RPS 2014 - Green innovations: radiographers pioneering sustainable healthcare

Author Block: J. M. Saude, N. Adubeiro, L. Nogueira, I. Ribeiro, A. Xavier, C. Carvalhais; Porto/PT
Purpose: Higher education institutions play an important role as they prepare the professionals, decision-makers, and democratic citizens of the future. In Allied Health education, it is crucial to develop a professional that, in addition to the technical and clinical content, also have a critical sense regarding environmental and social aspects. This study aims to survey medical imaging and radiotherapy (MIR) students’ perceptions and knowledge about environmental sustainability in MIR education and practice.
Methods or Background: A cross-sectional study was carried out, using a self-designed questionnaire, partially adapted and translated to Portuguese from previous studies. The final version of the questionnaire, after a pilot test, included twenty-six questions and was distributed amongst MIR bachelor’s degree students attending 1st, 2nd, 3rd and 4th academic years in September and October of 2024.
Results or Findings: A total of 175 students participated in the study. Results showed that almost everyone believes they possess general knowledge about Sustainability, however 23,0% demonstrate a lack of awareness about the negative impact that clinical practice has on the environment. Data also revealed that students considered there is a need for more teaching about sustainability in the course (49,0%). In general, participants demonstrated little knowledge about sustainable practices in the profession (34,0%), although, in daily life reported high adoption of sustainable practices (85,0%). Strong connection between their course and SDGs 3 (91,4%), 4 (53,7%), and 8 (38,8%), was reported.
Conclusion: Our findings revealed that there is room for curricula adjustments. Early exposure to sustainability concepts has the potential to promote the development of environmentally conscious professionals. By integrating sustainability into their education will potentially increase the knowledge and skills to make informed decisions that can reduce the negative environmental impacts of clinical practices.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is educational and received a favourable statement from the institutional Data Protection Officer.

Author Block: A. Roletto¹, D. Catania¹, L. Rainford², A. Savio³, M. Zanardo¹, G. R. Bonfitto¹, S. Zanoni³; ¹Milan/IT, ²Dublin/IE, ³Brescia/IT
Purpose: Energy consumption of radiology equipment, life cycle of consumables, waste generation, and CO2 emissions caused by staff travel are factors that influence the environmental impact of radiology departments. Through an international survey, the perception and knowledge of European radiographers on environmental sustainability issues was investigated.
Methods or Background: In March 2024, an online survey was developed and shared with radiographers and therapeutic radiographers across Europe. The survey consisted of 43 questions, covering demographic information and participants' views and actions related to environmental sustainability, energy consumption and waste generation in healthcare.
Results or Findings: In total, 253 responses were collected from 27 European countries. Most respondents highlighted the importance of environmental sustainability in healthcare. According to 63.6% (n=161) of participant, the main source of environmental impact in radiology comes from energy consumption of radiological equipment. Additionally, 44.7% (n=113) suggested that conducting diagnostic exams remotely could reduce the CO2 emissions caused by staff commuting. Regarding workplace practices, over 70% (n=192) reported that they turn-off devices after use. Among the possible obstacles to turning off radiological equipment, respondents identified long shutdown and/or restart times, loss of clinical/technical data and non-applicability to the radiographers’ role. Although recycling is practiced, it is limited to paper, plastic, and glass. Lack of environmental sustainability strategies in the workplace was reported by 66% (n=167). Meanwhile, 96.1% (n=243) believe that radiographers could play an active role in promoting environmental sustainability in their departments.
Conclusion: This study offers a comprehensive analysis of European radiographers' awareness and opinions on environmental sustainability. Although radiographers recognize the importance of creating eco-friendly radiology departments, there are still gaps in implementation of sustainable practices within radiology practices.
Limitations: Potential biases may have been introduced in relation to the complexity of the topics covered.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical exemption was granted by the host institution University College Dublin for this anonymous survey (LS-LR-24-25-Catania-Rainford)

Author Block: M. Champendal¹, B. Lokaj², J. Zaghir³, V. Durand De Gevigney², C. Lovis³, H. Müller⁴, J. Schmid², R. S. T. Ribeiro¹; ¹Lausanne/CH, ²Genève/CH, ³Geneva/CH, ⁴Sierre/CH
Purpose: To synthesize the existing literature on how the environmental sustainability of artificial intelligence (AI) in medical imaging is being addressed and to identify specific strategies that have been used.
Methods or Background: A scoping review was conducted following the Joanna Briggs Institute methodology. Comprehensive literature search was performed in MEDLINE, Embase, CINAHL, and Web of Science, targeting publications from 2014 to 2024 in English or French. The search used a combination of keywords and MeSH terms related to environmental sustainability, AI, and medical imaging modalities. Three independent reviewers screened abstracts, titles and full texts for eligibility.
Results or Findings: The search identified 2812 results, of which 11 met the inclusion criteria. The selected papers comprised 8 research articles, 3 reviews. Three key themes emerged: energy consumption (n=10), carbon footprint (n=4), and computational resources (n=4). The metrics CO2 equivalent, carbon intensity, training time, power use effectiveness, equivalent distance travelled by car were proposed to assess potential AI impact on the environment. Most energy-efficient techniques involved data, AI modelling and training such as data augmentation, data quantisation, lightweight model development, reduction of parameters. Identified strategies to enhance efficiency and reduce environmental impact include (i)integrating energy and carbon metrics in AI evaluation in addition to accuracy assessments, (ii)developing an ecolabel for AI tools, (iii)transitioning to cloud computing and (iv)developing lightweight AI models.
Conclusion: This review identified critical metrics and actionable strategies used to assess and improve sustainable practices in AI for medical imaging which include the integration of specific sustainability-related metrics, cloud computing adoption and development of efficient AI models.
Limitations: The limitations of this review include not assessing the quality of the articles, which is standard practice in scoping reviews, and restricting the search to only four databases.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

Author Block: A. Roletto¹, A. Savio², B. Marchi², S. Zanoni²; ¹Milan/IT, ²Brescia/IT
Purpose: Environmental sustainability topic is increasingly relevant in the radiology sector, which accounts for about 10% of healthcare sector's carbon footprint. Life-cycle assessment (LCA) is one of the main tools for analysing the environmental impact of processes. This study aims to review existing LCA approaches in radiology available in literature, identify their characteristics and limitations to propose a more comprehensive LCA framework for diagnostic imaging.
Methods or Background: Through a literature review on the topic of LCA in diagnostic imaging, performed according to the PRISMA statement, a novel LCA framework specifically for diagnostic imaging was developed. The framework includes all the features described by the various selected articles and overcoming their limitations.
Results or Findings: Regarding the literature review, an LCA approach was described by 5 articles. All studies electricity consumption in their framework. Usage of consumables and auxiliary equipment was included in 80% (4/5) of the studies. Equipment production, staff commuting, and waste generation were included in only 40% (2/5). Only two articles have considered a cradle-to-grave system approach. Subsequently, a novel LCA framework was designed to overcome the limitations by covering all aspects that can be included in the three phases: 1) Preclinical, production of imaging equipment and consumables, staff commuting; 2) Clinical, use of devices and consumables during diagnostic imaging; 3) Post-clinical, waste generation and data storage for the images produced.
Conclusion: This literature review provides an overview of studies focusing on LCA methodology for diagnostic imaging. The results culminated in the proposal of a comprehensive framework, which aims to overcome the identified limitations by providing a complete analysis of the environmental footprint of radiological procedures.
Limitations: Still sparse reporting of LCA in Diagnostic imaging limited the strength of the conclusions of this study.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

Author Block: L. Federico¹, A. Roletto², D. Catania², S. Zanoni³, S. Durante¹; ¹Bologna/IT, ²Milan/IT, ³Brescia/IT
Purpose: The healthcare system requires many resources to maintain the standards necessary to care for the population. It is the task of effective leadership to ensure the environmental sustainability clinical activities. The aim of this study is to examine the role of Green Transformational Leadership (GTL) in radiography, focusing on the mitigation strategies adopted by radiographer managers and their impact on promoting environmental sustainability in radiology departments.
Methods or Background: A systematic literature was conducted in accordance with the PRISMA statements in several databases, targeting studies on leadership in radiography, green innovation, and environmental responsibility. The search strategy employed keywords such as "green transformational leadership," "radiographer manager," and "environmental leadership in healthcare." Two reviewers independently screened titles and abstracts to select studies based on inclusion criteria.
Results or Findings: Among the retrieved articles, 6 met the inclusion criteria. The analysis highlighted how GTL can influence the implementation of sustainable practices in radiography. Radiographer managers using GTL play a key role in promoting sustainable practices, such as reducing energy consumption, encouraging use of reusable imaging equipment, and minimising waste generation. Interdisciplinary collaboration could be decisive in increasing effectiveness of green initiatives. Studies reviewed highlighted the importance of successful communication, measurable goals, and staff training for adopting green practices. Radiography service managers with emotional intelligence who fostered a climate of trust were more successful in promoting a culture of sustainability.
Conclusion: Radiography leaders who prioritise green strategies can significantly reduce the environmental impact of radiology departments. Investing in leadership development, promoting emotional intelligence, and encouraging interdisciplinary collaboration are critical steps in creating a green healthcare system that aims towards environmental sustainability without reducing quality patient care.
Limitations: Sparce literature of GTL limit the strength of the conclusions of this study.
Funding for this study: Not needed
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not needed

Author Block: D. Fonseca Ribeiro¹, K. Borg Grima², A. Geão³, C. Andersson⁴, S. Murphy⁵, P. Costa⁶, C. Baun⁷, A. Karangelis⁸, M. Champendal⁹; ¹London/UK, ²Naxxar/MT, ³Montijo/PT, ⁴Uppsala/SE, ⁵Dublin/IE, ⁶Porto/PT, ⁷Odense/DK, ⁸Patra/GR, ⁹Lausanne/CH
Purpose: Sustainable development seeks to balance economic growth, environmental impact, and social inclusion, which is critical in high-tech fields like nuclear medicine. This study reviewed published literature on sustainable practices in nuclear medicine, focusing on the three main pillars of sustainability: environmental, social, and economic.
Methods or Background: The scoping review was conducted in accordance with the Joanna Briggs Institute methodology. The search was performed on PubMed, Embase, Cinhal and Web of Science in November 2023 and included studies in English. The research equation combined keywords and Medical Subject Heading terms (MeSH) related to sustainability in Nuclear Medicine. Three independent review authors screened all abstracts and titles, and four reviewers conducted the data extraction and analysis.
Results or Findings: Thirty-two studies met the inclusion criteria for this scoping review, with most articles having been published in 2022 and 2023. Spain contributed the highest number of publications. Studies were categorised according to procedure type (n = 32; 31% therapy, 9% PET, 35% diagnostic & therapy, 19% SPECT) and study location (hospital based, non-hospital based, or both). The studies primarily focused on strategies related to the three sustainability pillars, with an emphasis on the environmental impact.
Conclusion: This review highlighted the growing interest in sustainability within the nuclear medicine field, especially in relation to environmental factors. However, significant knowledge gaps emerged on the impact of economic and social factors within nuclear medicine practices. Recommended strategies included proper radioactive waste management, resource optimisation, and fostering collaborative environments to ensure sustainable nuclear medicine practices.
Limitations: The limitations of the study are the exclusion of articles not available in the English language and the quality of the articles included was not assessed according to the methodology of a scoping review.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This study was a scoping review.

Author Block: M. A. Rawashdeh¹, A. England², M. F. Mcentee², M. Ali¹, M. E. S. Zakaria¹; ¹Ajman/AE, ²Cork/IE
Purpose: Previous research has examined the attitudes and behaviors of various professions regarding environmental sustainability. However, there is a paucity of studies specifically addressing the perspectives of radiographers. This study aims to investigate radiographers' perceptions, practices, and barriers to change related to environmental sustainability within the field of radiology.
Methods or Background: Ethical approval was obtained and data collection was conducted using Google Forms. The survey targeted 104 practicing radiographers across multiple countries. Questions were organized into five domains to gather insights into demographics, training related to global warming and climate change. Data analysis employed both descriptive and inferential statistics.
Results or Findings: A total of 104 radiographers completed the survey. Female respondents exhibited a significantly higher participation rate in environmental protection campaigns (P=0.01). The majority of participants (68%) acknowledged their awareness of climate change and its impact on the natural environment. Furthermore, 74% of respondents indicated a belief in the necessity to enhance sustainability practices. The most frequently employed strategies to reduce energy consumption and emissions included low-energy lighting (60%), real-time power monitoring tools (41%), and energy-efficient heating systems (32%). A notable concern regarding sustainability emerged among respondents, with time constraints (50%) and a lack of leadership (48%) identified as prevalent barriers.
Conclusion: Participants recognize the significance of environmental sustainability in the field of radiology; however, obstacles such as inadequate leadership, support, authority, and facility limitations impede the adoption of sustainable practices.
Limitations: The present study has several limitations. It relied on voluntary participation from radiographers and employed snowball sampling, which may introduce self-selection bias. Additionally, the online survey format may limit geographical or technical access, thereby affecting the generalizability of study findings.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: IRB from Gulf Medical University

Author Block: E. Scaramelli, G. R. Bonfitto, A. Roletto, S. V. Fasulo, L. Bombelli, D. Catania; Milan/IT
Purpose: ChatGPT has gained credit among radiographers, given its contribution to training and clinical activity. However, its environmental impact is overlooked. The increasing use of AI is contributing to rising Greenhouse gas emissions, water waste and energy consumption. This research aims to explore the environmental impact of using ChatGPT in radiography and raise awareness of its sustainability in daily clinical practice, underscoring the need for radiographers to engage, given the gap in AI's environmental impact studies within radiology.
Methods or Background: A literature review across databases (Google Scholar, PubMed) was conducted according to the PRISMA statement to find recent evidence on environmental impact of ChatGPT in radiography and, more generally, in healthcare.
Results or Findings: The literature shows limited evidence on the sustainability of AI in radiology, leading to an analysis of the broader healthcare sector to estimate its impact and develop insights for radiology. From this search, only 16 articles were found to be relevant to healthcare, and just one focused on radiology. The results reveal a dual nature of AI: while it's incredibly useful in healthcare, it has a significant environmental impact. Indeed, companies like Google, Microsoft, and Meta consume 2.2 billion cubic meters of water to cool their servers and produce electricity, marking a 48% increase in water usage. GPT-3 produces 8.4 metric tons of CO2 annually and requires 700,000 Liters of water for training. AI is also responsible for 1-2% of global electricity consumption, raising important questions about its long-term sustainability.
Conclusion: Although tools such ChatGPT show usefulness in clinical practice, including radiography, it’s essential to use them more responsibly, given their substantial environmental impact on planet's resources.
Limitations: The lack of evidence in the literature, limits the strength of the conclusions of this study.
Funding for this study: Not applicable
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

Author Block: A. A. Bherwani¹, M. Sudds², L. Townsend-Sanders³, A. Prieto Valero⁴; ¹Orlando, FL/US, ²Wymondham/UK, ³Tampa, FL/US, ⁴Madrid/ES
Purpose: This study highlights the critical need to incorporate sustainability in radiology, reducing the environmental impact without compromising diagnostic accuracy or patient care. Focusing on energy-efficient practices, waste reduction, and technological innovations in modalities like CT, MRI, and general radiography, the objective is to integrate eco-friendly strategies into radiological departments as part of broader healthcare sustainability goals.
Methods or Background: A comprehensive literature review of over 90 sources, including peer-reviewed articles, books, and case studies, was conducted. This research explores innovations such as energy-saving modes in MRI and CT, digital radiography's reduction of chemical waste, and sustainable contrast media practices. Case studies from several healthcare institutes globally are analyzed, illustrating real-world applications of green radiology practices.
Results or Findings: Adopting energy-efficient imaging systems and optimizing resource use led to significant environmental and financial benefits. For example, Singapore General Hospital reduced energy consumption by 30%, saving $1.2 million annually, while Mayo Clinic enhanced wastewater treatment, minimizing environmental contamination from contrast media. These practices and many others from various other institutions not only reduced greenhouse gas emissions but also operational costs.
Conclusion: Incorporating sustainable practices in radiology is vital for reducing healthcare’s environmental footprint while maintaining high standards of patient care. This research provides a scalable framework for radiology departments worldwide, illustrating how integrating sustainability can enhance operational efficiency and contribute to global health equity and environmental conservation.
Limitations: This study is based on case studies from select institutions, which may not reflect the diverse resources and regulatory environments of all healthcare systems. Additionally, the long-term impacts of implementing these sustainable radiology practices require further investigation.
Funding for this study: Not Applicable
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not Applicable

Author Block: Y. Anquetil¹, T. Leturgez², J. E. Jacquin¹, F. Kruta³, F. Jambon¹; ¹Perigueux/FR, ²La Garenne Colombes/FR, ³Paris/FR
Purpose: With the transition in France's contrast product supply model on March 1, 2024, the functionalities of CT injectors have been re-evaluated. This study assesses the impact of Centargo injectors on contrast media volume, patient care, preparation time, and environmental impacts at the CIMROD center, which acquired two Centargo injectors.
Methods or Background: To collect pertinent data, we conducted three measurements and utilized five data sources. The private hospital, equipped with two CT machines, transitioned from a single-use Stellant injector to a multi-use system, ultimately adopting the Centargo injector with enhanced features. Data sources included the volume of contrast media administered per patient, the time radiographers allocated to various tasks in their routines, protocol preparation and traceability times, and waste weight measurements. The evaluation period spanned from April to September and incorporated different injector configurations as well as a tagging system, Ubudu, to monitor workflow efficiency among radiographers.
Results or Findings: CIMROD aimed for an average contrast volume of 80 mL using Ultravist 370. The Centargo injector successfully achieved an average of 72.08 mL per injection across 1,099 procedures, and after further optimization, this volume decreased to 68.31 mL, resulting in a 15% reduction compared to the initial target. Workflow improvements included a 50% reduction in injector preparation time, a 14% increase in patient care time, and a 6% increase in image preparation time. Time savings of 16% per exam were noted, with waste production decreasing by 66% compared to the single-use Stellant, equating to an annual reduction of 1.4 tonnes.
Conclusion: The findings confirm the benefits of the Centargo injector, especially when combined with Smart Protocol and Nautilus software, RIS-Injector connectivity, and kVp optimization, leading to enhanced operational efficiency and reduced environmental impact.
Limitations: Single center evaluation.
Funding for this study: Bayer funded
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The experimentation isn't collecting patient level data so we didn't submitted it to an ethical committee.

Author Block: I. Ø. Brandsæter, E. Kjelle, E. R. Andersen, B. M. Hofmann; Gjøvik/NO
Purpose: The study aimed to investigate key stakeholders’ experiences with and reflections on success factors for implementing an intervention using return letters to reduce the use of three low-value magnetic resonance imaging (MRI) examinations.
Methods or Background: An intervention to reduce low-value MRI was designed and implemented in private imaging centres in Norway in October 2022. The intervention used return letters based on Choosing Wisely recommendations for poor referrals for MRI of the lower back, brain and knee sent to imaging centres.
Two semi-structured individual interviews were conducted with the medical directors of the two included imaging providers (radiologists) and two focus group interviews with nine managers from the various private imaging centres (radiographers) operated by the two imaging providers were conducted. Inductive content analysis in three steps was used to analyse the data.
Results or Findings: The analysis resulted in five categories: general experience, anchoring, organisation, return letter procedure and outcome. In general, the intervention was well received. Sufficient information, anchoring and support from the organisation’s leaders were identified as crucial success factors. However, there were some barriers to the implementation, e.g. the medical directors in charge of the implementation found it hard to be hands-on and distribute information to the radiogpraphers at the imaging centres. Additionally, some Choosing Wisely recommendations were found vague and difficult to use by the radiographers doing the referral assessment.
Conclusion: This study provides insights into the practical and crucial details of implementing interventions to reduce low-value imaging using Choosing Wisely recommendations. The intervention was generally well received, and several key success factors were identified.
Limitations: The limitations of the study are that only managers and medical directors were included in the study, interviewing referrers and patients would have provided other important perspectives.
Funding for this study: Funding was provided by the Research Council of Norway (Project number 302503).
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Ethical approval is unnecessary according to national regulations in Norway (LOV-2008–06-20–44), and this study was not submitted to the regional committees for medical and health research ethics.
The Norwegian Agency for Shared Services in Education and Research approved the processing and storage of personal information in this study (Ref. 974188)

Author Block: K. Iaccarino, D. Fazzini, S. Papa, M. Ali; Milan/IT
Purpose: To quantify the energy consumption of radiology reporting stations and explore a hypothetical scenario to mitigate energy waste in a healthcare setting.
Methods or Background: We monitored 10 reporting stations over a period of 90 days at the Centro Diagnostico Italiano (Milan, Italy). An energy logger was installed on each station to measure real-time power consumption, capturing data on both active and idle states. Stations were configured to enter stand-by mode after 4 hours of inactivity. We conducted a simulation to assess the impact of shutting down the stations after 1 hour of inactivity instead of allowing them to remain in stand-by mode.
Results or Findings: The overall power consumption of the 10 reporting stations was approximately 16,615.65 kWh, which is equivalent to about 6 households in Italy (average annual consumption of 2,700 kWh per household). We identified three main power consumption patterns: mainly-off, mainly-on, and always-off. The estimated on-mode consumption was 12,738.44 kWh per year, while stand-by consumption was 3,128.13 kWh and off-mode consumption was 749.06 kWh. By implementing the hypothetical scenario of shutting down after 1 hour of inactivity, we estimated potential energy savings of around 2,346.12 kWh/year. Considering that CDI has a total of 53 reporting stations across all sites, the estimated total annual energy savings would be approximately 12,434.44 kWh.
Conclusion: Optimizing energy usage in radiology departments is essential for promoting sustainability. Simple configuration changes can lead to significant reductions in energy waste, enhancing the environmental responsibility of healthcare facilities.
Limitations: The sample size of 10 reporting stations may not be representative of the entire radiology department, and the 90-day monitoring period might not account for seasonal variations in usage. The hypothetical scenario assumes uniform behavior across stations, which may not reflect actual workflows.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The ethics commettee approval is not applicable for this study