Green radiology: developing sustainable systems to reduce energy consumption and environmental impact in radiology

Radiology is one of the most energy-intensive and environmentally impactful sectors within modern healthcare systems, contributing substantially to hospitals’ overall ecological footprint. Considering the increasing need to align healthcare services with the United Nations Sustainable Development Goals and national decarbonisation strategies, this doctoral thesis examines the environmental sustainability of diagnostic imaging by integrating evidence from multiple research studies conducted between 2023 and 2025. The main objective was to quantify the energy consumption and environmental impact of diagnostic imaging departments, assess radiology staff perceptions regarding sustainability, and identify concrete mitigation strategies capable of supporting the transition toward more sustainable diagnostic services. The work covered multiple scientific domains and methods: qualitative and quantitative investigations into radiology staff perceptions and behaviours; analyses of energy consumption in Italian radiology units; on-site measurements of magnetic resonance imaging electricity usage before and after technological replacement; assessments of environmental product declarations published by major vendors; quantification of waste generation and contrast media wastage; and application of life cycle assessment to evaluate the environmental footprint of nuclear medicine diagnostic procedures. The results consistently demonstrate that diagnostic imaging has a significant and measurable environmental impact. magnetic resonance imaging and computed tomography systems emerge as major contributors due to their high electricity demand and the large share of idle-state consumption. life cycle assessment analyses show that the environmental burden of imaging extends far beyond scanner electricity use: heating, ventilation and air conditioning systems account for a dominant share of overall emissions. Waste analyses indicate that diagnostic activities generate substantial quantities of plastic, paper and glass, as well as significant waste of contrast media. The European survey confirms that radiology staff recognise the importance of environmental sustainability yet show limited knowledge of existing procedures and inconsistent adoption of eco-friendly practices. The multifactorial nature of radiology’s environmental performance is therefore evident. Technological innovation and low-consumption operating modes can lead to significant energy savings, but must be accompanied by organisational strategies, more efficient heating, ventilation and air conditioning management, and improved waste-handling pathways. Furthermore, the progressive decarbonisation of national electricity grids can substantially amplify the impact of local mitigation measures. Overall, this thesis provides an evidence-based foundation for advancing sustainable radiology. It demonstrates that diagnostic imaging contributes meaningfully to healthcare-related emissions yet offers substantial and actionable opportunities for improvement. By integrating engineering, clinical, organisational, and behavioural perspectives, the work presents a coherent framework to support hospital managers, policymakers and radiology professionals in implementing effective strategies to reduce environmental impact. In conclusion, environmental performance must progressively become a criterion for workflow planning, technology procurement, and professional training, enabling radiology to play a leading role in the transition toward a more sustainable and resilient healthcare system.