Exploring barriers to greener diagnostic radiography: ‘Sustainability can be embedded’

Sustainability in everyday life

Andrew England is the senior lecturer in medical imaging and radiation therapy at University College Cork, in Ireland. He was part of the team behind a paper published in 2024, entitled Green radiography: Exploring perceptions, practices, and barriers to sustainability. The paper built on earlier research that delved into the attitudes and behaviours of other allied health professionals regarding sustainability. Andrew and the research team, however, decided to target radiographers.

Andrew has been a Diagnostic Radiographer for 30 years, and spent the last 20 of those as a lecturer and university academic. He has also served as president of the European Federation of Radiographer Societies (EFRS), a term that concluded at the start of 2025. While he held that remit, Andrew was involved in developing the radiographers’ programme during the EFRS European Congress, which last year had a significant sustainability focus. 

“I know from clinical experience, particularly during Covid, just how enormous the use and disposal of single-use items is,” he says. 

“When you think about how much is sent to incineration or landfill, and particularly about contrast agents, just the alarming fact that it’s present in drinking water… The population’s getting bigger, people are living longer. Healthcare’s demands are growing. If we don’t do this [improve sustainability] soon, we’re almost at a point that we can’t recover from.”

From Andrew’s perspective, one of the biggest barriers is in the culture. The NHS has half a dozen competing priorities – recruitment and retention, improving patient care, service costs, health inequalities and more. Sustainability is certainly on the list, but he doubts many people would rank it near the top. 

A key reason for sustainability’s lower-priority status comes from a lack of awareness. Andrew was alarmed to discover just how much energy is used by scanners, even when in their idle state between patients. “Is there any way to make our workflow more efficient, so we have less idle time?” he asks. “Can we put scanners into a standby mode during these periods? Can we save energy even on things like computers and air conditioning by turning them off when not in use?”

With awareness must come sustainability training. People can be convinced that climate change is a problem but, if no one knows what they can start to do about it, nothing will change. Sustainability training needs to be embedded throughout the radiographer career pathway, Andrew continues. Rather than just having a one-off module on sustainability during training or education, he is advocating for making it a feature in everything a student, trainee or fully employed radiographer does.

Embedding sustainability within other learning areas would also help to manage the difficulties of competing priorities. Radiographers will only have a limited amount of education and training available to them – but that doesn’t mean they have to get rid of anything to consider sustainability. “That’s a challenge,” Andrew admits. “We want to teach more, but we’ve still got less time to teach than most. I don’t think we need to throw anything out, because sustainability can become embedded in what we do.”

Overcoming all these different barriers is certainly no easy task, though. Within departments, teams can get together to think about what they can do: are there opportunities to reduce waste? To improve recycling efforts? Andrew even suggests colleagues consider car sharing or walking to work, if possible. “There’s no quick win,” he adds. “Ultimately, it’s about building a culture where all of us accept it's part of our role. As a radiographer, we actively participate in improving the health of our patients; for example, talking to a patient about smoking cessation or reducing alcohol consumption. If there are opportunities to be more sustainable, that’s part and parcel of everyday life as a radiographer.”

Sparking conversation

Tarni Nelson is a radiographer and a lecturer in medical radiation science at Charles Sturt University in Port Macquarie, Australia. Since her graduation in 2012, Tarni has worked both in the UK and in Australia, where she now works partly in an academic role and partly as a clinician at John Hunter Hospital, in Newcastle, Australia. Though her focus clinically has been in CT, her research and teaching centres around environmental sustainability, a subject she is investigating in her Master of Philosophy course, which she hopes to continue during a PhD.

In her experience, sustainability is a subject that only continues to evolve, but she warns that a lack of awareness and understanding could slow that evolution. “There’s not enough education and training around environmental sustainability, and what we can be doing to make more environmentally friendly choices in medical radiation sciences,” she says.

Educating staff on how the procedures in their hospital contribute to emissions can help them understand where changes need to be made. Taking into account concepts such as those raised by Ben, such as the ‘total cost of ownership’, can help staff understand where changes are easier to justify. 

Tarni suggests conducting lifecycle assessments on various pieces of equipment (including scanners), products and activities to understand the environmental impacts and discover new ways to reduce them. By taking into account how costs can be reduced throughout its lifetime, the actual price of a scanner can be understood more completely. A more efficient scanner might have a higher upfront price but, over the course of its use, it requires less energy. This means fewer emissions and a lower cost overall.

Tarni wants to take that concept a step further, though. “The same process could happen when we’re trying to drive change, build a climate-resilient healthcare system – one that can be applied globally. Look at things from the top down, or from the bottom up – you can see things differently,” she says. 

“From a radiography standpoint, making any change is going to involve a more collaborative approach. To make organisational changes, we need specialists from various modalities, radiologists, equipment vendors... The list goes on.”

In fact, Tarni adds, making any change at the site level is going to need research, evidence and higher-level approval and, in healthcare, there’s no ‘one size fits all’ policy. Every 

trust is funded differently, has a different capacity and specialisation and different carbon emissions rates. 

The same is true across the globe, with different healthcare systems: where the NHS is centrally governed, Australia is more “fragmented”, she explains. Both public and private healthcare providers are common, which adds an extra layer of complexity to making large-scale change. 

But, she says, there are common themes that teams can highlight as big contributors to environmental emissions. Waste creation is a big one, from clinical waste products such as contrast agents to single-use items like those used in operating theatres. 

There’s space to redesign the systems that lack sustainability, even with the difficulty of doing so at scale. Doing so, however, means building proper education and awareness around sustainability and how every organisation can harness the resources they have available to them.

Tarni’s final message to radiographers who want to support sustainability efforts is one of encouragement. It will always be hard to get started, but doing so early can mean getting more people involved, and having a bigger impact later down the line. “Anyone who’s educating, advocating or researching environmental sustainability is going to encourage more people,” she says. “It builds awareness within our profession. It will continue to gain momentum.

“If you want to carry out a sustainability project, even something small will spark healthy conversation that, further down the line, can lead to collaboration. That [collaboration] will snowball and gain momentum.”