Florence Doo, MD, MA, previews the April JACR Focus Issue on sustainability, and how sustainable practices are being properly implemented into radiology.
Sustainability is a talking point that has gained traction over the past decade, and many radiology organizations have taken strides to make sure it is practiced. While some societies have taken important steps in this direction, there is still a lot of work to be done.
The April JACR Focus Issue dives into this topic of sustainability, focusing on a variety of topics such as energy management and clean energy sourcing, supplying chain stewardship and even reaching the broader question of appropriate utilization. Florence Doo, MD, MA, guest editor of the focus issue, talks about what led to the creation of this issue and what she hopes readers will take away from it.
I’m an assistant professor in abdominal imaging in the department of radiology at the University of Maryland School of Medicine, as well as director of innovation at the University of Maryland Medical Intelligence Imaging Center (an AI center). I also serve on the faculty at the Institute for Health Computing, conducting applied AI research. I like to focus on the intersection of technology, how it impacts clinical care and the sustainability of that for optimal patient care.
I got into this line of work for a couple of reasons. We want to provide the best possible care for our patients. I’ve always been looking into different ways that can happen, and one of them happens to be with AI. Considering my AI and technology background, it made me think about climate change and radiology in both an environmental and technological dimension. What happens when AI ramps up and we’re using more of it? How is that going to impact our patients and our planet? It fueled me to look more into this topic.
Sustainability happens to be a word that touches on a lot of topics. There’s an accompanying editorial with this focus issue, and the way that I’ve framed it there is the triple helix description — value, patient care and planet. An economist, John Elkington, described that we need to tally financial, social and environmental performance. He didn’t like how his own framework ended up siloing off those three areas because we now know they all interplay with each other. We must think about these concepts as an intertwined helix — the environmental impact of what we’re doing, how it impacts our patients and communities, and also the negative and positive value in the economy, as money can be a huge factor.
There are clusters of articles that dive into a variety of topics. One of these expands upon the work of Cassandra L. Thiel, PhD, who does a lot of life-cycle analysis at New York University. Thiel’s study was expanded upon into a more focused analysis on MRI, CT, radiography and ultrasound. That group of articles looks at how to mitigate the life cycle of emissions for a more positive effect on the environment.
Another group of articles focuses on solutions. For example, one article in this group focuses on the high-energy use of MRI and CT scans. The ultrasound article had a surprising and fun finding in that the energy output of the machine was not the issue — it was the amount of linen used by patients! If you’re scanning somebody and you’re using a lot of towels to wipe them off, you increase water usage due to the laundry you’re doing. Another practical aspect was about optimizing contrast use. Iodinated contrast is a dye that you inject into the vessels to highlight organs, and you don’t need the same dose for everyone. Lowering doses when necessary, helps reduce pollution of waterways.
I think creating this issue reaffirmed this belief to me: we’re all trying to do good for the world, and when we do this, it’s not just to make ourselves feel good — it’s also positive for the planet, people and bottom-line costs.
I think creating this issue reaffirmed this belief to me: we’re all trying to do good for the world, and when we do this, it’s not just to make ourselves feel good — it’s also positive for the planet, people and bottom-line costs. Another reaffirmed belief is that while we’re a part of the problem (we’re generating emissions as we practice healthcare) we’re also part of the solution. Sustainability is starting to be framed more as a quality improvement and operational efficiency problem. We need to do this right to reduce waste, improve our energy and optimize our workflow so we can do better as radiologists.
I think that radiology is doing well in the leadership aspect. There are a lot of leaders who are thinking about sustainability deeply and trying to innovate. We're now entering an exciting next phase — one where that leadership can grow and spread, where more champions can emerge across our field and also where sustainability teams working together can achieve things that no single individual could accomplish alone.
We also need to think more about how our technological processes from end to end really do contribute to healthcare emissions, because most of the technology in a health system lives with us in radiology specifically — MRI machines, CT machines and now AI. We can collaborate more with vendors, academic and industry partners. This means thinking about innovation in both the “green” sense — reducing energy use and minimizing waste and also in the sense of building practices and systems that are truly durable across our entire radiology workflow and ecosystem.
I hope readers are inspired to discover how sustainability can happen with each of us. We need to do the best we can, when we can and where we can. It’s important to do that from a day-to-day operations standpoint, as well as take a broader view of how the practice will evolve. We have this opportunity as radiologists to be leaders in doing this sustainable work because our practices have such a high impact on emissions.
The takeaway really is how do we want to practice radiology now and for generations to come? As you read this issue, think about what you want to change so that future radiologists and patients will have a sustainable world to live in. We each have a part to play.
Interview by Alex Utano, associate editor, ACR Press
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