Cancer imaging and image-guided procedures are central to prevention, diagnosis and treatment, yet they carry a sizeable environmental load. Medical imaging is estimated to account for nearly 1% of the global carbon footprint. Environmental degradation increases cancer risk, disrupts care pathways and worsens outcomes, creating feedback between rising incidence and greater demand for energy-intensive imaging and therapy. A pragmatic response spans operational change, technology development and careful measurement across the pathway. A 2030-oriented roadmap highlights actions to reduce emissions, steward waste, strengthen resilience and engage patients and communities while protecting quality and access.
Environmental Burden of Imaging and Interventions
Radiology’s emissions align with Greenhouse Gas Protocol scopes, with scope 2 (purchased energy) dominating departmental footprints and scope 3 (supply chain) also significant. Per-scan impacts are tangible: an MRI examination generates about 20 kg CO₂-equivalents, comparable to an 83-km drive in a petrol car. Beyond carbon, imaging contributes to pollution through energy demand and waste streams that include plastics, packaging and contrast media.
Interventional radiology (IR) has moved many procedures from operating rooms to interventional suites, which can lower emissions relative to surgery but still generates substantial waste and energy use. A single IR procedure can produce up to 8 kg of waste. Major drivers include climate control of procedure rooms, disposable supplies and equipment electricity loads. Powering down equipment when idle and reducing single-use items are effective mitigation measures. Environmental risks extend to water and air: about 95% of iodinated contrast is excreted unmetabolised, challenging standard purification systems and creating cytotoxic by-products, and ethylene oxide used to sterilise devices is associated with haematologic and breast cancers.
Radiation oncology has quantified large-scale impacts. External beam radiation therapy generated an estimated 3.3 million and 2.7 million metric tons of CO₂-equivalents in 2019 and 2020, respectively. Hypofractionation offers meaningful potential to reduce emissions where clinically appropriate. Nuclear medicine and theranostics require tailored approaches: although many PET radiotracers involve low administered doses and short half-lives, scope 2 and supply chain emissions still matter, and some theranostic agents such as lutetium-177, with a 6.65-day half-life, create more persistent radioactive waste and disposal needs. Geopolitical constraints around rare earth elements, including lutetium, yttrium and gadolinium, add further sustainability considerations for sourcing and end-of-life management.
Operational and Digital Levers for Emission Reduction
Radiology departments can reduce energy use without compromising care by combining equipment, workflow and facility measures. Practical steps include placing scanners in low-power or off modes when not in use, shortening MRI protocols where appropriate, concentrating activity during system-on phases and collaborating with vendors to deploy efficiency features. Facility design aligned with established green building standards, wider temperature set points and motion-sensing controls can lower heating, ventilation and cooling loads. Where electricity procurement is centralised, institutional advocacy for renewable or other zero-emission sources supports decarbonisation.
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Clinical decision support and artificial intelligence (AI) offer dual benefits: improving quality and safety while reducing unnecessary utilisation that carries environmental and financial costs. AI can optimise MRI acquisition, reduce contrast dose and refine therapy planning. Its own footprint, driven by data centre electricity and water consumption, warrants mitigation through principles such as matching digital growth with additional clean energy. Life-cycle assessment provides the quantitative frame to target the highest-yield interventions. Findings indicate that patient transportation is a major contributor in radiotherapy pathways, highlighting the value of teleconsultation for suitable visits. In IR, aligning cooling and ventilation with operating hours yields substantial reductions. Remote reporting, mobile units and robotic ultrasound can cut travel emissions while improving access where travel distance correlates with poorer outcomes.
Supply chains dominate health care emissions, accounting for 71% of the sector’s footprint. Within radiology, imaging equipment operation is a major departmental contributor, followed by equipment production and linen laundering. Sustainable procurement, vendor engagement and circular approaches to devices and materials can reduce emissions while strengthening resilience. Refurbished equipment and reprocessed devices, where safe and compliant, extend useful life and lower embodied carbon.
Roadmap 2030: Priorities, Measurement and Waste
A 2030 roadmap focuses on education, operational integration, technology, science, resilience, waste management, pathway decarbonisation, community involvement and governance with incentives. Education embeds climate and environmental content across training for clinicians, researchers and managers to normalise consistent practice change. Operational priorities tie sustainability to quality and cost, with dashboards to track emissions, waste and progress against defined targets. Technology development emphasises energy-efficient equipment, clinical decision support and AI aligned to appropriateness criteria that incorporate environmental impact.
Green laboratory standards can reduce research-related energy and material use, while adding environmental stewardship to responsible conduct of research aligns public benefit with funding and oversight. Screening for climate resilience can sit alongside population cancer screening to identify risks from air and water quality or extreme weather that disrupt diagnosis and treatment. Waste reduction spans contrast stewardship, multidose packaging, recovery and recycling of iodinated and gadolinium-based agents where available and improved decay-in-storage solutions for longer-lived radionuclides. Transitioning from single-use plastics to reusable alternatives and building closed-loop recycling pathways can cut waste and support supply security.
Measurement and governance underpin delivery. Existing sustainability certification programmes and health sector climate initiatives provide structure for goal setting, reporting and accountability. Policy levers include reimbursement models that recognise lower-emission care where clinically appropriate and requirements for default power-save modes on energy-intensive devices. Patients are essential partners, with strong reported support for sustainability in health care and a role in codesigning practices that reduce waste and emissions while protecting safety and access. Environmental and economic benefits align when unnecessary imaging and procedures are avoided, workforce pressures are eased and waste-related costs are reduced.
Sustainable cancer imaging and treatment require targeted action across systems, practices and technologies without compromising outcomes. Evidence from life-cycle assessments, operational audits and clinical pathways points to tractable opportunities, from energy management and appropriate use to travel reduction, waste stewardship and supply chain reform. With a clear 2030 roadmap, consistent measurement and collaboration among providers, patients, industry and policymakers, radiology can cut its environmental footprint and support resilient, equitable cancer care.
Source: Radiology: Imaging Cancer
Image Credit: iStock
