green nuclear medicine; health economics; molecular imaging; radionuclide therapy; radiopharmaceuticals; radiotheranostics
Abstract :
[en] There is a significantly growing interest in diagnostic and therapeutic radiopharmaceuticals, and it is foreseeable that an unprecedented number of patients will need to be treated with new nuclear medicine therapies. This predicted increase will have potentially significant environmental impacts. In this discussion, we show different areas of impact, as well as possible measures to reduce such impact. These measures may impact areas from the entire supply chain, starting at the production site of medical isotopes, the energy supply needed for production, transportation, and adaption of the injected amounts of radiopharmaceuticals in clinical use. Furthermore, arguments of local versus centralized production, potentially increasing or decreasing nuclear medicine procedures versus other greenhouse gas-emitting medical imaging tests, as well as radiopharmaceutical waste handling implications, are summarized and weighed against the current status. Overall, this summary hopefully serves as a basis for further discussion in the nuclear medicine community, potentially increases awareness of the environmental impact of this exciting medical field, and may even lead to implementation of measures.
Disciplines :
Radiology, nuclear medicine & imaging
Author, co-author :
Veit-Haibach, Patrick; Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada, patrick.veit-haibach@uhn.ca
Herrmann, Ken; Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany ; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
Zimmermann, Richard; Chrysalium Consulting, Lalaye, France, MEDraysintell, Louvain-la-Neuve, Belgium, and Oncidium Foundation, Mont-Saint-Guibert, Belgium, and
Hustinx, Roland ; Université de Liège - ULiège > Département des sciences cliniques > Médecine nucléaire
Brechin Vincent GP-E, Nicolas M, Richard Z, Paul-Emmanuel G. MEDraysintell nuclear medicine world market report & directory. MEDraysintell website. www.medraysintell.com. Published September 2024. Accessed October 18, 2024.
Yang W, Kang F, Chen Y, et al. Landscape of nuclear medicine in China and its progress on theranostics. J Nucl Med. 2024;65(suppl 1):29S–37S.
Wang J, Xu B. Removal of radionuclide 99Tc from aqueous solution by various adsorbents: a review. J Environ Radioact. 2023;270:107267.
Gephart RE. A short history of waste management at the Hanford site. Phys Chem Earth, Parts A/B/C. 2010;35:298–306.
Sgouros G, He B, Ray N, Ludwig DL, Frey EC. Dosimetric impact of Ac-227 in accelerator-produced Ac-225 for alpha-emitter radiopharmaceutical therapy of patients with hematological malignancies: a pharmacokinetic modeling analysis. EJNMMI Phys. 2021;8:60.
van Velzen L. Environmental Remediation and Restoration of Contaminated Nuclear and Norm Sites. Elsevier; 2015:132–137.
Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett. 2019;14:064004.
Eckelman MJ, Sherman J. Environmental impacts of the US health care system and effects on public health. PLoS One. 2016;11:e0157014.
Picano E, Mangia C, D’Andrea A. Climate change, carbon dioxide emissions, and medical imaging contribution. J Clin Med. 2022;12:215.
Doo FX, Vosshenrich J, Cook TS, et al. Environmental sustainability and AI in radiology: a double-edged sword. Radiology. 2024;310:e232030.
Hanneman K, Szava-Kovats A, Burbridge B, et al. Canadian Association of Radiologists statement on environmental sustainability in medical imaging. Can Assoc Radiol J. 2024:8465371241260013.
Marwick TH, Buonocore J. Environmental impact of cardiac imaging tests for the diagnosis of coronary artery disease. Heart. 2011;97:1128–1131.
McAlister S, McGain F, Petersen M, et al. The carbon footprint of hospital diagnostic imaging in Australia. Lancet Reg Health West Pac. 2022;24:100459.
Esmaeili A, McGuire C, Overcash M, Ali K, Soltani S, Twomey J. Environmental impact reduction as a new dimension for quality measurement of healthcare services: the case of magnetic resonance imaging. Int J Health Care Qual Assur. 2018;31:910–922.
Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.
Weyts K, Lasnon C, Ciappuccini R, et al. Artificial intelligence-based PET denoising could allow a two-fold reduction in [18F] FDG PET acquisition time in digital PET/CT. Eur J Nucl Med Mol Imaging. 2022;49:3750–3760.
Sarkar S, Mateus S. Doing more with less: how frugal innovations can contribute to improving healthcare systems. Soc Sci Med. 2022;306:115127.
Hossain M, Simula H, Halme M. Can frugal go global? Diffusion patterns of frugal innovations. Technol Soc. 2016;46:132–139.
Health care’s climate footprint report. Health Care Without Harm website. https://noharm-europe.org/content/global/health-care-climate-footprint-report. Accessed January 9, 2025.
Sumner C, Ikuta I, Garg T, et al. Approaches to greening radiology. Acad Radiol. 2023;30:528–535.
Prasanna PM, Siegel E, Kunce A. Greening radiology. J Am Coll Radiol. 2011;8: 780–784.
B€uttner L, Posch H, Auer T, et al. Switching off for future: cost estimate and a simple approach to improving the ecological footprint of radiological departments. Eur J Radiol Open. 2021;8:100320.
World Health Organization from Globocan 2020 data. International Agency for Research on Cancer website. https://gco.iarc.who.int/today/en. Published 2020. Accessed October 31, 2023.
Gothals PET, Zimmerman R. Cyclotrons used in nuclear medicine report & directory. MEDraysintell website. www.medraysintell.com. Published 2020. Accessed October 18, 2024.
Yakar D, Kwee TC. Carbon footprint of the RSNA annual meeting. Eur J Radiol. 2020;125:108869.
Saboury B, Bradshaw T, Boellaard R, et al. Artificial intelligence in nuclear medicine: opportunities, challenges, and responsibilities toward a trustworthy ecosystem. J Nucl Med. 2023;64:188–196.
Currie G, Hawk K, Rohren E. The potential role of artificial intelligence in sustainability of nuclear medicine. Radiography (Lond). 2024;30(suppl 1):119–124.
