ASNR-ESNR White Paper on Sustainability in Neuroradiology

This joint American Society of Neuroradiology-European Society of Neuroradiology (ASNR-ESNR) white paper addresses the call for sustainable practices in neuroradiology amid escalating climate challenges. Neuroradiology contributes substantially to the environmental footprint of health care through high-energy imaging, contrast agent use, and professional mobility.

The article outlines strategies to reduce the impact of gadolinium-based and iodinated contrast agents by promoting appropriate use, dose reduction, and exploring alternative agents. Waste reduction efforts follow the 6 Rs of refuse, reduce, reuse, refurbish, rebuild, and recycle, targeting preparation materials, single-use items, and equipment life cycles. Imaging appropriateness is reframed as both a clinical and ecological responsibility, supported by tools like the European Society of Radiology iGuide and American College of Radiology Appropriateness Criteria. Energy consumption, especially from MRI, can be curtailed via standby modes, protocol optimization, and artificial intelligence. Mobility-related emissions are addressed through teleradiology, sustainable commuting, and carbon-conscious meeting planning. Institutional alignment, metrics tracking, and change management are critical for implementation.

Finally, the article calls neuroradiologists to "Image Greenly," ie, adopting environmentally responsible behaviors as a core professional value. Through collaboration, innovation, and leadership, the specialty can help safeguard planetary health while maintaining excellence in patient care.