ASNR-ESNR White Paper on Sustainability in Neuroradiology.

N Kadom, A Rovira, C Zamora, D Ben Salem, N Lall, Y Anzai, C C Quattrocchi, P Parizel, A Camargo, T Yousry

Journal: AJNR. American journal of neuroradiology 2026;47(7):1771-1775

PMID: 42386378

Abstract

BACKGROUND

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.

METHODS

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.

KEY MESSAGE

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.

Address: From the Department of Radiology and Imaging Sciences (N.K., N.L., A.C.), Emory University School of Medicine, Atlanta, Georgia.; Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.; Department of Radiology (C.Z.), University of North Carolina, Chapel Hill, North Carolina.; Service d'Imagerie Médicale (D.B.S.), University of Brest, Brest, France.; NSERM UMR 1101 (D.B.S.), Laboratoire de Traitement de L'Information Médicale-LaTIM, Université de Bretagne Occidentale, Brest, France.; Department of Radiology and Imaging Sciences (Y.A.), University of Utah, Salt Lake City, Utah.; Centre for Medical Sciences-CISMed, (C.C.Q.), University of Trento, Trento, Italy.; Department of Diagnostic and Interventional Radiology (P.P.), Royal Perth Hospital, Perth, Western, Australia.; University of Western Australia (UWA) Medical School (P.P.), UWA Health Campus, Nedlands, Western, Australia.; Lysholm Department of Neuroradiology (T.Y.), University College London Hospitals National Hospital for Neurology and Neurosurgery, Neuroradiological Academic Unit, University College London Institute of Neurology, London, UK.

DOI: 10.3174/ajnr.A9238

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MeSH Terms: Humans, Contrast Media, Europe, Neuroradiography, United States, Neuroimaging, Societies, Medical, Radiology