Letter to the Editor Regarding Quantifying the Carbon Footprint of External Beam Radiation Therapy—A Narrative Review
Ana Luísa Soares, Isabel Bravo, José Guilherme Couto

TL;DR
This letter supports a review on how radiation therapy contributes to healthcare emissions and stresses the need for environmental training in the field.
Contribution
The letter emphasizes the importance of equipping radiation therapists with green skills to promote environmental responsibility.
Findings
Radiation therapy contributes to healthcare emissions through imaging, treatment delivery, and patient travel.
Empowering radiation therapists with green skills can foster environmental responsibility in their departments.
Abstract
This letter highlights the valuable contribution of the review titled ‘Quantifying the Carbon Footprint of External Beam Radiation Therapy—A Narrative Review’ (https://doi.org/10.1002/jmrs.70009) in understanding how radiation therapy impacts healthcare‐related greenhouse gas emissions, particularly through pre‐treatment imaging, treatment delivery, and patient travel. Therefore, the letter emphasizes that empowering radiation therapists with green skills is essential to foster a culture of environmental responsibility within radiation therapy departments.
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Taxonomy
TopicsClimate Change and Health Impacts · Advances in Oncology and Radiotherapy · Radiation Dose and Imaging
Kyeyune KM, Leech M. Quantifying the Carbon Footprint of External Beam Radiation Therapy—A Narrative Review. J Med Radiat Sci. https://doi.org/10.1002/jmrs.70009
We want to congratulate Kyeyune and Leech on their timely and insightful article, “Quantifying the Carbon Footprint of External Beam Radiation Therapy—A Narrative Review” [1]. Their work makes a valuable contribution to understanding how radiation therapy impacts healthcare‐related greenhouse gas emissions, particularly through pre‐treatment imaging, treatment delivery, and patient travel, and provides a solid foundation for further research in this area.
As indicated in Kyeyune and Leech's paper, in the context of the current climate emergency, it is critical that all healthcare sectors meaningfully engage with sustainability in their daily practice, including radiation therapy. The authors summarize the evidence and support the work of future researchers exploring this topic.
Their work closely aligns with broader concerns about integrating sustainable practices across all healthcare sectors. Soares et al. [2] previously identified nine key dimensions for the applicability of green practices within healthcare facilities (energy, water, procurement, building, food, travel, waste, behaviour, and green team). Kyeyune and Leech brilliantly summarise the evidence across two of these areas: energy and travel. According to Chuter et al. [3] these are the two most significant contributors to the carbon footprint of radiation therapy departments. However, we would like to encourage researchers worldwide to also explore the other dimensions, as they are significantly under‐researched. As demonstrated in the paper by Anudjo et al. [4] evidence of research exists only in some of the dimensions of sustainability.
Practices are still inconsistently implemented worldwide despite increasing awareness and urgency. Their review emphasizes the importance of integrating sustainability not only into infrastructure but also into clinical practice, workforce culture, and professional competencies [2].
Furthermore, the role of radiation therapists (RTs) in leading this transformation is crucial. As healthcare professionals, RTs are uniquely positioned to promote sustainability initiatives, as they typically treat patients five times a week. Moreover, when provided with the resources and knowledge to encourage and educate colleagues and radiation therapy patients, such as through supporting treatments in centres closer to patients' homes or implementing hypofractionation schemes [5, 6], their impact on environmental awareness and sustainable practice can be significant. Additionally, Roletto [7] highlighted the knowledge gap among European radiographers and RTs regarding sustainability, highlighting the urgent need to include green skills to foster a greener culture. Therefore, we would like to emphasise that empowering RTs with these skills is essential to encourage and nurture a culture of environmental responsibility within radiation therapy departments.
Kyeyune and Leech's article is an important call to action. Connecting environmental accountability with clinical practice reinforces the case for making sustainability a fundamental value in radiation oncology, and their contribution advances this critical discussion towards a more sustainable future for radiation therapy.
Conflicts of Interest
The authors declare no conflicts of interest.
The reference list from the paper itself. Each links out to its DOI / PubMed record.
- 1K. M. Kyeyune and M. Leech , “Quantifying the Carbon Footprint of External Beam Radiation Therapy—A Narrative Review,” Journal of Medical Radiation Sciences 72, no. 4 (2025): 407–416.40631754 10.1002/jmrs.70009 PMC 12661070 · doi ↗ · pubmed ↗
- 2A. L. F. Soares , S. C. Buttigieg , B. Bak , et al., “A Review of the Applicability of Current Green Practices in Healthcare Facilities,” International Journal of Health Policy and Management 12 (2023): 6947, 10.34172/ijhpm.2023.6947.37579377 PMC 10461902 · doi ↗ · pubmed ↗
- 3R. Chuter , C. Stanford‐Edwards , J. Cummings , et al., “Towards Estimating the Carbon Footprint of External Beam Radiotherapy,” Physica Medica 112 (2023): 102652, 10.1016/j.ejmp.2023.102652.37552912 · doi ↗ · pubmed ↗
- 4M. N. K. Anudjo , C. Vitale , W. Elshami , et al., “Considerations for Environmental Sustainability in Clinical Radiology and Radiotherapy Practice: A Systematic Literature Review and Recommendations for a Greener Practice,” Radiography 29, no. 6 (2023): 1077–1092, 10.1016/j.radi.2023.09.006.37757675 · doi ↗ · pubmed ↗
- 5L. Cavanna , C. Citterio , C. Bosi , S. Vecchia , M. Proietto , and P. Mordenti , “Travel Burden and Carbon Dioxide Emission Reductions Through a Model of Cancer Care Closer to the Patient,” Oncologist 30, no. 2 (2025): oyaf 021, 10.1093/oncolo/oyaf 021.39963827 PMC 11833240 · doi ↗ · pubmed ↗
- 6R. Chuter , “Could Building More Satellite Centres Reduce the Carbon Footprint of External Beam Radiotherapy?,” IPEM‐Translation 6 (2023): 100021, 10.1016/j.ipemt.2023.100021. · doi ↗
- 7A. Roletto , D. Catania , L. Rainford , et al., “Sustainable Radiology Departments: A European Survey to Explore Radiographers' Perceptions of Environmental and Energy Sustainability Issues,” Radiography 30 (2024): 81–90, 10.1016/j.radi.2024.06.022.38996669 · doi ↗ · pubmed ↗
