EcoRad: Integrating Sustainability and Economics in Radiology

Radiologists are increasingly seeking ways to implement sustainable practices within their departments, yet they often face perceived economic barriers. A recent article in BJR Open, co-authored by Benjamin Northrup, MD, from the Mallinckrodt Institute of Radiology, addresses these challenges by introducing the concept of "EcoRad." This approach underscores the alignment between ecological sustainability and economic viability, encouraging radiology departments to adopt practices that are both environmentally and financially beneficial.

Dr. Northrup, in collaboration with co-authors such as Reed A. Omary, MD, of Vanderbilt University, emphasizes that reducing waste not only lowers costs but also enhances efficiency and patient care. Omary explains, “The practical point of EcoRad is simple. Reducing waste often lowers costs, improves efficiency and strengthens patient care. Put another way: high-quality radiology practices have the least waste.”

Despite the clear benefits, the transition to sustainable practices is often hindered by cognitive biases. These include the status quo bias, where leaders may resist change because it appears safer and less demanding cognitively or financially, and the sunk cost fallacy, in which institutions persist with inefficient methods due to past investments. Dr. Northrup cautions against ignoring hidden costs that may surpass the expense of adopting more efficient methods.

Kate Hanneman, MD, vice chair at the University Health Network in Toronto, notes that one of the largest barriers is the presumption that sustainable practices incur higher costs. However, she suggests that these perceived biases skew perceptions, emphasizing, “One of the biggest barriers to sustainable radiology is the belief that it costs more. Biases persist because they make sustainable choices feel expensive when this is not necessarily true.”

To initiate sustainable practices, Dr. Hanneman advises institutions to begin by measuring their environmental impacts. By examining emissions per imaging modality, departments can identify key areas to target for improvement. Tools such as life cycle assessment can help quantify the dual benefits of reducing environmental impact and lowering costs.

Efficiency is a crucial step towards sustainability. Dr. Northrup states, “Reducing unnecessary imaging, optimizing workflows to reduce patient travel and increase patient throughput, and switching off monitors at night are not only good for the planet, but they also have the potential to help alleviate the current workforce shortage and reduce burnout while lowering overhead costs, increasing patient safety, and bettering the patient experience.”

Looking forward, frameworks like "Green Lean Six Sigma" and "green budgeting" can institutionalize long-term changes by optimizing resource use and tracking both financial and environmental costs. Aligning financial incentives with positive patient outcomes, sustainability, and efficiency through value-based care further strengthens these efforts.

Dr. Hanneman underscores the necessity of focusing on patient-centered care within sustainability initiatives, elaborating that improving the environmental impact of radiology is inherently linked to enhancing patient care.

In conclusion, the EcoRad initiative encourages radiologists to adopt a "triple bottom line" approach — prioritizing patients, the planet, and profits. Highlighting the substantial influence of radiology on the environmental and economic frameworks of hospital systems, Dr. Northrup expresses optimism that the specialty can lead the charge in a more circular economy by collaborating with industry on sustainable imaging technologies and practices.