Developing a Roadmap for Sustainability Research in Radiology

“Most early radiology literature on sustainability focuses on calls-to-action and narrative reviews, fragmenting the science in this space,” said Dr. Foster, a radiology resident at the University of Michigan in Ann Arbor. “A formal assessment hasn’t yet been performed to guide our future efforts.”

Dr. Foster and a team of researchers, including an expert health sciences informationist, conducted a comprehensive search of four medical databases—Ovid Medline, Clarivate Web of Science, Elsevier Embase and Elsevier Scopus.

The scoping review included all original research on diagnostic imaging and image-guided procedures that stated environmental impact as an outcome. Conference abstracts, narrative reviews, commentaries and editorials were excluded.

The team collected publication details including study design, country of origin and environmental outcome, each summarized with descriptive statistics. Of the 2,280 abstracts reviewed, the team included 98 papers published between 1971 and 2024. Most studies were observational, retrospective and cross-sectional.

“Among thousands of publications addressing environmental sustainability and medical imaging, only a small percentage provide primary data,” Dr. Foster said.

Dr. Foster said the final body of research included international representation, with the U.S. and Europe publishing the most studies. The most researched topics were nuclear medicine waste, energy and waste from image acquisitions, and energy from radiology operations. She said nuclear medicine had an early awareness of environmental impacts, and gadolinium pollution has also emerged as a research subtopic.

“MRI was the most energy intensive modality, with annual CO₂ emissions from one scanner comparable to about 11 homes electrically powered for one year,” Dr. Foster said.

The research team identified several knowledge gaps in the research, including validating existing estimates of modality-specific emissions and obtaining initial emissions estimates for nuclear medicine, breast imaging and research on the efficacy of proposed mitigation strategies.

“There are many aspects of MRI practice that deserve further attention, including setting differences between vendors, age of magnets, protocols, and the balance between green considerations and clinical efficacy,” Dr. Foster said.

She urged the radiology community to conduct practice-wide lifecycle analyses, which provide the best opportunities for interventions and to publish and share technical reports on their own system-wide testing and interventions.

“This structured scoping review is the first of its kind in radiology that assesses the current state of literature and gives a picture of where our efforts have been focused thus far,” Dr. Foster said. “With only five percent of the existing literature containing primary data, there’s a huge opportunity for scholarly impact.”

“We hope that by identifying the research gaps, we’ve provided a jumping-off point and roadmap for further research in this space,” Dr. Foster concluded.