The carbon footprint of hospital diagnostic imaging in Australia

McAlister, Scott; McGain, Forbes; Breth-Petersen, Matilde; Story, David A; Charlesworth, Kate; Ison, Glenn; Barratt, Alexandra

doi:10.1016/j.lanwpc.2022.100459

Cited by 71 publications

(42 citation statements)

References 20 publications

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“…We therefore included emissions caused by patient travel to their clinic. We did not include any other sources of emissions in our estimate and emissions from public transport were assumed to be zero, consistent with previous approaches [ 17 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance

Williams

Bell

Morton

et al. 2022

Appl Health Econ Health Policy

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Aims Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. Methods Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a societal perspective. Environmental impacts were calculated using a type of carbon footprinting methodology called process-based life cycle analysis. This method considers three scopes of carbon emissions: Scope 1, which occur directly from the intervention; Scope 2, which occur indirectly from the intervention's energy use; and Scope 3, which occur indirectly because of the value chain of the intervention. In this study we only included emissions from patient transport to attend their melanoma clinic over the study period of 6 months. ResultsThe environmental impact per participant across allocated groups for patient transport to their melanoma clinic was estimated to be 10 kg carbon dioxide equivalent. Economic costs across the allocated groups indicated substantial health system costs, out-of-pocket costs, and productivity losses associated with melanoma surveillance. The largest cost contributor was health system costs, and the most expensive category of health system cost was hospital admission. Conclusion Calculating environmental impacts is worthwhile and feasible within a cost analysis framework. Further work is needed to address outstanding conceptual and practical issues so that a comprehensive assessment of environmental impacts can be considered alongside economic costs in health technology assessments.

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Section: Methodsmentioning

confidence: 99%

Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance

Williams

Bell

Morton

et al. 2022

Appl Health Econ Health Policy

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“…Of 12,302 publications retrieved and screened from electronic databases and 73 publications that were identified and screened using Google, Google Scholar and hand searches of citations, 122 full-text articles were assessed for eligibility and 48 were excluded (Fig 1). Reasons for exclusion were wrong topic (n = 25) , wrong setting (n = 3) [50][51][52], wrong population (n = 1) [53], unclear population (n = 4) [54][55][56][57], and duplicates (n = 15) (see S1 Table and S2 Data for more detail). Nine conference abstract publications were classified as awaiting assessment [58][59][60][61][62][63][64][65][66] (see S2 Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Almost three-quarters were related to orthopaedic surgery which is consistent within other health fields that have recognised surgery as a large contributor of greenhouse gas emissions [ 134 – 136 ]. Of the 24 included original research studies less than half directly measured the environmental impact relating to climate change for any aspect of musculoskeletal health care and none quantified the carbon footprint of well-recognised contributors of greenhouse gas emissions such as hospital stays, pharmaceuticals and imaging [ 4 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

The environmental impact of health care for musculoskeletal conditions: A scoping review

et al. 2022

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Background Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions. Methods We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed. Results Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1). Conclusion Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.

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“…on-site fossil fuel use, anaesthetics, inhalers). Life cycle assessments have identified emissions involved in different hospital departments or operations [ 8 – 10 ] that could be reduced simply and cheaply through, for example, reducing waste [ 11 , 12 ], changing anaesthetic gases used [ 13 ], and reducing unnecessary testing [ 14 ] and imaging [ 15 ].…”

mentioning

confidence: 99%

“…Lastly, pathology and diagnostic imaging account for approximately 9% of healthcare’s carbon footprint in Australia [ 22 ]. Opportunities for intervening in this context include turning off scanners to reduce emissions from standby power and reducing ordering of unnecessary imaging or substituting high-impact imaging (e.g., MRI and CT) with lower-impact imaging (e.g., X-Ray and ultrasound) to reduce carbon and costs [ 15 ].…”

mentioning

confidence: 99%

Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: a systematic review

Batcup

Breth-Petersen

Dakin

et al. 2023

BMC Health Serv Res

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Background Clinical activity accounts for 70–80% of the carbon footprint of healthcare. A critical component of reducing emissions is shifting clinical behaviour towards reducing, avoiding, or replacing carbon-intensive healthcare. The objective of this systematic review was to find, map and assess behaviour change interventions that have been implemented in healthcare settings to encourage clinicians to reduce greenhouse gas emissions from their clinical activity. Methods Studies eligible for inclusion were those reporting on a behaviour change intervention to reduce carbon emissions via changes in healthcare workplace behaviour. Six databases were searched in November 2021 (updated February 2022). A pre-determined template was used to extract data from the studies, and risk of bias was assessed. The behaviour change techniques (BCTs) used in the interventions were coded using the BCT Taxonomy. Results Six full-text studies were included in this review, and 14 conference abstracts. All studies used a before-after intervention design. The majority were UK studies (n = 15), followed by US (n = 3) and Australia (n = 2). Of the full-text studies, four focused on reducing the emissions associated with anaesthesia, and two aimed at reducing unnecessary test ordering. Of the conference abstracts, 13 focused on anaesthetic gas usage, and one on respiratory inhalers. The most common BCTs used were social support, salience of consequences, restructuring the physical environment, prompts and cues, feedback on outcome of behaviour, and information about environmental consequences. All studies reported success of their interventions in reducing carbon emissions, prescribing, ordering, and financial costs; however, only two studies reported the magnitude and significance of their intervention’s success. All studies scored at least one item as unclear or at risk of bias. Conclusion Most interventions to date have targeted anaesthesia or pathology test ordering in hospital settings. Due to the diverse study outcomes and consequent inability to pool the results, this review is descriptive only, limiting our ability to conclude the effectiveness of interventions. Multiple BCTs were used in each study but these were not compared, evaluated, or used systematically. All studies lacked rigour in study design and measurement of outcomes. Review registration The study was registered on Prospero (ID number CRD42021272526) (Breth-Petersen et al., Prospero 2021: CRD42021272526).

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The carbon footprint of hospital diagnostic imaging in Australia

Cited by 71 publications

References 20 publications

Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance

Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance

The environmental impact of health care for musculoskeletal conditions: A scoping review

Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: a systematic review

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