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McKee H, Brown MJ, Kim HHR, Doo FX, Panet H, Rockall AG, Omary RA, Hanneman K. Planetary Health and Radiology: Why We Should Care and What We Can Do. Radiology 2024; 311:e240219. [PMID: 38652030 DOI: 10.1148/radiol.240219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Climate change adversely affects the well-being of humans and the entire planet. A planetary health framework recognizes that sustaining a healthy planet is essential to achieving individual, community, and global health. Radiology contributes to the climate crisis by generating greenhouse gas (GHG) emissions during the production and use of medical imaging equipment and supplies. To promote planetary health, strategies that mitigate and adapt to climate change in radiology are needed. Mitigation strategies to reduce GHG emissions include switching to renewable energy sources, refurbishing rather than replacing imaging scanners, and powering down unused scanners. Radiology departments must also build resiliency to the now unavoidable impacts of the climate crisis. Adaptation strategies include education, upgrading building infrastructure, and developing departmental sustainability dashboards to track progress in achieving sustainability goals. Shifting practices to catalyze these necessary changes in radiology requires a coordinated approach. This includes partnering with key stakeholders, providing effective communication, and prioritizing high-impact interventions. This article reviews the intersection of planetary health and radiology. Its goals are to emphasize why we should care about sustainability, showcase actions we can take to mitigate our impact, and prepare us to adapt to the effects of climate change. © RSNA, 2024 Supplemental material is available for this article. See also the article by Ibrahim et al in this issue. See also the article by Lenkinski and Rofsky in this issue.
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Affiliation(s)
- Hayley McKee
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Maura J Brown
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Helen H R Kim
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Florence X Doo
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Hayley Panet
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Andrea G Rockall
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Reed A Omary
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
| | - Kate Hanneman
- From the Temerty Faculty of Medicine (H.M.) and Department of Medical Imaging (H.M., H.P., K.H.), University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.J.B.); Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash (H.H.R.K.); University of Maryland Medical Intelligent Imaging (UM2ii) Center, Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Md (F.X.D.); Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (A.G.R.); Department of Radiology, Imperial College Healthcare NHS Trust, London, England (A.G.R.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (R.A.O.); Joint Department of Medical Imaging, University Medical Imaging Toronto, Toronto, Ontario, Canada (K.H.); and Toronto General Hospital Research Institute, University Health Network, University of Toronto, 1 PMB-298, 585 University Ave, Toronto, ON, Canada M5G 2N2 (K.H.)
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Sullivan GA, Petit HJ, Reiter AJ, Westrick JC, Hu A, Dunn JB, Gulack BC, Shah AN, Dsida R, Raval MV. Environmental Impact and Cost Savings of Operating Room Quality Improvement Initiatives: A Scoping Review. J Am Coll Surg 2023; 236:411-423. [PMID: 36648269 DOI: 10.1097/xcs.0000000000000478] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Operating rooms are major contributors to a hospital's carbon footprint due to the large volumes of resources consumed and waste produced. The objective of this study was to identify quality improvement initiatives that aimed to reduce the environmental impact of the operating room while decreasing costs. STUDY DESIGN A literature search was performed using PubMed, Scopus, CINAHL, and Google Scholar and included broad terms for "operating room," "costs," and "environment" or "sustainability." The "triple bottom line" framework, which considers the environmental, financial, and social impacts of interventions to guide decision making, was used to inform data extraction. The studies were then categorized using the 5 "Rs" of sustainability-refuse, reduce, reuse, repurpose, and recycle-and the impacts were discussed using the triple bottom line framework. RESULTS A total of 23 unique quality improvement initiatives describing 28 interventions were included. Interventions were categorized as "refuse" (n = 11; 39.3%), "reduce" (n = 8; 28.6%), "reuse" (n = 3; 10.7%), and "recycle" (n = 6; 21.4%). While methods of measuring environmental impact and cost savings varied greatly among studies, potential annual cost savings ranged from $873 (intervention: education on diverting recyclable materials from sharps containers; environmental impact: 11.4 kg sharps waste diverted per month) to $694,141 (intervention: education to reduce regulated medical waste; environmental impact: 30% reduction in regulated medical waste). CONCLUSIONS Quality improvement initiatives that reduce both cost and environmental impact have been successfully implemented across a variety of centers both nationally and globally. Surgeons, healthcare practitioners, and administrators interested in environmental stewardship and working toward a culture of sustainability may consider similar interventions in their institutions.
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Affiliation(s)
- Gwyneth A Sullivan
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Hayley J Petit
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Audra J Reiter
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer C Westrick
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
| | - Andrew Hu
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer B Dunn
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Brian C Gulack
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Ami N Shah
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Richard Dsida
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mehul V Raval
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
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Cockrell HC, Maine RG, Hansen EE, Mehta K, Salazar DR, Stewart BT, Greenberg SLM. Environmental impact of telehealth use for pediatric surgery. J Pediatr Surg 2022; 57:865-869. [PMID: 35918239 DOI: 10.1016/j.jpedsurg.2022.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The healthcare sector is responsible for 10% of US greenhouse gas emissions. Telehealth use may decrease healthcare's carbon footprint. Our institution introduced telehealth to support SARS-CoV-2 social distancing. We aimed to evaluate the environmental impact of telehealth rollout. METHODS We conducted a retrospective cohort study of pediatric patients seen by a surgical or pre anesthesia provider between March 1, 2020 and March 1, 2021. We measured patient-miles saved and CO2 emissions prevented to quantify the environmental impact of telehealth. Miles saved were calculated by geodesic distance between patient home address and our institution. Emissions prevented were calculated assuming 25 miles per gallon fuel efficiency and 19.4 pounds of CO2 produced per gallon of gasoline consumed. Unadjusted Poisson regression was used to assess relationships between patient demographics, geography, and telehealth use. RESULTS 60,773 in-person and 10,626 telehealth encounters were included. This represented an 8,755% increase in telehealth use compared to the year prior. Telehealth resulted in 887,006 patient-miles saved and 688,317 fewer pounds of CO2 emitted. Demographics significantly associated with decreased telehealth use included Asian and Black/African American racial identity, Hispanic ethnic identity, and primary language other than English. Further distance from the hospital and higher area deprivation index were associated with increased telehealth use (IRR 1.0006 and 1.0077, respectively). CONCLUSION Incorporating telehealth into pediatric surgical and pre anesthesia clinics resulted in significant CO2 emission reductions. Expanded telehealth use could mitigate surgical and anesthesia service contributions to climate change. Racial and linguistic minority status were associated with significantly lower rates of telehealth utilization, necessitating additional inquiry into equitable telemedicine use for minoritized populations. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Rebecca G Maine
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Elizabeth E Hansen
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, 4800 Sand Point Way, NE, Seattle WA 98105, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 Pacific Street, BB-1469, Seattle, WA 98195, USA
| | - Kajal Mehta
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Daniela Rebollo Salazar
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sarah L M Greenberg
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA
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