Radiology in Our Changing Climate: A Call to Action

Sustainability in radiography: Knowledge, practices, and barriers among radiographers in Zimbabwe and Zambia

INTRODUCTION

As the global demand for radiography services increases, departments need to be aware of the environmental impact of their practices and strive to reduce their carbon footprint. However, sustainability in radiography, particularly in low-resource settings, remains underexplored. This study aimed to investigate the knowledge, practices, and barriers to sustainability in radiography practice among radiographers in Zimbabwe and Zambia.

METHODS

A quantitative cross-sectional study involving 216 consecutively sampled radiographers who completed an online questionnaire was conducted. Data analysis was performed using descriptive statistics, the Chi-square test, and exploratory factor analysis using principal component analysis.

RESULTS

Overall, 81.49 % of the radiographers had some familiarity with the concept of sustainability. The radiography educational curriculum was singled out as lacking sufficient content on sustainability (44.44 %). More than half of the radiographers reported the absence of deliberate sustainable practices in place in their respective departments (Zambia 51.02 %, Zimbabwe 54.69 %). The top reported barriers to sustainability include; a lack of priority for sustainability from leadership and organization (73.61 %), a lack of incentives for sustainability (75.46 %), and a lack of partnerships between suppliers and consumers on ways to improve diagnosis, patient safety and sustainability (82.4 %).

CONCLUSION

This study offers valuable insights into the current state of sustainability in radiography in Zambia and Zimbabwe, highlighting the need for academic reforms, intentional departmental practices, and systemic changes to drive sustainable efforts in the field. Future research should aim to enhance the sustainability of radiographic examinations and procedures, thereby advancing the core practice of radiographers.

Reducing Intravenous Contrast Utilization for CT: A Health System-Wide Intervention With Sustained Impact

OBJECTIVE

To determine the volume of intravenous iodinated contrast media used for CT before, during, and after the global iohexol shortage over a total of 17 months at a multisite health system.

METHODS

This retrospective study included all patients who underwent CT at a large health system with 12 sites. Standardized contrast doses for 13 CT examinations were implemented May 23, 2022. Mean contrast utilization per CT encounter was compared between three periods (preintervention: January 1, 2022, to May 22, 2022; intervention: May 23, 2022, to September 11, 2022; postintervention: September 12, 2022, to June 30, 2023). Contrast doses and CT encounter data were extracted from the enterprise data warehouse. Categorical variables were compared with a χ2 test, and continuous variables were compared with a two-tailed t test. Multivariable linear regression assessed significance, with coefficients noted to determine magnitude and direction of effect.

RESULTS

Preintervention, there were 152,009 examinations (87,722 with contrast [57.7%]); during the intervention, there were 120,031 examinations (63,217 with contrast [52.7%]); and during the postintervention, there were 341,862 examinations (194,231 with contrast [56.8%]). Preintervention, mean contrast dose was 89.3 mL per examination, which decreased to 78.0 mL after standardization (Δ of -12.7%) (P < .001). This decrease continued throughout the intervention and persisted in the postintervention period (80.4 mL; Δ -10.0%, P < .001). On multivariable analysis, patient weight, sex, and performing site were all associated with variations in contrast dose. Most but not all sites (9 of 12) sustained the decreased contrast media dose in the postintervention period.

DISCUSSION

Implementing standardized contrast media dosing for commonly performed CT examinations led to a rapid decrease in contrast media utilization, which persisted over 1 year.

Role of green and sustainable practices in shaping the future of medical imaging technology: A cross-sectional multi-stakeholder analysis among students, radiographers, and academic experts

INTRODUCTION

The detection and treatment of diseases like COVID, diabetes, cancer, cardiovascular conditions, etc., have made medical imaging technology more necessary, so it is expected that the demands of imaging modalities are also increasing and are major contributors to carbon emissions in the healthcare industry. Hence, the Radiology departments, like the rest of the healthcare industry should adapt the procedures to become more sustainable.

METHODS

A total of 1016 respondents completed the online survey to assess the perception, current practices, and challenges in adopting green and sustainable practices in medical imaging. The radio technologists, teaching faculties, and students of medical imaging were recruited for the study. The survey tool was distributed to the closed groups through social media and emails.

RESULTS

The majority of participants (66.6%) highlighted the importance of green and sustainable practices in medical imaging whereas only 21.06% of participants seem to have implemented these practices. Most of the participants give positive responses on the use of zero-lead aprons (77%), refurbished medical systems (85.8%), and eco-friendly packaging (89.5%). The mixed response was received from waste segregation and energy-saving measures. The majority (60.3%) of them have no formal education or training. However, they have a good attitude towards the willingness to adopt green practices.

CONCLUSIONS

There is a gap between perception and implementation of green and sustainable practices due to leadership and information barriers. Comprehensive training for stakeholders of medical imaging is crucial to fully integrate sustainability practices, possibly through webinars or educational modules.

IMPLICATIONS FOR PRACTICE

The study's findings shed light on how important medical imaging stakeholders view green and sustainable practices as well as potential obstacles to their implementation at the local level whilst suggesting the need for exclusive training on these practices to promote sustainability.

Healthcare Sustainability to Address Climate Change: Call for Action to the Infectious Diseases Community

The US healthcare system's contribution to greenhouse gas emissions and climate change is disproportionately high and harms the public. Several medical specialties are now reassessing how they can mitigate healthcare's harmful environmental impact. Healthcare sustainability is broadly defined as measures to decrease greenhouse gas emissions, waste, and other pollutants generated during the healthcare delivery process. Prior efforts and programs by infectious diseases (ID) professionals, such as antimicrobial stewardship and infection prevention and control can form a framework for ID professionals to help apply this expertise to healthcare environmental sustainability more broadly. This call to action proposes strategies for ID societies and professionals to incorporate climate change education for trainees, increase research and funding opportunities in healthcare sustainability, and calls for action by ID societies to champion system changes to decrease greenhouse gas emissions.

Planetary Health: Should We Care?

The delivery of radiologic services and other health care produces a large amount of environmental pollution, which increases human morbidity and mortality. Planetary health looks for sustainable strategies to deliver high-quality health care and reduce environmental impact. Radiologists should consider the sustainability and resilience of their practice in the face of limited natural resources and increasing extreme weather events. Additionally, there is a strong business case for including planetary health in radiology given the financial benefits of sustainability efforts. The extent of radiology's environmental impact and the central role radiologists play in patient care should encourage radiologists to lead these efforts in health care.

Environmental sustainability in radiography in low-resource settings: A qualitative study of awareness, practices, and challenges among Zimbabwean and Zambian radiographers

INTRODUCTION

Evidence suggests that radiography activities have a significant impact on the environment. With growing awareness of the negative environmental consequences of radiography services, there is an increasing call for radiographers to adopt sustainable practices. However, little is known about the levels of awareness, current practices, and challenges faced by radiographers working in low-resource settings on this subject. Therefore, this study aimed to explore the awareness, practices, and challenges among Zimbabwean and Zambian radiographers about environmental sustainability in radiography.

METHODS

An exploratory descriptive qualitative research design was used in this study. Two focus group discussions (FGDs) were conducted with 19 purposively sampled participants (N = 8 and N = 11) in Zimbabwe and Zambia, respectively. The audio recordings were transcribed verbatim and analysed using Braun and Clarke's thematic analysis six-phase framework.

RESULTS

Following thematic data analysis three main themes emerged: awareness of the concept of sustainability among radiographers, sustainability practices in radiography, and challenges of implementing sustainability in radiography. The study found that some radiology departments continue to rely on film-screen imaging systems due to insufficient financial resources to transition to digital imaging systems. Consequently, this constraint emerged as the central obstacle thwarting the implementation of sustainable practices in radiography.

CONCLUSION

Most radiographers understood the concept of sustainability in radiography; however, they were concerned about the negative impact of radiography practices on the environment and wanted more training and financial support to mitigate this impact.

IMPLICATIONS FOR PRACTICE

Environmental sustainability should be integrated into the radiography curriculum and provision of continuing professional development (CPD) to impart radiographers with knowledge and the best practices. Periodical audits should be conducted to monitor sustainable practices and reward deserving radiology departments.

The environmental impact of energy consumption and carbon emissions in radiology departments: a systematic review

OBJECTIVES

Energy consumption and carbon emissions from medical equipment like CT/MRI scanners and workstations contribute to the environmental impact of healthcare facilities. The aim of this systematic review was to identify all strategies to reduce energy use and carbon emissions in radiology.

METHODS

In June 2023, a systematic review (Medline/Embase/Web of Science) was performed to search original articles on environmental sustainability in radiology. The extracted data include environmental sustainability topics (e.g., energy consumption, carbon footprint) and radiological devices involved. Sustainable actions and environmental impact in radiology settings were analyzed. Study quality was assessed using the QualSyst tool.

RESULTS

From 918 retrieved articles, 16 met the inclusion criteria. Among them, main topics were energy consumption (10/16, 62.5%), life-cycle assessment (4/16, 25.0%), and carbon footprint (2/16, 12.5%). Eleven studies reported that 40-91% of the energy consumed by radiological devices can be defined as "nonproductive" (devices "on" but not working). Turning-off devices during idle periods 9/16 (56.2%) and implementing workflow informatic tools (2/16, 12.5%) were the sustainable actions identified. Energy-saving strategies were reported in 8/16 articles (50%), estimating annual savings of thousand kilowatt-hours (14,180-171,000 kWh). Cost-savings were identified in 7/16 (43.7%) articles, ranging from US $9,225 to 14,328 per device. Study quality was over or equal the 80% of high-quality level in 14/16 (87.5%) articles.

CONCLUSION

Energy consumption and environmental sustainability in radiology received attention in literature. Sustainable actions include turning-off radiological devices during idle periods, favoring the most energy-efficient imaging devices, and educating radiological staff on energy-saving practices, without compromising service quality.

RELEVANCE STATEMENT

A non-negligible number of articles - mainly coming from North America and Europe - highlighted the need for energy-saving strategies, attention to equipment life-cycle assessment, and carbon footprint reduction in radiology, with a potential for cost-saving outcome.

KEY POINTS

• Energy consumption and environmental sustainability in radiology received attention in the literature (16 articles published from 2010 to 2023). • A substantial portion (40-91%) of the energy consumed by radiological devices was classified as "non-productive" (devices "on" but not working). • Sustainable action such as shutting down devices during idle periods was identified, with potential annual energy savings ranging from 14,180 to 171,000 kWh.

Health Care Feels the Heat: A Primer for Radiologists on Climate Change-Related Regulatory and Policy Trends

In the ensuing decade, health care will encounter risks and opportunities stemming from a regulatory and policy environment that is increasingly shaped by the climate crisis. The startling multiplication of climate change-related extreme weather events has increased public support for action, creating pressure on policymakers and regulatory agencies to provide solutions. Health care must decarbonize along with other sectors of the economy; therefore, health care organizations should be prepared to respond to climate-related regulations and take advantage of abundant green energy incentives to achieve the largest greenhouse gas emissions reductions possible and capture financial opportunities related to the national green energy transition. Radiology is an energy-intensive specialty; therefore, radiologists can have a powerful voice in efforts to decarbonize their organizations and will be more effective advocates if they have a basic understanding of the broader national and international climate change-related regulatory and policy trends. The necessity to address climate change is ever clearer; we can either help our organizations lead in these efforts, or we can wait for policymakers and health care regulators to dictate our actions.

The Environmental, Social, Governance Movement and Radiology: Opportunities and Strategy

The environmental, social, governance (ESG) movement has come to health care organizations, in part through the Biden administration's challenge to them to reduce greenhouse gas emissions by 50% by 2030 and achieve net zero emissions by 2050, in support of more robust environmental sustainability. Radiology practices should become knowledgeable about ESG concepts and look for opportunities that are meaningful and achievable to support their host organizations' ESG efforts. Examples of initiatives to support improved environmental sustainability include selecting the least energy intensive imaging method for a given diagnosis, shutting down equipment in standby mode, sourcing energy from renewable sources, and reducing waste through recycling. Optimizing imaging protocols can reduce radiation exposure to patients, energy used per examination, and the use of other resources such as iodinated contrast media, an environmental pollutant. Achieving socially equitable access to services for ethnic and racial minorities remains a challenge in the US health care system. Extending hours of operation for screening services to include nights and weekends can provide options for patients who otherwise must take time away from work with loss of income. With respect to governance, more transparency in leadership selection and greater opportunities for participation by women and racial/ethnic minorities in the leadership of professional organizations should be supported in radiology. To succeed in ESG initiatives, radiology practice leaders should consider appointing a lead person and a multifunctional team that includes broad representation from the radiology workplace. The team should work to identify opportunities that are realistic and achievable within their institutional contexts.

Technical and Administrative Advances to Promote Sustainable Radiology

Climate change mandates that we take steps to understand and mitigate the negative environmental consequences of the practice of health care, so that health care advances sustainably. In this article, the authors review and discuss a sample of technical and administrative advances required to align the practice of radiology with principles of environmental sustainability.

Environmental Sustainability and AI in Radiology: A Double-Edged Sword

According to the World Health Organization, climate change is the single biggest health threat facing humanity. The global health care system, including medical imaging, must manage the health effects of climate change while at the same time addressing the large amount of greenhouse gas (GHG) emissions generated in the delivery of care. Data centers and computational efforts are increasingly large contributors to GHG emissions in radiology. This is due to the explosive increase in big data and artificial intelligence (AI) applications that have resulted in large energy requirements for developing and deploying AI models. However, AI also has the potential to improve environmental sustainability in medical imaging. For example, use of AI can shorten MRI scan times with accelerated acquisition times, improve the scheduling efficiency of scanners, and optimize the use of decision-support tools to reduce low-value imaging. The purpose of this Radiology in Focus article is to discuss this duality at the intersection of environmental sustainability and AI in radiology. Further discussed are strategies and opportunities to decrease AI-related emissions and to leverage AI to improve sustainability in radiology, with a focus on health equity. Co-benefits of these strategies are explored, including lower cost and improved patient outcomes. Finally, knowledge gaps and areas for future research are highlighted.

Evaluation of Climate-Aware Metrics Tools for Radiology Informatics and Artificial Intelligence: Toward a Potential Radiology Ecolabel

Radiology is a major contributor to health care's impact on climate change, in part due to its reliance on energy-intensive equipment as well as its growing technological reliance. Delivering modern patient care requires a robust informatics team to move images from the imaging equipment to the workstations and the health care system. Radiology informatics is the field that manages medical imaging IT. This involves the acquisition, storage, retrieval, and use of imaging information in health care to improve access and quality, which includes PACS, cloud services, and artificial intelligence. However, the electricity consumption of computing and the life cycle of various computer components expands the carbon footprint of health care. The authors provide a general framework to understand the environmental impact of clinical radiology informatics, which includes using the international Greenhouse Gas Protocol to draft a definition of scopes of emissions pertinent to radiology informatics, as well as exploring existing tools to measure and account for these emissions. A novel standard ecolabel for radiology informatics tools, such as the Energy Star label for consumer devices or Leadership in Energy and Environmental Design certification for buildings, should be developed to promote awareness and guide radiologists and radiology informatics leaders in making environmentally conscious decisions for their clinical practice. At this critical climate juncture, the radiology community has a unique and pressing obligation to consider our shared environmental responsibility in innovating clinical technology for patient care.

The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC

Since the 2009 publication of the stress echocardiography expert consensus of the European Association of Echocardiography, and after the 2016 advice of the American Society of Echocardiography-European Association of Cardiovascular Imaging for applications beyond coronary artery disease, new information has become available regarding stress echo. Until recently, the assessment of regional wall motion abnormality was the only universally practiced step of stress echo. In the state-of-the-art ABCDE protocol, regional wall motion abnormality remains the main step A, but at the same time, regional perfusion using ultrasound-contrast agents may be assessed. Diastolic function and pulmonary B-lines are assessed in step B; left ventricular contractile and preload reserve with volumetric echocardiography in step C; Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery in step D; and ECG-based heart rate reserve in non-imaging step E. These five biomarkers converge, conceptually and methodologically, in the ABCDE protocol allowing comprehensive risk stratification of the vulnerable patient with chronic coronary syndromes. The present document summarizes current practice guidelines recommendations and training requirements and harmonizes the clinical guidelines of the European Society of Cardiology in many diverse cardiac conditions, from chronic coronary syndromes to valvular heart disease. The continuous refinement of imaging technology and the diffusion of ultrasound-contrast agents improve image quality, feasibility, and reader accuracy in assessing wall motion and perfusion, left ventricular volumes, and coronary flow velocity. Carotid imaging detects pre-obstructive atherosclerosis and improves risk prediction similarly to coronary atherosclerosis. The revolutionary impact of artificial intelligence on echocardiographic image acquisition and analysis makes stress echo more operator-independent and objective. Stress echo has unique features of low cost, versatility, and universal availability. It does not need ionizing radiation exposure and has near-zero carbon dioxide emissions. Stress echo is a convenient and sustainable choice for functional testing within and beyond coronary artery disease.

Optimization of Iodinated Contrast Media Inventory Management: Effect of Inventory Diversification on Waste Reduction

PURPOSE

Iodinated contrast medium (ICM) is available in single- and multiuse vials of varying sizes, but CT departments often preferentially stock only a single or a limited number of vial sizes. The aims of this study were to assess actual ICM waste at a large safety-net hospital and to compare with estimated waste if single-use vials in a variety of vial sizes or multiuse vials were used.

METHODS

ICM administrations were retrospectively reviewed for all CT examinations performed in 2021 in a department that stocked only 100-mL ICM vials. Administered ICM dose, opened ICM volume and number of vials, and wasted ICM were compared with hypothetical models using optimally sized single-use vials and multiuse vials. Contrast use was also compared by patient class.

RESULTS

In total, 40,393 ICM administrations over 49,670 CT examinations among 26,028 patients were reviewed, totaling 4,168,335 mL of contrast media. The mean dose was 103 mL, with mode of 100 mL. Exclusive use of 100-mL vials resulted in 1,006,165 mL waste (mean waste, 26 mL/administration). Optimally sized single-use vials resulted in 436,515 mL waste (mean waste, 11 mL/administration). Multiuse vials resulted in 537,074 mL waste (mean waste, 13 mL/administration). The distribution of optimal single-use vial size differed significantly by patient class (P < .001), with inpatient examinations more amenable to the use of smaller single-use vials.

CONCLUSIONS

Optimizing ICM inventory can reduce contrast waste by 50% to 59%. Regular monitoring of contrast use may help optimize inventory selection across care settings. This retrospective review supports scrutiny of ICM inventory management to reduce waste, save costs, and mitigate the impacts of supply-chain disruptions.

Economic, ethical, and environmental sustainability of cardiac imaging

Current cardiology guidelines assign a class of recommendation 1 for the diagnosis of chest pain to five imaging techniques based on either anatomic (coronary computed tomography angiography) or functional approaches, such as stress single-photon emission tomography, stress positron emission tomography, stress cardiovascular magnetic resonance, and stress echocardiography. The choice is left to the prescribing physician, based on local availability and expertise. However, the five techniques differ substantially in their cost, applicability based on patient characteristics, long-term risk, and environmental impact. The average European immediate cost ranges from 50 to 1000 euros. The radiation exposure ranges from 0 to 500 chest x-rays. The environmental footprint ranges from 3 to 300 kg of carbon dioxide emissions equivalent. The ethical code of the World Medical Association 2021 recommends the responsible use of healthcare money by doctors, with the minimization of potential damage to patients and the environment. The Euratom law 2013/directive 59 reinforces the justification principle and the optimization principle for medical radiation exposures, with the legal responsibility of both the referrer and the practitioner. A small cost, a minimal long-term risk, and a modest carbon emission per examination multiplied by billions of tests per year become an unaffordable economic burden in the short-term, significant population damage to public health over the years, and impacts on climate change in decades. The cardiology community may wish to adopt a more sustainable practice with affordable, radiation-optimized, and carbon-neutral practices for the benefit of patients, physicians, payers, and the planet.

The green and sustainable radiology department

As manmade climate change threatens the health of the planet, it is important that we understand and address the contribution of healthcare to global emissions. Medical imaging is a significant contributor to overall emissions. This article aims to highlight key issues and examples of sustainable practices, in order to empower radiologists to make a change within their department.

Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice

INTRODUCTION

Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research.

METHODS

A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings.

RESULTS

A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel.

CONCLUSIONS

Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare.

IMPLICATIONS FOR PRACTICE

Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.

Exploring the Clinical Translation of Generative Models Like ChatGPT: Promise and Pitfalls in Radiology, From Patients to Population Health

Generative artificial intelligence (AI) tools such as GPT-4, and the chatbot interface ChatGPT, show promise for a variety of applications in radiology and health care. However, like other AI tools, ChatGPT has limitations and potential pitfalls that must be considered before adopting it for teaching, clinical practice, and beyond. We summarize five major emerging use cases for ChatGPT and generative AI in radiology across the levels of increasing data complexity, along with pitfalls associated with each. As the use of AI in health care continues to grow, it is crucial for radiologists (and all physicians) to stay informed and ensure the safe translation of these new technologies.

Climate toxicity: An increasingly relevant clinical issue in Cancer Care

In recent years the terms time and financial toxicities have entered the vocabulary of cancer care. We would like to introduce another toxicity: climate toxicity. Climate toxicity is a double-edge sword in cancer care. Increasing cancer risk by exposure to carcinogens, and consequently increasing treatment requirements leads to ever growing damage to our environment. This article assesses the impact of climate change on patients, the climate toxicity caused by both healthcare workers and healthcare facilities, and suggests actions that may be taken mitigate them.

The environmental cost of unwarranted variation in the use of magnetic resonance imaging and computed tomography scans

BACKGROUND

Pollution is a major threat to global health, and there is growing interest on strategies to reduce emissions caused by health care systems. Unwarranted clinical variation, i.e. variation in the utilization of health services unexplained by differences in patient illness or preferences, may be an avoidable source of CO2 when related to overuse. Our objective was to evaluate the CO2 emissions attributable to unwarranted variation in the use of MRI and CT scans among countries of the G20-area.

METHODS

We selected seven countries of the G20-area with available data on the use of CT and MRI scans from the organization for Economic Co-operation and Development repository. Each nation's annual electric energy expenditure per 1000 inhabitants for such exams (T-En_ex-1000) was calculated and compared with the median and lowest value. Based on such differences we estimated the national energy and corresponding tons of CO2 that could be potentially avoided each year.

RESULTS

With available data we found a significant variation in T-En_ex-1000 (median value 1782 kWh, range 1200-3079 kWh) and estimated a significant amount of potentially avoidable emissions each year (range 2046-175120 tons of CO2). In practical terms such emissions would need, in the case of Germany, 71900 and 104210 acres of forest to be cleared from the atmosphere, which is 1.2 and 1.7 times the size of the largest German forest (Bavarian National Forest).

CONCLUSION

Among countries with a similar rate of development, unwarranted clinical variation in the use of MRI and CT scan causes significant emissions of CO2.

Climate Change, Carbon Dioxide Emissions, and Medical Imaging Contribution

Human activities have raised the atmosphere's carbon dioxide (CO₂) content by 50% in less than 200 years and by 10% in the last 15 years. Climate change is a great threat and presents a unique opportunity to protect cardiovascular health in the next decades. CO₂ equivalent emission is the most convenient unit for measuring the greenhouse gas footprint corresponding to ecological cost. Medical imaging contributes significantly to the CO₂ emissions responsible for climate change, yet current medical guidelines ignore the carbon cost. Among the common cardiac imaging techniques, CO₂ emissions are lowest for transthoracic echocardiography (0.5-2 kg per exam), increase 10-fold for cardiac computed tomography angiography, and 100-fold for cardiac magnetic resonance. A conservative estimate of 10 billion medical examinations per year worldwide implies that medical imaging accounts for approximately 1% of the overall carbon footprint. In 2016, CO₂ emissions from magnetic resonance imaging and computed tomography, calculated in 120 countries, accounted for 0.77% of global emissions. A significant portion of global greenhouse gas emissions is attributed to health care, which ranges from 4% in the United Kingdom to 10% in the United States. Assessment of carbon cost should be a part of the cost-benefit balance in medical imaging.

Mitigation Tactics Discovered During COVID-19 with Long-Term Report Turnaround Time and Burnout Reduction Benefits

RATIONALES AND OBJECTIVES

The purpose is to describe a hybrid teleradiology solution utilized in an academic medical center and its outcomes on radiology report turnaround time (RTAT) and physician wellness.

MATERIALS AND METHODS

During coronavirus disease 2019, we utilized an alternating teleradiology solution with procedural and education attendings working in the hospital and other faculty remote to keep the worklist clean. RTAT data was collected for remote vs. in house emergency department (ED) and inpatient cases over a 6-month period. Pre and post implementation burnout surveys were administered.

RESULTS

RTAT significantly improved for ED and inpatient MR and CT, and inpatient US and radiographs when interpreted remotely compared to in-hospital. Physician wellness scores improved and open-ended comments reflected positive feedback about the hybrid work solution. 74% enjoyed the autonomy and flexibility, and 51% said the solution positively influences my desire to remain in my current institution and improves their clinical and/or academic productivity.

CONCLUSION

Hybrid work from home solutions allow faculty autonomy and flexibility with work-life balance, improving wellness. It is important to alternate the at-home faculty to maintain interdepartmental relations, particularly for junior faculty, and prevent isolation. The hybrid solution also demonstrated improved patient care metrics, possibly due to decreased distractions at home compared to the reading room.

The scope for radiology to contribute to the NHS net zero target: findings from a survey of radiology staff in the UK

AIM

To assess attitudes towards the climate emergency among radiology staff and to identify current practices that may contribute towards the National Health Service (NHS) net zero target.

MATERIALS AND METHODS

An online survey of radiology staff was conducted assessing current attitudes to the climate emergency. Further questions focused on staff travel, home working, virtual conferences, and recycling.

RESULTS

Two hundred and forty-two responses were received from all staff groups within radiology. There were high levels of concern about the climate emergency among radiology staff. Active travel accounts for a relatively small proportion of commuting related to provision of radiology services. Some energy-saving measures are implemented commonly in radiology departments but these are likely to account for only a small proportion of energy use within a department.

CONCLUSION

There is significant scope for reducing the carbon footprint of radiology services by reducing travel, both for work and for radiology education. We discuss the potential for large savings related to energy-saving measures.