an ethics committee? Not applicable
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Author Block: A. Kuehne, D. Chen; New Haven, CT/US
Purpose: Our objective is to provide an overview of the diverse nonprofit and charitable efforts within radiology, categorize the major organizational models, highlight global and European initiatives, and demonstrate practical pathways for radiologists to engage meaningfully in service and advocacy at varying levels of commitment.
Methods or Background: While global medical charities such as Doctors Without Borders and the Red Cross are well known, radiology-specific nonprofit work is comparatively recent, accelerating over the past two decades with advances in digital imaging. Despite radiology’s central role in modern medicine, the World Health Organization estimates that up to two-thirds of the global population lacks access to basic imaging technologies, with access to advanced modalities even more limited. This disparity underscores the need for radiology-focused charitable efforts.
Results or Findings: Radiology nonprofit organizations can be broadly grouped into four categories:

Standalone charitable organizations: RAD-AID, Radiologists Without Borders, Project C.U.R.E., UNITS USA, as well as European groups such as the European Society of Radiology’s (ESR) “Invest in the Youth” and outreach initiatives, and the European School of Radiology (ESOR), which provide training and support in resource-limited settings.
Societal charitable arms: RSNA Research & Education Foundation, ARRS, ASER, ESR Foundation.
Charitable arms of for-profit organizations: VRAD’s First Read Initiative, funding equipment and PACS infrastructure for underserved hospitals.
Educational initiatives: Road2IR, which supports interventional radiology training in Africa, with growing partnerships from European and North American institutions.
Conclusion: Philanthropic opportunities in radiology are expanding rapidly, with significant potential to address global imaging inequities. By engaging in nonprofit efforts, whether through clinical service, education, fundraising, or advocacy, radiologists can leverage their specialized expertise to deliver disproportionate impact in global health, fostering sustainable change across diverse healthcare systems.
Limitations: n/a
Funding for this study: n/a
Has your study been approved by an ethics committee? Not applicable
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