Greening computed tomography: a position paper on environmentally responsible imaging practice from the computed tomography subspecialty section of the Italian society of radiology

Abstract Healthcare accounts for 4.4–4.5% of global greenhouse gas emissions, with computed tomography (CT) representing one of the most resource-intensive and energy-demanding diagnostic modalities. Sustainability should be integrated as a core component of quality in CT practice, achieving the perfect balance between diagnostic excellence and environmental responsibility. Several key intervention areas can be identified. CT scanners consume substantial amounts of energy, with 44–72% used during nonproductive idle periods. Potential mitigation strategies include protocol optimization, automated power-down systems, and infrastructure improvements. The current “store-everything” approach to CT datasets generates a considerable carbon footprint; adopting “digital temperance” by retaining only clinically relevant images can reduce storage-related emissions. Although workstations consume less energy than scanners, their cumulative impact can be reduced through automated policies and optimized hardware lifecycle management. Iodinated contrast media persist in aquatic ecosystems and may generate toxic by-products. Sustainable strategies include personalized weight-based dosing, multi-energy CT to reduce contrast volume, and recovery or recycling programs. Single-use consumables and the environmental costs of artificial intelligence were also addressed. A 17-item action list was developed to translate the evidence-informed recommendations into practical actions for sustainable CT practice. The transition toward environmentally responsible CT practice is an ethical and professional necessity that can no longer be delayed. This position paper identifies the key challenges and proposes practical, evidence-informed strategies to transform resource-consuming CT practices into actionable and sustainable workflows, while maintaining clinical effectiveness.