Faculty Bibliography

OBJECTIVE:To assess the environmental impact of radiography and fluoroscopy, using life cycle assessment (LCA), focusing on energy use and emissions. METHODS:This ISO 14040-guided LCA-based study focused on radiography and fluoroscopy services, including the production and use of two radiography and two fluoroscopy machines, at a quaternary care 800-bed academic medical center in the Southeastern United States over a 1-year period. Data were collected through direct observation, record review, staff interviews, and energy metering. Environmental impacts were assessed using SimaPro 9.3.0.2 and the Ecoinvent v3.8 database. RESULTS:e per scan). Medical linens or textiles accounted for 24% of total emissions. Other significant environmental impacts included ozone depletion, smog, acidification, and eutrophication. DISCUSSION/CONCLUSIONS:Reducing energy consumption by decarbonizing electricity sources and optimizing equipment use can significantly decrease greenhouse gas emissions. Implementing sustainable practices in linen use, procurement, and end-of-life management is also crucial. Reducing low-value imaging can further mitigate environmental impact.

PURPOSE/OBJECTIVE:The aim of this study was to compare the total cost of ownership and environmental impact of linear and circular MRI business models at an academic medical center in the United States. METHODS:The authors compared replacing an existing MRI scanner with a conventional linear business model (purchasing a new scanner) and two circular business models (purchasing an on-site upgrade or a refurbished scanner). The impact of these business models on total cost of ownership for the hospital was assessed. In addition, greenhouse gas (GHG) emissions and materials used (kilograms) were compared using data from a life cycle assessment. RESULTS:Compared with a conventional linear purchase of a new MRI scanner, circular business models reduced (1) total cost of ownership by up to 21%, (2) GHG emissions by up to 8% when using a conventional energy grid and 37% when using a clean energy grid, and (3) material use by up to 92%. Upgrading an existing scanner on site delivered the most beneficial gains, driven primarily by the reuse of critical components. CONCLUSIONS:This study highlights the potential value of circular MRI business models for hospitals, patients, and the planet. By embedding innovative procurement strategies, imaging centers can deliver care with less cost while reducing GHG emissions and saving critical materials. The authors recommend that hospitals consider upgrading existing MRI scanners on site or purchasing refurbished scanners before pursuing replacement with entirely new ones. The authors also encourage further investigation into the financial and environmental benefits for other imaging equipment.

OBJECTIVE:To assess the environmental impact of magnetic resonance (MR) and computed tomography (CT) imaging using life cycle assessment (LCA), focusing on energy use, resource consumption, and emissions. METHODS:This ISO 14040-guided LCA-based study focused on MRI and CT services, including the production and use of three MRI and four CT scanners, at a quaternary care 800-bed academic medical center in the Southeastern USA over a one-year period. Data were collected through direct observation, record review, staff interviews, and energy metering. Environmental impacts were assessed using SimaPro 9.3.0.2 and the Ecoinvent v3.8 database. RESULTS:MRI and CT services at this site generate an estimated 221 and 108 tons of CO2e per year, respectively. This is equivalent to the emissions of 52 (MRI) and 25 (CT) cars driven annually. Energy consumption accounted for the largest portion of emissions (58% for MRI, 33% for CT), followed by disposable supplies (26% for MRI, 16% for CT), capital equipment production (7% for MRI, 13% for CT), and linens (4% for MRI, 11% for CT). Switching to solar photovoltaic electricity could reduce total MRI emissions by 70% and CT emissions by 40%, increasing the relative impacts of scanner production, disposable supplies, and linens. DISCUSSION/CONCLUSIONS:This study highlights the significant environmental impact of MRI and CT services, particularly energy consumption. Renewable energy sources, such as solar photovoltaics, offer the greatest potential for mitigating the environmental footprint. Additional strategies include optimizing scanner utilization, adopting reusable or reprocessable supplies, and embracing circular business practices such as circular manufacturing and extending the lifespan of capital equipment.

IMPORTANCE/UNASSIGNED:Health care systems can help protect patients from the increasing threat of extreme heat-driven morbidity and mortality. Electronic health records (EHRs) provide insight into trends and local variation in thresholds above which extreme heat is associated with emergency department (ED) use among at-risk patient populations. OBJECTIVE/UNASSIGNED:To examine associations between extreme heat exposure and all-cause ED visits among patients aged 65 years and older. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This matched case-control study of patients seeking emergency care at an urban health care system during the summer (May 1 to September 30) from 2022 to 2024. Two New York City (NYC) EDs were included: (1) ED-1, predominantly serving Medicaid-enrolled patients from minoritized racial and ethnic groups, and (2) ED-2, predominantly serving White, privately insured patients. Included patients were aged 65 years or older and presented to ED-1 and ED-2 during the study period. Data were analyzed from April to August 2025. EXPOSURES/UNASSIGNED:Daily maximum heat index (HImax) values during the summer were calculated from the National Centers for Environmental Information monitor-derived recordings. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Daily all-cause ED use counts were derived from EHRs, and extreme heat exposure-outcome curves were calculated. Daily HImax anomalies were calculated based on a 30-year baseline average. The cumulative odds ratio (OR) and 95% CIs were calculated. RESULTS/UNASSIGNED:This study included 55 200 ED encounters and represented 15 092 unique patients at ED-1 and 19 559 at ED-2 with a mean (SD) age of 74.9 (8.92) years at ED-1 and 74.9 (8.72) years at ED-2. Compared with ED-2, more ED-1 patients were female (8589 [56.9%] vs 10 767 [55.0%]), Hispanic (3544 [23.5%] vs 2576 [13.2%]), and Medicaid-enrolled (1321 [8.8%] vs 824 [4.2%]). At ED-1, daily HImax associations increased after 66 °F (OR, 1.10 [95% CI, 1.01-1.21]), peaking at 101 °F (OR, 1.24 [95% CI, 1.11-1.39]), and were higher on days with HImax anomalies between 15 °F (OR, 1.07 [95% CI, 1.01-1.13]) and 18 °F (OR, 1.10 [95% CI, 1.01-1.20]) warmer than average. At ED-2, daily HImax ED use associations were not significant and were significantly negative for days with HImax anomalies above 16 °F, nadiring at 21 °F (0.84, 95% CI [0.73, 0.95]) warmer than average. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this case-control study of the association between heat exposure and ED use in adults aged 65 years and older, positive associations were only observed at ED-1, which served a predominantly lower-income population from minoritized racial and ethnic groups. These association thresholds were not fully captured by NYC heat advisories, which were triggered by 2 days above HImax 95 °F or any time above 100 °F, highlighting an opportunity for future research to develop targeted, risk-informed health care system-based heat warning strategies.

BACKGROUND/PURPOSE/OBJECTIVE:e) from EBRT in the U.S., estimate their down-stream impact on human health in terms of disability-adjusted life-years (DALYs) lost, and evaluate the potential reduction in emissions through increased adoption of hypofractionation, using early-stage breast cancer as a model. MATERIALS/METHODS/METHODS:This is a retrospective analysis using life cycle assessment (LCA) methodologies, integrating real-world data on patient transportation and energy use, and simulations of alternative fractionation schedules following previously established breast treatment guidelines. The study included 556,426 patients who received EBRT for nine cancer types (breast, central nervous system, gastrointestinal, genitourinary, gynecological, head and neck, musculoskeletal, skin, and thoracic), as recorded in the National Cancer Database (NCDB) in 2019 and 2020. Of these, 49,909 patients with early-stage breast cancer (stages I-II, node-negative) were modeled for hypofractionation scenarios. RESULTS:e, respectively. Corresponding DALYs lost were 1,040 in 2019 and 863 in 2020. Simulations showed that increasing use of hypofractionation for eligible breast cancer treatments could reduce GHG emissions by up to 64 %. CONCLUSIONS:Establishing baseline U.S. GHG emissions from EBRT offers a foundation for identifying opportunities to mitigate emissions. Investigating clinical practices from an environmental perspective can yield dual benefits: improved quality of care and significant emissions reductions.

INTRODUCTION/UNASSIGNED:Cataract surgery, among the most common procedures worldwide, significantly contributes to climate change through both solid waste and air pollution, highlighting the urgent need for targeted interventions. Implementation faces hurdles including legal constraints and concerns about infection risks and malpractice. METHODS/UNASSIGNED:This article examines federal and state regulatory structures around two key waste reduction strategies: reduction of multidose medications and distribution of partly-used operating room medication to patients post-surgery. RESULTS/UNASSIGNED:We find little-to-no legitimate regulatory barriers to either waste reduction practice. Dispensing and redistributing partly-used medication has been codified in law in some states. Evidence-based reports indicate minimal risks for infection with proper handling. From 1998 until August 2024, according to the Ophthalmic Mutual Insurance Company, there were no reported endophthalmitis lawsuits from using multidose eye drops perioperatively. Malpractice fears also appear to be generally unfounded considering guidelines by various professional organizations identifying these practices as acceptable standards of care and lack of related lawsuits. CONCLUSION/UNASSIGNED:In order to implement evidence-based sustainability interventions, more education and training is needed to ensure clinicians and staff are aware of real and perceived barriers.

BACKGROUND:Healthcare is responsible for 8.5% of greenhouse gas emission in the United States. Physicians are becoming increasingly concerned about the climate crisis, particularly in the field of ophthalmology where there is a growing body of literature related to sustainability. Although emissions of cataracts surgery, one of the most performed surgical procedures in the world, have been quantified, modifications to practice have yet to be made. This study aims to uplift the perspectives of a diverse set of healthcare workers on implementing environmentally sustainable practices in the cataract surgery setting. METHODS:16 semi-structured interviews were conducted with professionals working in various direct patient care or administrative roles at a large health center to gain insight on implementing a variety of sustainability initiatives. We focused on initiatives related to supply reduction, reusable supplies, multi-dosing pharmaceuticals, and health system process and policy shifts. RESULTS:Participants most frequently identified infection prevention and control (IPC) concerns as a primary barrier to implementation. Additionally, the IPC department was most often cited as a key stakeholder in implementation. However, participants from this department did not share these same concerns. Additionally, participants most often cited that these initiatives would be successfully implemented by those providing direct patient care. CONCLUSIONS:Themes generated from the collection of responses underscore a broader discussion of disconnect between policy and practice in healthcare as a barrier to implementation of these initiatives and an opportunity in harnessing clinically led change to implement sustainable practices in a growing healthcare system.

STUDY OBJECTIVE/OBJECTIVE:To quantify and characterize waste generated in robotic gynecologic surgery and assess its environmental impact, with the goal of identifying strategies to reduce waste and improve sustainability. DESIGN/METHODS:Waste audit and life cycle impact assessment of robotic gynecologic surgery. SETTING/METHODS:Single academic institution. PATIENTS/METHODS:Twenty robotic gynecologic surgery cases, including hysterectomies (n = 10), myomectomies (n = 6), and tubal, ovarian, or endometriosis surgeries (n = 4). INTERVENTIONS/METHODS:A detailed waste audit of all surgical waste to categorize materials into municipal solid waste (MSW) and regulated medical waste (RMW), allowing for subsequent life cycle impact assessment. MEASUREMENTS AND MAIN RESULTS/RESULTS:e (SD 0.27) per minute of operative time, with shorter surgeries producing the most emissions per minute. Cotton products contributed up to almost one-third of an impact category despite accounting for 5% of the total waste by weight. CONCLUSION/CONCLUSIONS:Opportunities to reduce the environmental impact of robotic gynecologic surgeries include reorganizing surgical kits to avoid the unnecessary opening of commonly unused items, increasing reprocessing of single-use devices, properly sorting recyclable plastics and paper products, appropriately using RMW streams, considering alternative surgical modalities for less complex cases, and exploring reusable or more environmentally-friendly alternatives to cotton and spunbond-meltblown-spunbond polypropylene products.

In LA County, contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus require 7.3 million gowns annually generating 506 tons of plastic waste and 1.73 million kilograms of carbon dioxide equivalents, which cause the loss of 4.07 disability-adjusted life-years. Unintended consequences of gown use necessitates exploration of infection prevention alternatives.