Radiology AI and sustainability paradox: environmental, economic, and social dimensions

Artificial intelligence (AI) is transforming radiology by improving diagnostic accuracy, streamlining workflows, and enhancing operational efficiency. However, these advancements come with significant sustainability challenges across environmental, economic, and social dimensions. AI systems, particularly deep learning models, require substantial computational resources, leading to high energy consumption, increased carbon emissions, and hardware waste. Data storage and cloud computing further exacerbate the environmental impact. Economically, the high costs of implementing AI tools often outweigh the demonstrated clinical benefits, raising concerns about their long-term viability and equity in healthcare systems. Socially, AI risks perpetuating healthcare disparities through biases in algorithms and unequal access to technology. On the other hand, AI has the potential to improve sustainability in healthcare by reducing low-value imaging, optimizing resource allocation, and improving energy efficiency in radiology departments. This review addresses the sustainability paradox of AI from a radiological perspective, exploring its environmental footprint, economic feasibility, and social implications. Strategies to mitigate these challenges are also discussed, alongside a call for action and directions for future research. CRITICAL RELEVANCE STATEMENT: By adopting an informed and holistic approach, the radiology community can ensure that AI's benefits are realized responsibly, balancing innovation with sustainability. This effort is essential to align technological advancements with environmental preservation, economic sustainability, and social equity. KEY POINTS: AI has an ambivalent potential, capable of both exacerbating global sustainability issues and offering increased productivity and accessibility. Addressing AI sustainability requires a broad perspective accounting for environmental impact, economic feasibility, and social implications. By embracing the duality of AI, the radiology community can adopt informed strategies at individual, institutional, and collective levels to maximize its benefits while minimizing negative impacts.