April 13, 2021

Climate Change and Radiology

By Julia Schoen, MD & Amanda Marrero-Gonzalez, MD

Climate change is not a topic that comes up routinely in the reading room. But it should be. Climate change is linked to a wide range of cardiovascular, respiratory, infectious and mental health outcomes that will shape the future of human health.

Over the next few decades, rising global temperatures will have widespread impacts on both our health and the economy1. Already, we have seen a 53.7% increase in heat-related mortality in elderly populations over the past 20 years. Our hospitals are not resilient to the impacts of climate change. We have begun to see this as climate-sensitive extreme weather events, like wildfires in California and major hurricanes on the Atlantic Coast, negatively impact healthcare access and increase financial burdens for healthcare institutions. NYU lost approximately $1.4 billion in revenue after Hurricane Sandy2. From 2016–2019, the United States alone saw an increase of over 470,000 daily wildfire exposures compared to 2001–20041.

Extreme weather events linked to climate change prompt hospital evacuations, destabilize electrical grids and displace hospital employees2. Our radiology practices and our healthcare systems are not prepared for these events. Unfortunately, as residents and fellows, these impacts will become increasingly relevant throughout our careers.

To understand the potential impacts of climate change on radiology practice, we can look to the devastating example of recent hurricanes in Puerto Rico. Three and a half years after Hurricanes Irma and Maria, Puerto Rico is still rebuilding. Maria was the strongest hurricane to hit Puerto Rico in more than 80 years. Occurring just two weeks after hurricane Irma, it was a strong category 4 storm with 155 mph winds at landfall. The hurricanes gravely damaged the island’s infrastructure and roads, and caused a complete collapse of the electrical grid. As essential services, like food and water, became interrupted, healthcare and imaging were also affected. The medical community, including radiologists, faced many challenges to provide patient care.

The challenges faced by radiologists on the island after the hurricanes has limited the capacity to meet patients’ imaging needs. Structural damage to imaging centers and equipment, lack of electrical power, potable water and telecommunications, all hindered healthcare delivery. Lack of electricity posed a unique problem to radiologists on the island.

The number of imaging modalities offered had to be decreased in response to the high cost of continuing power plant operations as a result of problems with mechanical damage and diesel dispatch. Disrupted telecommunications and internet connectivity prevented teleradiology services from operating on the island, further limiting patient access to basic medical imaging.

For radiology residents in Puerto Rico, these conditions were intensified due to their duty as physicians and first responders, academic responsibilities, personal losses and financial difficulties. The diagnostic radiology residency program on the island had to quickly determine the whereabouts of all residents. With only four residents per year, they had to promptly overcome scheduling difficulties and make sure every rotation was covered and that no service was interrupted.

Every resident suffered some degree of personal and material loss, leading to significant emotional impact, making the conditions in the aftermath of Hurricane Maria increasingly demanding. However, radiologists remained committed to their work and continued providing for the needs of their patients.

The aftermath following Hurricanes Irma and Maria has confirmed that the physical presence of radiologists in hospitals and imaging centers is essential to meet the medical needs of the community. Technological advances, such as artificial intelligence and teleradiology, are promising for the future of radiology.

However, reliance on these advances would have a negative impact on the health of patients if our electrical grids and telecommunications systems are vulnerable to climate-sensitive weather events. We need to make sure our practices are resilient to such events, with plans to respond quickly in the event of a natural disaster.

An estimated 62% increase in Puerto Rico’s mortality rate occurred after Hurricane Maria4. We must limit global warming to “well below 2C”, the internationally agreed upon target, to protect human health and mitigate the predicted impacts of climate change. To do this, it is estimated that we need to decrease global carbon emissions by 7.6% annually over the next 10 years1. This will require rapid innovations from every sector, including radiology.

Luckily, rapid technological innovation is radiology’s forte. As such, we are uniquely poised to lead the healthcare sector in these efforts. Our healthcare system is responsible for approximately 10% of the United States’ greenhouse gas emissions3. While data about radiology’s contribution to healthcare emissions is sparse, our impact is likely significant.

In a study from one Swiss hospital, three CT scanners and one MR scanner accounted for approximately 4% of the hospital’s energy use5. Furthermore, the bulk of healthcare’s carbon footprint is attributed to the supply chain. In radiology, we have no shortage of single-use devices and procedure kits that are thrown out after one or even zero uses. Our PACS stations are another energy sink in the radiology department. Turning off idle PACs stations would generate cost and energy savings benefits for our departments at minimal inconvenience to the individual radiologist.

Addressing climate change on a global scale is a daunting task, but it becomes approachable when we look for ways to make an impact within our own departments. As such, we have started a working group on environmental sustainability in radiology that is open to any interested radiologist or trainee. Below are a number of ways that residents and fellows can being to make a difference:

  • Join our radiology working group on environmental sustainability (contact jschoen@wakehealth.edu).
  • Be aware of how your practice can affect the environment.
  • Keep up to date with current methods to practice sustainability of medical imaging.
  • Advocate for environmental sustainability policy within radiology societies.
  • Complete quality improvement and research projects focused on environmental sustainability.
  • Join your hospital’s sustainability team, if open to trainees.
  • Promote awareness about the health impacts of climate change and healthcare’s carbon footprint in our departments and communities.
  • Adopt simple green work habits to reduce power consumption, like powering down room lights and workstations when not in use.


  1. Watts, Nick, et al. "The 2020 Report of The Lancet Countdown on Health and Climate Change: Responding to Converging Crises," The Lancet, 2020.
  2. Salas, Renee N., et al. "Adding a Climate Lens to Health Policy in the United States: Commentary Explores How Health Care Policy Makers Can Integrate a Climate Lens as They Develop Health System Interventions." Health Affairs, 39.12: 2020, pp. 2063–2070.
  3. Eckelman, Matthew J., and Jodi Sherman. "Environmental Impacts of the US Health Care System and Effects on Public Health." PloS one, 11.6: 2016, e0157014.
  4. Kishore, Nishant, et al. "Mortality in Puerto Rico After Hurricane Maria." New England Journal of Medicine, 379.2: 2018, pp. 162–170.
  5. Heye, Tobias, et al. "The Energy Consumption of Radiology: Energy- and Cost-Saving Opportunities for CT and MRI Operation." Radiology 295.3: 2020, pp. 593–605.