Celebrating small wins: how the Green Radiotherapy Framework is shaping sustainability in radiography

St Bartholomew’s Hospital’s radiotherapy department is the first to receive the Gold award under the Green Radiotherapy Framework. The team shared why it’s important to celebrate all victories – even the small ones

By 2040, the NHS plans for the carbon emissions under its control to have reached net zero. With the health service responsible for 5 per cent of the UK’s total greenhouse gas emissions, the journey isn’t going to be easy.

In radiotherapy, that mission is especially challenging – linear accelerators, for example, are intense energy users, and radiotherapy patients travel to the hospital many times, with radiotherapy emissions accounting for roughly 0.3 per cent of global healthcare emissions.

Rather than getting discouraged by the challenge of sustainability, however, the winners of the first Gold award under the Green Radiotherapy Framework (gRTF), the radiotherapy department at St Batholomew’s Hospital in London, saw a goal to be reached – step by step, small win by small win.

Synergy spoke to members of the St Bartholomew’s team, as well as the Radiotherapy Board Environmental Sustainability Working Group – the team behind the framework itself – to find out more about how radiographers from across the country can start their sustainability journey.

‘Even if you only achieve something small, that’s a win’

Launched in July 2025, the gRTF is an 18-page document that outlines different levels of sustainable development possible within radiotherapy departments, labelling them as Bronze, Silver and Gold. The aim of this classification is to provide a step-by-step guide healthcare professionals can follow to reduce the carbon footprint of cancer care.

Created by the Radiotherapy Board, a partnership led by the SoR, alongside the Royal College of Radiologists and the Institute of Physics and Engineering in Medicine, the framework acts as a roadmap for how departments and teams can to go from the absolute beginning of the sustainability journey all the way to best practice.

Zankhana Jani is a digital radiographer at the Royal Marsden Hospital and is part of the Radiotherapy Board’s Environmental Sustainability Working Group, which developed the gRTF. She explains that the goal of the framework is to serve as a step-by-step guide to sustainability, and answer some fundamental questions, including: where do I begin? What do I aim for? What do I need to do?

“It doesn’t matter if you are only doing things at a Bronze level or if everything’s Gold,” she says. “It’s about setting yourself a goal, looking to see how much you’ve done. Once you start, you realise you’re doing more than you think. That will encourage people.

“In an ideal world, everyone would want to be Gold. But every department is different, is a different size and has different priorities. The framework should give departments a bit of control over what they can do, because they understand radiotherapy. It’s so different from other areas in a hospital.”

The Environmental Sustainability Working Group began work on the document in June 2023. Zankhana says the group became increasingly aware that national requirements on sustainability were increasing, as set out in the Health and Care Act 2022, which embeds net-zero targets into UK legislation. The working group then came to a simple conclusion: teams cannot wait to be told what needs to be done. They need to act now.

The group has since been working to build an effective database of evidence and guidance on sustainability within radiotherapy departments.

‘Once you start, you realise you’re doing more than you think. That will encourage people’

Louise Turtle, a research and development radiographer at the Clatterbridge Cancer Centre in Liverpool, joined the working group in November 2023.

The pair explain that it had taken a long time to build the framework because everyone involved is a volunteer – any work being done was additional to their normal workload. That, they expect, will also be the biggest issue for departments wanting to submit. For the vast majority of radiotherapy teams, the submission process will not fall under protected time.

During the development process, everyone on the working group contributed their suggestions on areas of focus for sustainability. They made sure to focus on those that radiographers could reasonably accomplish.

When trying to be more sustainable in your radiotherapy practice, the key is to focus on the simple things, says Zankhana. One of the many changes that can be made is more efficient fractionation (division of radiation doses) and equipment management to minimise downtime. Understanding the limitations and possibilities for implementing sustainability in each of these areas was a process of months for the working group and required widespread contributions from a multiprofessional team.

Now, with a formal application process developed and advertisements sent out to raise awareness of the initiative, applicants can gather evidence of their sustainability within their department and submit via an online portal. Evidence is then judged by members of the working group, who will make a decision on the sustainability tier level that department is working at.

Work is also underway to establish a new judging committee, separate from the working group that initially produced the document.

On any advice she would give to departments thinking of applying for the award, Louise says: “Just persevere. If you find people who are interested, they will keep trying. It’s slow, and you do need to do some of the driving, but just keep trying. Even if you just achieve something small, that’s a win.”

Zankhana Jani

Louise Turtle

St Barts radiotherapy team with the gRTF Gold award

Reaching for Gold

With the gRTF having now been in place for more than a year, the first Gold award has been awarded to the radiotherapy team at St Bartholomew’s Hospital in London.

The radiotherapy team submitted their application to the gRTF earlier this year and were delighted to find out in January that they were the first to receive the highest award under it.

Luke Eggerton is the research, development and innovations lead at St Bartholomew’s, and the team lead on implementing the recommendations of the gRTF. His previous role was in informatics at the hospital, where he has previous experience leading sustainability initiatives, particularly in his efforts to reduce paper usage.

He explains that the radiotherapy team first decided to submit to the framework after winning the trust’s internal WeImprove award, recognising their efforts to reducing gown usage in the department.

That gown reduction project came about as part of setting up a ‘green team’ to take ownership of sustainability initiatives. During that process, they discovered one team member – Ahmed Ifthaker, a medical physicist – was already involved in similar work with the Institute of Physics and Engineering in Medicine, all eventually leading to the gRTF process. “We were able to move quickly by sharing ownership of the work across the team,” says Luke. “We’d already started to explore areas such as transport, so we could build on that and move forward in a more coordinated way.

“We’re incredibly proud of achieving the Gold award… It reflects a real collective effort across the team. This is very much a team achievement, and it’s been great to see that recognised. We’ve focused on supporting staff to develop skills in presenting, project work, audit and data collection. The award reflects that investment in people as much as the outcomes themselves.”

A lot of the evidence gathering, he adds, was focused on finding where the radiotherapy department was already aligned with aspects of the framework through their day-to-day activities. “From the beginning, we were trying to hit every single point, and see what we had. We already had a lot of data, and we found that much of our existing work aligned with the framework,” he explains.

“For teams starting out, having a clear green agenda and focusing on projects that reduce emissions, alongside auditing activity, is a strong place to begin.”

That realisation was one of the biggest takeaways for the team, he says. Once the tracking of green initiatives began, they saw that they were much further along the journey than they had assumed.

The multiprofessional approach taken by the green team was an extremely important aspect of their success too, Luke says. Not only did they have team members from the physics side, they also had a clinician as part of the team.

A hidden benefit of submitting to the framework, he explains, is the fact that it forces departments to bolster their interprofessional links: “It shows how effective a collaborative, multiprofessional approach can be. Like any service, balancing this work alongside clinical priorities can be challenging but, by working closely with operational teams, we were able to make it work.”

“It shows how effective a collaborative, multiprofessional approach can be”

The team also recognised the challenge of limited protected time for sustainability initiatives.

Linking their evidence to both sustainability and financial benefits was key to gaining support from within trust management and maintaining momentum.

By taking the structured approach suggested by the framework, the team were able to get started with the small things, such as starting to introduce protected time specifically for sustainability, or deleting old emails. “It doesn’t have to be anything big," says Luke. “Focusing on small, practical changes can have a real impact over time. Those incremental improvements build into something meaningful.

“While many teams will naturally aim for Gold, the real strength of the framework is in demonstrating progression – whether that’s starting at Bronze or working towards Gold, it’s about continuous improvement.

“The most important thing is to start where you are and build from there. The framework supports that journey and helps teams keep moving forward.”

Barts Health NHS Foundation Trust 'green team' department leads

More about sustainability and the SoR

Sustainable healthcare delivers healthcare without damaging the environment. The NHS aims to be the world’s first net-zero national health service by 2040. In order to support the service in meeting these goals, the SoR has worked to ensure members have access to resources and communities involved in sustainability.

Members can join the SoR Health Improvement/Public Health in Radiography Special Interest Group, develop their knowledge through e-learning and online education and join the Sustainable Healthcare Networks platform.

Find out more about the events and groups available to membership online now.

Find out more about the Green Radiotherapy Framework

The Radiotherapy Board – a collaborative committee established by the SoR, the Royal College of Radiologists and the Institute of Physics and Engineering in Medicine – developed the Green Radiotherapy Framework to enable radiotherapy departments to assess and demonstrate how their day-to-day practice is contributing to the NHS response to climate change.

Through the framework, departments can apply for an award that will be assessed at one of three levels – Gold, Silver or Bronze – to indicate their contribution to sustainability.

Information on the framework and how to use it can be found online here.

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