Green national policy, constrained practice: The sustainability gap in Rwandan medical imaging

Medical imaging has a significant environmental footprint. While existing research focuses on high-income countries, a critical gap remains in low- and middle-income countries. Rwanda is a fascinating case study, being a leader in national environmental policy yet having a resource-constrained healthcare system. This study aimed to evaluate Rwandan radiographers' knowledge, practices, and perceived barriers to implementing sustainable imaging.

A self-reported descriptive cross-sectional online survey was conducted among radiographers in Rwanda between October and November 2025. Radiographers were recruited through total population sampling from the national registry. Data were collected using an adapted questionnaire and analysed using descriptive and inferential statistics in R software version 4.5.1.

A total of 153 out of a population of 220 radiographers took part in the survey (70% response rate). Most radiographers (81%) reported high familiarity with sustainability concepts. Common practices included turning off equipment (80%), using digital workflows (89%), and optimising patient scheduling (83%). However, systemic practices like waste recycling were less common (34%). Key barriers included limited staff awareness (85%), lack of priority from leadership (83%), and inadequate waste disposal systems (70%). A significant association was found between higher education levels and knowledge of sustainability (p = 0.005).

Despite high awareness of environmental sustainability among Rwandan radiographers, a significant gap exists between knowledge and the implementation of systemic sustainable practices. This ``policy-practice gap'' is driven by leadership, awareness, and infrastructural barriers. This highlights the challenge of translating national environmental policy into departmental-level action in a resource-constrained setting.