Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care
2022; Elsevier BV; Volume: 113; Issue: 5 Linguagem: Inglês
10.1016/j.ijrobp.2022.04.039
ISSN1879-355X
AutoresKatie E. Lichter, Justin D. Anderson, Austin J. Sim, Claire C. Baniel, Cassandra L. Thiel, Robert Chuter, Amy Collins, Erin Carollo, Christine D. Berg, C. Norman Coleman, May Abdel‐Wahab, Surbhi Grover, Lisa Singer, Osama Mohamad,
Tópico(s)COVID-19 and healthcare impacts
ResumoIntroductionClimate change is among the most pressing global threats. Action now and in the coming decades is critical. Rising temperatures exacerbate the frequency and intensity of extreme weather events, including wildfires, hurricanes, floods, and droughts. Such events threaten not only our ecosystems, but also our health. Climate change's negative effects on human health are slowly becoming better understood and are projected to increase if emissions mitigation remains inadequate.1Atwoli L Baqui AH Benfield T et al.Call for emergency action to limit global temperature increases, restore biodiversity, and protect health.Lancet. 2021; 398: 939-941Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar,2Watts N Amann M Arnell N et al.The 2020 report of The Lancet Countdown on health and climate change: Responding to converging crises.Lancet. 2021; 397: 129-170Abstract Full Text Full Text PDF PubMed Scopus (519) Google Scholar3IPCC, 2022: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press. In Press.Google Scholar Emerging research notes a disproportionate effect of climate change on vulnerable populations (eg, older populations, children, low-income populations, ethnic minorities, and patients with chronic conditions, including cancer) who are the least equipped to deal with these outsized effects.4United States Environmental Protection Agency. Climate change and social vulnerability in the United States: A focus on six impacts. Available at:www.epa.gov/cira/social-vulnerability-report. Accessed June 30, 2022.Google Scholar, 5Castillo MD Kinney PL Southerland V et al.Estimating intra-urban inequities in PM2.5-attributable health impacts: A case study for Washington, DC.GeoHealth. 2021; 5e2021GH000431Crossref PubMed Scopus (3) Google Scholar, 6Hsu A Sheriff G Chakraborty T Manya D. Disproportionate exposure to urban heat island intensity across major US cities.Nat Commun. 2021; 12: 2721Crossref PubMed Scopus (61) Google Scholar, 7Masri S Scaduto E Jin Y Wu J. Disproportionate impacts of wildfires among elderly and low-income communities in California from 2000-2020.Int J Environ Res Public Health. 2021; 18: 3921Crossref PubMed Scopus (12) Google Scholar, 8Nazrul Islam S, Winkel J. Climate Change and Social Inequality.Available at: https://www.un.org/development/desa/publications/working-paper/wp152. Accessed June 30, 2022.Google Scholar, 9Balbus JM McCannon CJ Mataka A Levine RL. After COP26: Putting health and equity at the center of the climate movement.N Engl J Med. 2022; 386: 1295-1297Crossref PubMed Scopus (1) Google ScholarClimate change has been an issue in the public discourse for decades, but collective action remains inadequate. We are just beginning to understand the effect climate change has on oncology and the cancer control continuum.10Hiatt RA Beyeler N. Cancer and climate change.Lancet Oncol. 2020; 21: e519-e527Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 11Schiller JH Averbuch SD Berg CD. Why oncologists should care about climate change.JCO Oncol Pract. 2020; 16: 775-778Crossref PubMed Scopus (4) Google Scholar, 12Ortiz AP Calo WA Mendez-Lazaro P et al.Strengthening resilience and adaptive capacity to disasters in cancer control plans: Lessons learned from Puerto Rico.Cancer Epidemiol Biomarkers Prev. 2020; 29: 1290-1293Crossref PubMed Scopus (6) Google Scholar, 13Hantel A Abel GA. An action plan for environmentally sustainable cancer care.JAMA Oncol. 2020; 6: 469-470Crossref PubMed Scopus (3) Google Scholar, 14Nogueira LM Yabroff KR Bernstein A. Climate change and cancer.CA A Cancer J Clin. 2020; 70: 239-244Crossref PubMed Scopus (26) Google Scholar, 15Nogueira LM Sahar L Efstathiou JA Jemal A Yabroff KR. Association between declared hurricane disasters and survival of patients with lung cancer undergoing radiation treatment.JAMA. 2019; 322: 269-271Crossref PubMed Scopus (20) Google Scholar These effects span a wide range, from increasing causal factors of certain cancers to disruption of the complex health care systems required for cancer prevention, screening, diagnosis, treatment, and survivorship (Fig. 1). Unlike infectious diseases, which have direct temporal proximity to the exposure brought on by climate change, cancer incidence rates are affected through climate-affected causal pathways involving air pollution, exposure to ultraviolet radiation, disruptions in food and water supply, exposure to industrial toxins, and possibly infectious causes10Hiatt RA Beyeler N. Cancer and climate change.Lancet Oncol. 2020; 21: e519-e527Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar,16Ciabattini M Rizzello E Lucaroni F Palombi L Boffetta P. 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For example, diminished air quality and pollution will exacerbate and increase the prevalence of other health conditions, including respiratory disease and cancers including lung and skin.1Atwoli L Baqui AH Benfield T et al.Call for emergency action to limit global temperature increases, restore biodiversity, and protect health.Lancet. 2021; 398: 939-941Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar,5Castillo MD Kinney PL Southerland V et al.Estimating intra-urban inequities in PM2.5-attributable health impacts: A case study for Washington, DC.GeoHealth. 2021; 5e2021GH000431Crossref PubMed Scopus (3) Google Scholar,16Ciabattini M Rizzello E Lucaroni F Palombi L Boffetta P. Systematic review and meta-analysis of recent high-quality studies on exposure to particulate matter and risk of lung cancer.Environ Res. 2021; 196110440Crossref PubMed Scopus (16) Google Scholar,19Turner MC Andersen ZJ Baccarelli A et al.Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations.CA Cancer J Clin. 2020; 70: 460-479Crossref Scopus (142) Google Scholar, 20Kaffenberger BH Shetlar D Norton SA Rosenbach M. The effect of climate change on skin disease in North America.J Am Acad Dermatol. 2017; 76: 140-147Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 21Diffey B. Climate change, ozone depletion and the impact on ultraviolet exposure of human skin.Phys Med Biol. 2003; 49: R1-R11Crossref Scopus (126) Google Scholar Beyond such causal factors, climate change and extreme weather events cause major disruptions to the infrastructure of health care systems required for prevention, screening, diagnosis, treatment, and cancer care follow-up.Fig. 2Pathways from climate change to cancer outcomes.9Balbus JM McCannon CJ Mataka A Levine RL. After COP26: Putting health and equity at the center of the climate movement.N Engl J Med. 2022; 386: 1295-1297Crossref PubMed Scopus (1) Google ScholarView Large Image Figure ViewerDownload Hi-res image Download (PPT)More than half of cancer patients will require radiation therapy (RT) during the course of their illness.22Baskar R Lee KA Yeo R Yeoh KW. Cancer and radiation therapy: Current advances and future directions.Int J Med Sci. 2012; 9: 193-199Crossref PubMed Scopus (1055) Google Scholar,23Delaney G Jacob S Featherstone C Barton M. The role of radiotherapy in cancer treatment: Estimating optimal utilization from a review of evidence-based clinical guidelines.Cancer. 2005; 104: 1129-1137Crossref PubMed Scopus (1005) Google Scholar As most RT courses are delivered using fractionated external beam radiation (EBRT), patients undergoing EBRT are vulnerable to treatment disruptions from climate events. Notably, disruption of RT treatments due to severe weather events has been shown to affect patient treatment and survival.15Nogueira LM Sahar L Efstathiou JA Jemal A Yabroff KR. Association between declared hurricane disasters and survival of patients with lung cancer undergoing radiation treatment.JAMA. 2019; 322: 269-271Crossref PubMed Scopus (20) Google Scholar,24Huse E Malone J Ruesch E Sulak T Carroll R. An analysis of hurricane impact across multiple cancers: Accessing spatio-temporal variation in cancer-specific survival with Hurricane Katrina and Louisiana SEER data.Health Place. 2020; 63102326Crossref PubMed Scopus (3) Google Scholar,25Man RXG Lack DA Wyatt CE Murray V. The effect of natural disasters on cancer care: A systematic review.Lancet Oncol. 2018; 19: e482-e499Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar As radiation oncologists, it is imperative to recognize and further investigate the effects of climate change on health and cancer outcomes and understand the specific vulnerabilities of patients receiving RT to the effects of climate change. We must also advance our understanding of the contribution of radiation oncology as a specialty to greenhouse gas (GHG) emissions, and what measures may be taken in our daily practices to join the international efforts in reducing our negative environmental impact.Taking Action to Transition to Climate-Smart Radiation Oncology PracticeIn the United States (US), the health care sector accounts for approximately 8.5% of GHG emissions and 9% of air pollutants,26Eckelman MJ Sherman J. Environmental impacts of the US health care system and effects on public health.PLOS One. 2016; 11e0157014Crossref PubMed Scopus (310) Google Scholar with a significant portion attributed to hospital care and physician services (47%).27Eckelman MJ Huang K Lagasse R Senay E Dubrow R Sherman JD. Health care pollution and public health damage in the United States: An update.Health Affairs. 2020; 39: 2071-2079Crossref PubMed Scopus (61) Google Scholar Thus, resource consumption and emissions generated by medical care activities have a negative effect on our climate, and thus our health and wellbeing. For example, single-use supplies are often sterilized using ethylene oxide (ETO), a known carcinogen.28Vincent MJ, Kozal JS, Thompson WJ, et al. Ethylene oxide: Cancer evidence integration and dose-response implications. Sage Journals.Online December 11, 2019.Google Scholar As a localized example of the adverse public health effects of medical care, Sterigenics, a medical supply sterilization facility north of Chicago, was forced to close in 2019 due to public outcry of the use of ETO gas. A recent report by the Environmental Protection Agency showed increased cancer rates in that community, validating these concerns.29Henninger K. Review of the controversy surrounding the use of ethylene oxide in medical device sterilization. Available at:https://www.jhsph.edu/research/centers-and-institutes/center-of-excellence-in-regulatory-science-and-innovation/training/Katelin%20Henninger%202020%20CERSI%20Writing%20Competition%20Submission.pdf. Accessed June 30, 2022.Google Scholar, 30Sheehan PJ Lewis RC Kirman CR Watson HN Winegar ED Bus JS. Ethylene oxide exposure in US populations residing near sterilization and other industrial facilities: Context based on endogenous and total equivalent concentration exposures.Int J Environ Res Public Health. 2021; 18: 607Crossref Scopus (3) Google Scholar, 31Olaguer EP Robinson A Kilmer S Haywood J Lehner D. Ethylene oxide exposure attribution and emissions quantification based on ambient air measurements near a sterilization facility.Int J Environ Res Public Health. 2020; 17: 42Crossref Scopus (10) Google Scholar, 32Logomasini A. Deploy rational science-based policies for medicalplant sterilization. Available at: https://cei.org/sites/default/files/Angela_Logomasini_-_Deploy_Rational_Science-Based_Policies_for_Medical_Plant_Sterilization.pdf. Accessed June 30, 2022Google Scholar Although the plant was closed, ETO remains the primary sterilizing agent for single use, sterile medical supplies, highlighting the need for health care facilities and professionals to investigate the environmental and health effects of current practices.33Ebrahimi P Barbieri M. Gadolinium as an emerging microcontaminant in water resources: Threats and opportunities.Geosciences. 2019; 9: 93Crossref Scopus (47) Google Scholar, 34Skinner L Fahimian BP Yu AS. Tungsten filled 3D printed field shaping devices for electron beam radiation therapy.PLOS One. 2019; 14e0217757Crossref Scopus (10) Google Scholar, 35Breitkreutz DY Skinner L Lo S Yu A. Nontoxic electron collimators.J Appl Clin Med Phys. 2021; 22: 73-81Crossref PubMed Scopus (1) Google Scholar, 36Brooksbank J. Public health vs public health: Balancing environmental concerns with the need for sterile medical devices. Minnesota J Law Science Technol 2020;21:441-476.Google ScholarUnderstanding the environmental effect and measuring the GHG contribution of daily radiation delivery in the US and globally remain a priority, as this enables us to focus efforts to reduce the environmental impact of our specialty. To our knowledge, this has not been investigated rigorously before. Radiation oncologists must take steps to understand our contribution to the climate crisis and initiate changes to create sustainable, climate-smart health care practices. Climate-smart health care refers to an approach that bridges the divide between adaptation and mitigation to prioritize both low-carbon and resiliency strategies.37Bouley T, Roschnik S, Karliner J, et al. Climate-smart healthcare: Low-carbon and resilience strategies for the health sector (English).Available at: https://openknowledge.worldbank.org/handle/10986/27809. Accessed March 17, 2022.Google Scholar In an effort to transition to such, we encourage all members in the field of radiation oncology to actively engage in this transition. Herein, we present points-of-action presented in the framework of the 4 Rs: reduce, reuse, recycle, and rethink (Fig. 3).Fig. 3The 4 Rs to address environmental impact of radiation oncology care: reduce, reuse, recycle, rethink.View Large Image Figure ViewerDownload Hi-res image Download (PPT)ReduceReduce consumption of equipment energyDespite manufacturers' claims of energy efficiency, little data exists describing and comparing the energy consumption of different radiation therapy treatments and/or machines. Energy consumption of different diagnostic imaging modalities is better defined in the radiology literature than therapeutic machines within radiation oncology. Imaging is known to be a large contributor to health care energy use and many radiology departments have invested time and resources to better characterize this use.38Goetzler W, Guernsey M, Foley K, Young J, Chung G.Energy Savings Potential and RD&D Opportunities for Commercial Building Appliances (2015 Update). 2016:DOE/EE—1393, 1420229.Google Scholar For example, the University of California, San Francisco has partnered with Siemens Health and is working to meter diagnostic imaging machines to help measure real-world use.39University of California, San Francisco (UCSF). Siemens Healthineers and UCSF create first carbon-neutral radiology imaging service. Available at: https://www.ucsf.edu/news/2021/11/421756/siemens-healthineers-and-ucsf-create-first-carbon-neutral-radiology-imaging. Accessed February 14, 2022.Google Scholar Computed tomography (CT) and magnetic resonance imaging account for approximately 4% (615,000 kWh) of a hospitals' yearly energy consumption.40Heye T Knoerl R Wehrle T et al.The energy consumption of radiology: Energy- and cost-saving opportunities for CT and MRI operation.Radiology. 2020; 295: 593-605Crossref PubMed Scopus (19) Google Scholar In one study, the annual energy consumption of a single CT scanner in a hospital is equivalent to that of 5 households (78,679 kWh) and an MR scanner is equivalent to that of 26 households.40Heye T Knoerl R Wehrle T et al.The energy consumption of radiology: Energy- and cost-saving opportunities for CT and MRI operation.Radiology. 2020; 295: 593-605Crossref PubMed Scopus (19) Google Scholar Furthermore, emerging research and efforts in radiology demonstrate a reduction in energy expenditure without reducing the number of patient scans performed.40Heye T Knoerl R Wehrle T et al.The energy consumption of radiology: Energy- and cost-saving opportunities for CT and MRI operation.Radiology. 2020; 295: 593-605Crossref PubMed Scopus (19) Google Scholar, 41PE International. Magnetic resonance equipment (MRI): Study on the potential for environmental improvement by the aspect of energy efficiency. Available at:https://www.cocir.org/fileadmin/6_Initiatives_SRI/SRI_Status_Report/pe_international_-_improvement_potentials_for_mri.pdf. Accessed September 13, 2021.Google Scholar, 42Schoen J McGinty GB Quirk C. Radiology in our changing climate: A call to action.J Am Coll Radiol. 2021; 18: 1041-1043Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Specifically, imaging technology most commonly has several distinct modes of operation: scanning, idle or "ready-to-scan," and "off." Surprisingly, the amount of energy in the idle and off states is significant due to the need for cooling.40Heye T Knoerl R Wehrle T et al.The energy consumption of radiology: Energy- and cost-saving opportunities for CT and MRI operation.Radiology. 2020; 295: 593-605Crossref PubMed Scopus (19) Google Scholar Thus, users could optimize the degree of utilization per period, and manufacturers could decrease energy consumption during nonproductive idle and system-off states.Radiation therapy machines and other capital equipment likely consume similarly high amounts of energy; however, the exact data are limited to date. Radiation oncologists should engage in similar efforts to measure energy use of our radiation and capital equipment and improve the efficiency of these machines both during treatment and idle periods. We could partner with vendors to emphasize the value of more efficient machines, which could also lead to financial savings with a decreased monthly electric bill.43Zero30. Halcyon saves energy and saves lives. Available at: https://zero30.uk/2022/01/26/halcyon-saves-energy-and-saves-lives/. Accessed April 4, 2022.Google Scholar Such information could be used by the Environmental Protection Agency and manufacturers to develop metrics for establishing energy-efficient ratings for radiation therapy machines similar to ENERGY STAR ratings under development for medical imaging equipment and hospitals.44ENERGY STAR. ENERGY STAR score for hospitals (general medical and surgical). Available at: https://www.energystar.gov/buildings/tools-and-resources/energy-star-score-hospitals-general-medical-and-surgical. Accessed September 29, 2021.Google ScholarTo achieve these goals, an essential initial step will be an analytical evaluation of the different radiation oncology practices/processes with life-cycle assessments (LCA). LCA is an internationally standardized (ISO 14040) modeling tool used to quantify the environmental effect of a product or process across its "life cycle" including extraction of raw materials, manufacturing, and disposal.45ISO. ISO 14044:2006: Environmental management — Life cycle assessment — Requirements and guidelines. Available at:https://www.iso.org/cms/render/live/en/sites/isoorg/contents/data/standard/03/84/38498.html. Accessed September 14, 2021.Google Scholar LCA is the first step toward a better understanding of the environmental effect of radiation oncology delivery before suggesting steps to reduce our carbon footprint.Reduce consumption of energy broadlyIn addition to imaging equipment, lighting, computers, electronics, and picture archiving and communications systems stations significantly contribute to energy use within radiology departments. A radiology department at a university teaching hospital in Dublin, Ireland measured energy use of computers, electronics, and picture archiving and communications systems stations left "on" overnight and/or during weekends and found that the 78% of systems left on resulted in CO2 emissions equivalent to the annual emissions of over 10 passenger cars.46McCarthy CJ Gerstenmaier JF O' Neill AC McEvoy SH Hegarty C Heffernan EJ EcoRadiology"—Pulling the plug on wasted energy in the radiology department.Acad Radiol. 2014; 21: 1563-1566Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar If this rough estimate from a single radiology center was multiplied across the estimated 2313 radiation oncology facilities reported in 2020 in the US,47Maroongroge S Wallington DG Taylor PA et al.Geographic access to radiation therapy facilities in the United States.Int J Radiat Oncol Biol Phys. 2022; 112: 600-610Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar this would result in a reduction of emissions equivalent to the annual emissions of over 23,130 passenger cars (assuming radiation oncology has similar energy use as radiology departments). To better understand this environmental effect, the annual emissions of a typical car in the US assumes 11,500 miles are driven per year for an average vehicle with a fuel economy of 22.0 miles per gallon. Radiation oncology departments and clinics should encourage habits of regularly turning off lights and powering down electronics and other systems at night and over the weekend when they are not needed for patient care. Such initiatives can reduce energy costs and simultaneously reduce GHG emissions.Decarbonize energy sourcesDecarbonizing energy sources aims to replace fossil fuel (such as coal, oil, or natural gas) with energy sources with significantly less GHG emissions, such as wind, solar, and nuclear energy. Decarbonizing the energy system is a major step in the global efforts to mitigate our carbon footprint. Although this is a bigger task involving hospital-wide systems, radiation oncology departments along with cancer centers should be involved with local, national, and international advocacy groups to pursue green energy options to power the energy needs of our specialty. Increased utilization of renewable energy sources such as wind and solar or more carbon-neutral solutions of nuclear energy can help mitigate the envionrmental impact of our specialty. Physicians and health systems should actively engage in framing local/federal policies and international initiatives (ie, International Energy Agency's pledge for carbon neutrality by 2050) that will help us achieve cleaner energy. For example, the National Health Service in the United Kingdom is aiming to become net carbon zero by 2040. Each hospital or group of hospitals must create a board approved sustainability plans48Greener NHS. Organisations. Available at: https://www.england.nhs.uk/greenernhs/get-involved/organisations/. Accessed April 3, 2022.Google Scholar to enable this to happen. As part of this, all National Health Service hospitals are required to switch to renewable energy.Reduce medical wasteHospitals are a major source of waste generation with many medical supplies disposed after a single use.49Thiel CL Eckelman M Guido R et al.Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States.Environ Sci Technol. 2015; 49: 1779-1786Crossref PubMed Scopus (130) Google Scholar, 50Zygourakis CC Yoon S Valencia V et al.Operating room waste: Disposable supply utilization in neurosurgical procedures.J Neurosurg. 2017; 126: 620-625Crossref PubMed Scopus (37) Google Scholar, 51Stockert EW Langerman A. Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays.J Am Coll Surg. 2014; 219: 646-655Crossref PubMed Scopus (86) Google Scholar Ultimately, waste produced in hospitals and clinics ends up in landfills, oceans, or is incinerated.52World Health Organization. Health-care waste. Available at:https://www.who.int/news-room/fact-sheets/detail/health-care-waste. Accessed March 17, 2022.Google Scholar Not only do incinerators and landfills emit gases such as methane into the atmosphere, but the transportation of waste requires fossil fuel-burning trucks and is financially costly.53Riedel LM. Environmental and financial impact of a hospital recycling program.AANA J. 2011; 79: S8-14PubMed Google Scholar Reducing, or preventing waste, is key to transitioning to climate-smart care. Performing departmental, procedural, or clinical waste-audits can identify areas for waste diversion or waste management improvement.53Riedel LM. Environmental and financial impact of a hospital recycling program.AANA J. 2011; 79: S8-14PubMed Google Scholar Past audits have noted improper sorting of medical waste (eg, hazardous waste versus solid waste) and disposal of unused products that were opened but ultimately not used.54Kubicki MA McGain F O'Shea CJ Bates S Auditing an intensive care unit recycling program.Crit Care Resusc. 2015; 17: 135-140PubMed Google Scholar, 55McGain F Jarosz KM Nguyen MNHH Bates S O'Shea CJ Auditing operating room recycling: A management case report.A A Case Rep. 2015; 5: 47-50Crossref PubMed Scopus (39) Google Scholar, 56Hsu S Thiel CL Mello MJ Slutzman JE. Dumpster diving in the emergency department: quantity and characteristics of waste at a level I trauma center.West J Emerg Med. 2020; 21: 1211-1217Crossref PubMed Scopus (6) Google Scholar Improper hazardous waste disposal increases both the footprint and cost of transporting and treating normal solid waste. Avoiding disposal of unused products can decrease financial and environmental costs associated with product manufacturing, transportation, and disposal. The University of California, San Francisco and Stanford University have collaborated to design a 6-minute waste audit toolkit for brachytherapy that could be used by radiation oncologists globally to analyze clinical processes and reduce financial and environmental costs. Additionally, waste can be reduced through climate-smart procurement and supply decisions. We can choose products with limited or zero packaging waste or encourage suppliers to consider packaging that is recyclable or compostable. Numerous sustainable procurement guides exist such as that published by Practice Greenhealth,57Practice Greenhealth. Sustainable procurement guide. Available at:https://practicegreenhealth.org/sustainableprocurementguide. Accessed March 16, 2022.Google Scholar which could guide leaders within radiation oncology to establish department- or nation-wide processes to reduce medical waste within the field.ReuseNumerous LCAs have highlighted the environmental and economic benefits of moving toward reusable products and away from single-use disposable items. In 2014, University of California Los Angeles Health implemented a program to switch to reusable surgical and isolation gowns. Since then, University of California Los Angeles Health has reported an estimated annual waste reduction of 234 tons and costs savings of over $450,000 each year. Additionally, a recent pandemic-focused study from Stanford University has found reusable gowns use 28% less total energy compared with disposable gowns in the product life cycle leading to a 30% reduction in GHG emissions and a 93% to 99% reduction in solid waste generation.58Baker N Bromley-Dulfano R Chan J et al.COVID-19 solutions are climate solutions: Lessons from reusable gowns.Front Public Health. 2020; 8: 811Crossref Scopus (10) Google ScholarWithin radiation therapy, working to ensure the use of reusable products, operative supplies (eg, applicators, surgical gowns, packs, drapes), and treatment supplies such as patient immobilization devices (eg, reusable Vac-loc systems) has the potential to reduce waste, cost, and the environmental impact. We should prefer reusable products over recycling given the additional energy required in the process of recycling.59Sherman JD Raibley LAI Eckelman MJ. Life cycle assessment and costing methods for device procurement: Comparing reusable and single-use disposable laryngoscopes.Anesth Analg. 2018; 127: 434-443Crossref PubMed Scopus (71) Google Scholar Further efforts can be made within radiation oncology to collaborate with supply chain leaders, regulatory agencies (eg, the Food and Drug Administration),60United States Food and Drug Administration. Medical Device User Fee and Modernization Act of 2002 (MDUFMA), P.L. 107-250. Available at:https://www.fda.gov/industry/medical-device-user-fee-amendments-mdufa/medical-device-user-fee-and-modernization-act-2002-mdufma-pl-107-250. Accessed September 30, 2021.Google Scholar and industry/original equipment manufacturers to reduce single-use products and favor reusable supplies throughout the scope of our practice. Additionally, radiation oncologists could advocate for environmental impact to be considered within current single-use reprocessing legislation60United States Food and Drug Administration. Medical Device User Fee and Modernization Act of 2002 (MDUFMA), P.L. 107-250. Available at:https://www.fda.gov/industry/medical-device-user-fee-amendments-mdufa/medical-device-user-fee-and-modernization-act-2002-mdufma-pl-107-250. Accessed September 30, 2021.Google Scholar and regul
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