0:01

Hello, and welcome to Noon Conference, hosted

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by MRI Online Noon Conference connects the global radiology

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community through free live educational webinars

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that are accessible for all

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and is an opportunity

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to learn alongside top radiologists from around the world.

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You can access the recording

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of today's noon conference in previous noon conferences

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by creating a free MRI online account.

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Today we are honored to welcome Dr. Reed Omri

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for a lecture entitled Radiology's Opportunity

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to Benefit Patients and the Planet.

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Dr. Omri was chair

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of radiology at Vanderbilt University Medical Center from

0:37

2012 to 2023,

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and has fully pivoted his career

0:42

into sustainable healthcare.

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He now works with healthcare to reduce carbon pollution

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and to advance sustainable practices that benefit patients,

0:50

communities, and the planet.

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At the end of the lecture, please join Dr.

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Oie in a q and a session

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where he will address questions you may

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have on today's topic.

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Please remember to use the q

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and a feature to submit your questions so we can get to

1:03

as many as we can before our time is up.

1:06

With that, we are ready to begin today's lecture. Dr.

1:09

Omri, please take it from here.

1:12

A good day, everyone.

1:13

It's, uh, it's a pleasure to be here

1:15

and I really wanna thank, uh, modality, uh,

1:19

for inviting me to speak today about something

1:22

that is really, uh, near and dear to my heart.

1:25

Uh, we're gonna be discussing

1:27

how radiology has the opportunity to benefit patients

1:31

and the, the planet.

1:33

And, you know, the founder of Modality, Daniel Arnold.

1:37

He had, uh, recently posted on social media

1:41

that he recommended, uh, people join today

1:44

and bring their popcorn and notebook.

1:47

And, uh, to that, I would add one other request that most

1:51

of all you bring in open mind.

1:53

Uh, while we will be discussing, uh, topics today, that

1:58

that might not, uh, be tested in terms

2:02

of a maintenance certification, uh, for radiologists

2:06

or may not directly be on the boards for any of those, uh,

2:11

uh, still in training.

2:13

This is a topic that really affects all of us.

2:16

And so I, uh, I do want

2:19

to emphasize the importance of

2:21

what we're gonna be discussing today, uh, is not just, uh,

2:25

for us in radiology.

2:27

It's not just for our, uh, other colleagues in medicine,

2:32

but fundamentally, the topic, uh, affects the future

2:36

of all children and grandchildren

2:38

and all subsequent generations.

2:40

So, with that in mind, I would like to dedicate this talk,

2:44

uh, to, uh, to children, uh, across the globe.

2:48

I would like to, uh, just also begin

2:51

with some disclosures here.

2:53

And, uh, let's, uh, let's move on.

2:55

So I'm gonna start with a story.

2:58

Um, this is a picture of me from, uh, about a year ago.

3:03

I spent the past year on sabbatical, um, one of the,

3:07

the lucky folks who, uh, is within an academic institution.

3:12

And I was provided this chance to, uh, to go

3:16

and learn to learn about climate change

3:19

and sustainable medicine.

3:21

And so I spent this past year, uh, speaking

3:25

to hundreds of people, literally over 350 people from

3:29

around the, the world.

3:30

These are, uh, CEOs to chefs, their scientists, the

3:35

to students, their politicians, to poets.

3:38

And I have, uh, during this journey,

3:41

I've learned an immense amount.

3:43

I've, I have, uh, across the globe to visit many, uh,

3:48

health centers and, uh,

3:50

universities across the United States and also in the eu.

3:54

And I would like to share those learnings with you so

3:59

that you can consider how to think about the relationship

4:04

of the planet's health, uh, to those, uh,

4:07

who we care about in our work lives, patients.

4:12

Uh, I'm going to start with a term that some

4:16

of you may have seen.

4:17

Some of you may not, but this is one of these terms.

4:20

Once you, once I explain it, you'll start seeing it pop up,

4:25

uh, in many, uh, places from newspapers, uh,

4:29

to magazines, to even songs.

4:33

Uh, the Anthropocene is a really big word,

4:37

and what it means, uh, fundamentally, is that we are in the

4:42

age, the geological epoch,

4:46

where humans have become a force of nature.

4:50

Um, this is an image of Crawford Lake.

4:53

It is about 20 miles away from Toronto.

4:56

I've never been there, but I've been to a lake

5:00

that is similar to Crawford Lake in, uh,

5:03

New York just a couple weeks ago.

5:04

Green Lake, which is outside of Syracuse.

5:07

And what these lakes share in common is that the water, uh,

5:12

doesn't actually mix.

5:14

It just sits there.

5:16

And, uh, because of that, they are a tremendous,

5:21

uh, laboratory to see

5:23

what has happened over the geological ages.

5:27

And, uh, scientists actually, uh, uh,

5:31

they go down in the bottom of these lakes

5:33

and they bore down,

5:34

and they take a specimen, think of it as, uh,

5:37

as doing radiology of the, the bottom of this lake.

5:41

And they run tests and, uh, fundamentally try

5:46

and, uh, look at the differences in time, uh,

5:50

from those specimens.

5:51

And this lake is ground zero for

5:56

where we have physical evidence, geological

6:01

evidence, that humans have actually affected the planet.

6:06

And that evidence points to the year 1950,

6:11

which is the, uh, when we have, um,

6:17

compounds which have been, uh, generated

6:20

after the detonation of, uh, nuclear weapons

6:25

have landed in here.

6:27

And we can say that without a doubt,

6:29

this would not have happened without humans.

6:32

And so this concept of the Anthropocene, uh,

6:36

really says that humans have changed the planet,

6:40

and we've changed the planet physically.

6:43

And, uh, this is now taken on a, a, a lot of

6:49

narratives within, uh, within fiction, within, uh,

6:53

psychology, within even, uh, political science.

6:58

I would also like to say that the effect of humans

7:03

is not just geological.

7:07

I'm going to show a video

7:11

of the effect of humans on

7:14

wild animals at the Kruger National Park in South Africa.

7:19

This is a fascinating study that was published last year,

7:23

and these scientists wanted to know, how do

7:27

wild animals respond to the human voice?

7:32

Are animals more, uh, receptive

7:37

or are they more scared of the human voice, say, compared to

7:42

the roar of a lion or to a gunshot?

7:47

And I wanna, uh, I wanna show you a video that, uh,

7:52

the scientists essentially took, uh,

7:55

60 decibel human voice.

7:57

You're gonna hear the voices.

7:59

They're, they're not screaming.

8:00

They're just human voices in different languages.

8:03

And the response that animals have

8:07

to this, let's begin.

8:13

My dad grew up in, only I knew was,

8:18

So you see these gir running away.

8:30

You Got the Jaguar running away.

8:38

There's A hyena that wants nothing to do

8:41

with human voices.

8:44

I think there were

8:48

Same thing.

8:58

I dunno that I started loving the law

9:03

because we have 11 official languages.

9:07

English is that one that everybody speaks.

9:10

So a fascinating depiction of

9:14

how it's not just, uh, nuclear bombs.

9:19

It's not just fossil fuels

9:21

that are impacting our planet.

9:25

It's actually humans in a sociological way.

9:29

The animals, it turns out, feared human voices

9:33

more than gunshots

9:35

and more than a lion's roar, which is fascinating.

9:39

So let's recognize that our presence

9:43

on the planet is actually changing the planet.

9:50

The World Health Organization has deemed the single

9:54

biggest threat facing humanity as climate change.

9:58

It's not COVID, it's, it's not an unknown, uh, still,

10:03

uh, yet unknown pathogen.

10:05

It's actually climate change.

10:07

And what I would like to discuss today is the relationship

10:11

of climate change and other factors to human health,

10:17

and how this is relevant for the field of radiology.

10:24

Uh, let, let's be really clear.

10:28

The main cause of climate change is the burning

10:32

of fossil fuels.

10:35

Um, you know, the main cause

10:37

of lung cancer has been smoking.

10:41

And, uh, just like the tobacco industry, you know,

10:47

big oil has a lot hanging on the line here.

10:50

And so we need to just understand from a human health

10:54

perspective that the burning of fossil fuels

11:00

has become a public health emergency.

11:05

A public health crisis, over

11:08

7 million people die across

11:12

the world each year from pollution

11:18

caused by fossil fuels.

11:20

And this is something that, uh, is, uh, become so

11:25

important that the New England Journal of Medicine,

11:29

the highest ranked journal in medicine, is

11:34

devoting a monthly series to this very issue.

11:38

And I'll, I'll even show you right here.

11:41

This is Science magazine, you know,

11:44

the top rated science journal, uh, in the United States.

11:49

Um, every other week

11:51

or so there, there tends to be a series of articles, uh,

11:56

discussing the link, um, between, uh,

12:00

climate change and human health.

12:03

In this case, we have a special issue

12:05

that just came out last month, which is, uh, focused

12:09

entirely on air pollution.

12:12

And we see this in all of our, uh,

12:16

mainstream journals too.

12:18

We see this in newspapers. We see these in the economists.

12:22

And this is something that fundamentally we can't

12:26

run away from.

12:27

It is here. We're not at the point where

12:32

we need to ask, is climate change real?

12:37

Um, asking that question is equivalent

12:40

to asking the question, does,

12:43

is smoking bad for your health?

12:45

We're like decades beyond that.

12:48

What we should be asking is how we

12:53

can address climate change, how we can address

12:57

the effects of tobacco to benefit the health

13:01

of, of humans.

13:03

And, uh, we see the effects of climate change in many ways.

13:08

Uh, this is a slide I constructed, uh,

13:11

um, probably last fall.

13:13

And, uh, this showed, uh, this incredible wildfire in Hawaii

13:18

that killed over a hundred individuals.

13:21

It shows New York City, uh, last, uh,

13:25

June from 2023, where it is apocalyptic.

13:29

And that really is the same thing on the cover of this, uh,

13:33

this journal from science.

13:35

Uh, it shows the Florida beaches

13:38

where the temperature got close

13:40

to a hundred degrees in the ocean.

13:43

And of course, the Canadian wildfires from, uh,

13:47

the summer before last.

13:49

I bring this up because I, while I created it

13:54

last year, these sorts of extreme

13:58

weather events are happening with more frequency,

14:03

and they're happening in different parts of the country.

14:07

And it's just a matter of, uh, you know,

14:10

which images do I want to show here is

14:15

last week in Connecticut in the United States, uh, one

14:19

of my, uh, one of my friends, Sarah Finney shared this

14:22

with me in her town in Connecticut.

14:24

They'd never seen flooding like this.

14:27

This is a friend of mine who was

14:30

visiting Arizona this year.

14:33

And so he texted me

14:35

and he said, you know, yesterday was 118 degrees, like

14:40

straight up temperature, 118 degrees.

14:43

So I said, Hey, can you,

14:45

can you send me what it is right now?

14:47

And he just took a picture from his phone, 112.

14:50

This is straight up. This is not like heat index.

14:53

Um, I have a friend in Houston who is a biomedical engineer,

14:58

who told me the day

14:59

before last was 115 degrees, uh, heat index in Houston.

15:05

Um, when the temperature gets this,

15:07

so when the temperature gets this hot, it is,

15:11

uh, it is actually really dangerous,

15:15

and it's dangerous for, uh, for so many individuals,

15:20

kids, and, uh, our elders.

15:24

Uh, a story from Arizona when it was so hot,

15:28

there was an example where a a, uh,

15:32

a parent came home

15:34

and a five-year-old boy, uh, went out from the front door

15:39

to greet the father who was coming home.

15:43

That boy wasn't wearing shoes.

15:46

The pavement was so hot that the, the young

15:51

child had third degree burns on their, on their feet.

15:55

So this isn't just theoretical,

15:57

this really affects so many of us.

16:01

And so this example of the child

16:06

who burned their foot is, is an example of

16:11

how climate change targets the vulnerable first,

16:14

and who are the vulnerable, the vulnerable

16:17

children are elders can be, uh, those who are

16:22

socioeconomically disadvantaged.

16:25

Uh, those who are marginalized.

16:26

There are entire nations that are at much greater risk,

16:31

uh, for the effects of climate change, um,

16:35

and do not have the capacity to address it.

16:39

Uh, like, uh, some

16:42

of the wealthier nations like the United States

16:46

and the the eu, um, there's a,

16:51

uh, in the United States,

16:52

there's a climate vulnerability index, uh,

16:56

which has been generated.

16:58

You can go to this, uh, URL at the bottom.

17:02

And you can see based on color code,

17:06

the darker parts are the most vulnerable

17:11

to climate change

17:14

and the health impacts of climate change.

17:18

And you can see there's a preponderance of dark, uh,

17:23

in the southern part of the United States.

17:28

Uh, this is based on census track,

17:32

and there are over 70,000 census tracks

17:35

in the United States.

17:37

Uh, if you look at the, the 10 most vulnerable, uh,

17:41

census tracks, five of them are in Louisiana.

17:46

So when we come from a perspective of health equity, we have

17:50

to think about climate change

17:53

and the effects it has on the patients

17:56

that we are serving in radiology.

18:00

And so you might think, oh, well, I'm lucky.

18:03

I don't, uh, you know, I don't live in Louisiana,

18:07

or I'm lucky I'm not in Houston where it's super hot today.

18:11

But what's really interesting about this,

18:15

if you live in the United States,

18:16

is you can actually type in where you live

18:19

and you can see dramatic differences.

18:22

I'm gonna show you Nashville where I live. Okay?

18:27

So, uh, I just, uh, in this case,

18:31

I've shown the part of Nashville

18:33

where Vanderbilt is located, where downtown is located.

18:38

And, uh, compared to the 70,000 plus

18:42

census tracts, we're at the 74th percentile.

18:46

That means that we are more

18:51

vulnerable than 74%

18:55

of the nation to the effects of climate change.

18:59

There's a river in tent in Nashville called the Cumberland.

19:05

And, uh, this river, I've actually swam ac swam within it,

19:10

uh, as I've done triathlons.

19:11

And you go from, uh, downtown Nashville,

19:15

and you cross over to

19:17

East Nashville, east Nashville.

19:20

99 percentile means like it's

19:25

amongst the 1% of most vulnerable areas

19:31

in the United States.

19:32

So, even within, uh, uh, the town

19:36

where I live, there are dramatic

19:39

differences in vulnerability.

19:41

And I'll tell you that fundamentally, when we look at

19:46

health outcomes, 50%

19:49

of health outcomes in the United States

19:52

can be attributed to zip code.

19:54

So, where we live matters

19:59

and where our patients live matters, we need

20:03

to consider that.

20:05

Uh, broadly, when we think about our roles

20:09

as radiologists, when we think of our roles

20:12

as healthcare professionals, when we think of our roles as

20:16

parents, how do we help those

20:21

in our local communities who don't have the resources, uh,

20:26

to, um, and access to health

20:30

and the ability to withstand climate change?

20:35

Um, we are talking about vulnerable populations.

20:39

And I I wanna really emphasize

20:43

that these vulnerable populations, um, they're, they're,

20:48

they're not others.

20:51

They're, they're not those, uh, uh,

20:55

unrelated to us in radiology

20:58

or, uh, unrelated to us in healthcare.

21:03

They can be us, is individuals. Okay?

21:08

There's a tick called the lone star Tick,

21:13

which is associated, uh, with a tick bite itself,

21:17

causes what's called Alpha gal syndrome.

21:19

And Alpha Gal Syndrome is a severe allergy

21:25

to, uh, mammalian products, uh,

21:28

most commonly from eating beef.

21:31

And one of our faculty at Vanderbilt told me

21:34

about this tick.

21:35

And he had had it

21:36

and had a, a near anaphylactic reaction to it, uh,

21:41

and had to then avoid all mammalian, uh,

21:46

products for a year and a half.

21:49

I have another friend who is a dean of a medical school

21:53

who had, uh, uh, this alpha gal

21:58

reaction and ended up in the ICU, uh,

22:02

a dermatology friend of mine, uh, Dr.

22:05

Eva Parker, uh, from Vanderbilt.

22:08

She shares this slide of this tick,

22:11

and you see it as this little white

22:12

spot in the middle of it.

22:14

This tick traditionally was in the southeast.

22:16

It is now gone up, uh, into the north of the United States.

22:21

It's, uh, so it's, uh, its range has expanded

22:27

due to the effects of climate change.

22:29

And, you know, this picture that she shows of a tick,

22:33

specifically the lone star tick,

22:35

it's the best image she has of it.

22:39

When she gives her dermatology talks,

22:41

she's showing this picture, and she's showing that tick

22:44

and that tick I took on me.

22:48

Uh, I was bitten by two lone star ticks last year.

22:52

And let me just tell you, I do not recommend it.

22:55

Um, and we think about these, uh,

22:58

we think about the air pollution

23:00

that has been coming down from Canada, that caused

23:05

my, my 11-year-old daughter, uh, a year ago,

23:10

to develop asthma.

23:12

So these aren't theoretical concerns.

23:15

What is happening with increased wildfires and flooding,

23:19

and the vector-borne illnesses

23:22

is not just affecting patients.

23:24

It is affecting us as radiologists.

23:30

The concept then, of thinking about the planet, I would like

23:35

to really simplify

23:37

and let's all of us who are in medicine, all

23:41

of us in radiology

23:42

and healthcare, let's start thinking about

23:46

the planet as our patient.

23:50

It's the biggest patient of all.

23:51

And so I wanna talk about that, uh, from the perspective

23:56

of the planet's health.

23:58

Now, we were talking about, uh, climate change

24:02

and climate change is related to greenhouse gases.

24:07

These are most commonly, uh, carbon dioxide emissions.

24:12

They can, uh, they can also be, um,

24:16

uh, from methane.

24:18

Uh, methane comes, uh, methane's a fancy, uh,

24:22

um, term.

24:24

That also is what na natural gas is.

24:27

So when you hear, uh, commercials talk about natural gas

24:32

as being clean, I just want you to recognize it's methane.

24:36

And methane is also emitted, uh, in large quantities

24:41

by cattle.

24:43

Uh, so the rise in temperatures that are, are happening,

24:49

uh, from climate change,

24:51

and the severe weather events are due to the,

24:55

the emissions of these, so-called greenhouse gases,

25:00

and they basically sit there as a greenhouse,

25:03

and they allow the, the sun's ray to come in,

25:06

but don't allow them to leave.

25:10

And so it sort of heats up things,

25:12

and the amount of greenhouse gases keeps increasing,

25:15

which then leads into this positive feedback loop.

25:20

Um, the Paris Agreement, which happened in 2015,

25:25

between over a hundred nations, was to try to limit

25:28

that rise to 1.5 to two degrees Celsius.

25:32

This figure really means nothing to most people, like one,

25:37

1.5, two degrees.

25:39

They don't sound like a lot. First of all, it's in Celsius.

25:42

So if you're in the United States, you're like,

25:44

I don't even know what that is in, um, in Fahrenheit,

25:49

well, 1.5 degrees in Fahrenheit is 2.7,

25:54

and, uh, two degrees is 3.6 Fahrenheit.

25:58

Once again, it doesn't sound like a lot,

26:00

but let me be really clear.

26:02

The, this rise has happened on a,

26:05

on a scale like this.

26:07

And what we find is fundamentally, as this temperature

26:13

rises, it means more

26:16

and more humans, more

26:20

and more species, more

26:22

and more coral, all of that starts

26:25

to be affected negatively.

26:28

So you might think, well, geez, you know, I'm in medicine,

26:31

I'm in radiology, I'm busy.

26:35

How does this relate to me?

26:36

Well, one, one thing is that the emissions

26:40

that we cause in healthcare in the United States

26:45

are 8.5% of all emissions.

26:48

And across the world, it's about four to 5%.

26:52

So, uh, some of you may be aware how

26:57

aviation, you know, we wanna limit our

26:59

travel and, and all that.

27:00

Well, healthcare generates more emissions

27:05

than aviation and shipping combined.

27:09

Um, said another way, when,

27:12

when you feel guilty about flying,

27:14

should actually feel more guilty about the emissions

27:17

that we're generating in healthcare.

27:21

The emissions that we are generating in healthcare cause

27:26

iatrogenic harm to the communities outside

27:31

of our health systems who are least able to tolerate it.

27:36

And so, if we were a country,

27:38

healthcare would be the fifth largest emitter

27:41

of emissions across the globe.

27:43

And there's a major impact on this in terms of dollars.

27:47

And in terms of human health, I think it's important

27:50

that we, we recognize that across the world,

27:55

when we look at the most trusted communicators,

28:00

the most trusted individuals are still doctors.

28:06

The second most trusted, despite all the, the covid stuff

28:10

that's, that's happened, or scientists.

28:11

And the third are teachers.

28:14

So we as physicians, we

28:18

as scientists, we as teachers,

28:22

have the opportunity to educate others about

28:28

climate change and be considered a credible source,

28:32

often more trusted

28:35

than the climate scientists themselves.

28:40

Now, there are a number of strategies

28:43

that we can take in radiology to reduce our

28:48

impact on the environment.

28:50

And I use the term planetary health.

28:54

The, the planetary health is a concept where the health

28:59

of the planet, for instance,

29:02

is affected by climate change.

29:05

The health of the planet is also affected by biodiversity.

29:09

You know, what happens to the 2 million other, uh,

29:14

species that are alive?

29:16

It's also affected by plastics, I think is, uh, some

29:20

of you may be aware, plastics never go away.

29:24

They just become smaller and smaller.

29:26

And almost certainly everyone watching this

29:31

lecture today has micro

29:34

and nanoplastics in your body.

29:38

Uh, I hate to say that, but that's the reality.

29:41

That's where we find ourselves.

29:42

So when we think about the health of the planet,

29:44

there are all these other inputs that extend beyond

29:48

just climate change that we need to consider.

29:52

And when we try

29:53

and reduce our impact on

29:57

climate change, that's called mitigation.

30:00

When we try to help manage it, it's here.

30:04

That's called adaptation.

30:07

And a stellar medical student

30:10

from Toronto was the first author of this, uh,

30:15

recent radiology paper.

30:17

You, you see a little, uh, um, QR code here that, uh,

30:23

describes many of the actions that we can take in radiology.

30:27

And, uh, I really wanna, uh, congratulate Dr.

30:32

Kate Hamman as the, uh, senior author

30:35

and mentor on this, uh, for involving, uh,

30:40

a medical student and bringing together, uh,

30:43

radiologists from around the world to, uh,

30:47

talk about the different strategies

30:49

that we can take in radiology.

30:53

Um, we, at, at Vanderbilt, in conjunction with Phillips,

30:58

have conducted a study where we looked at all the emissions

31:02

that a diagnostic radiology part, uh, department has, uh,

31:07

generated over a 10 year period.

31:09

And this is not just from the daily operations,

31:13

but it's from the manufacturing of our equipment.

31:16

I'd like to emphasize that in radiology,

31:19

what is our biggest emitter?

31:22

And it's hands down on MRI scanners.

31:26

Uh, so when we, uh, perform

31:30

RI scans, we actually, those are

31:34

of all the imaging techniques, the, that is the one that

31:38

generates the most emissions.

31:41

Uh, CT is next.

31:42

Uh, what's interesting is the, the, the least, uh, uh,

31:47

emitter is ultrasound.

31:48

So we think about all the different modalities recognize

31:52

that they have, uh, differential impact.

31:58

Uh, another place where we, uh,

32:01

can impact the environment is through plastic waste.

32:07

Uh, back in 2022, there was a

32:10

lockdown in Shanghai, China due to COID, uh,

32:14

which reduced the supply of ated contrast agents

32:20

that was, uh, produced in that, uh, factory.

32:23

And that affected, uh, globally the supply.

32:26

We at Vanderbilt, when once we received notification

32:30

of this, we had only a seven day supply

32:33

of I need contrast agent, uh, available.

32:37

And so we went into an active mode.

32:40

And in, uh, work led by Dr.

32:42

Lavelle Allen, we actually showed that we could, uh, uh,

32:46

on a dime, we could, uh, massively reduce our use

32:50

of ated contrast agent.

32:53

Well, Jennifer Lindsey, who's one

32:55

of our stellar residents at Vanderbilt, went on

32:58

to further study what would be the effect

33:01

of moving from single use vials that are like, you know,

33:05

these dollar general size vials, a contrast agent moving

33:09

to more of like a Costco size, uh, vial.

33:13

And she showed that, uh, doing

33:15

so would reduce pharmaceutical waste by three-fourths

33:19

plastic waste by over 90%.

33:22

But here, what, this is what's really key

33:25

over six CT scanners, it would reduce our expenses

33:29

by a half million dollars a year.

33:31

This is, these are funds that then could be used

33:35

to improve the care

33:37

and access for patients without insurance.

33:39

They could be used to hire more radiology technologists.

33:43

They could be used to hire radiology room, uh,

33:47

reading room assistance.

33:48

So when we conduct sustainable interventions,

33:52

like going from single to multi-use files,

33:55

we actually save money.

33:58

And we can take those dollars

34:00

and we can put them into other things

34:02

that make our lives better as radiologists.

34:07

And really like to emphasize

34:08

that when we can consider sustainability,

34:11

sustainability is reducing waste.

34:14

That can include contrast agent, it can include scans,

34:18

it can include dollars.

34:20

Fundamentally, when we reduce waste,

34:23

we operate more efficiently.

34:26

The greenest radiology is the radiology that is not needed.

34:31

So when we bring a sustainability mindset to radiology,

34:36

we also have the capacity

34:37

to reduce these never ending work lists.

34:42

I'd like to, to, uh, now end with a series

34:47

of call to actions.

34:49

There're gonna be three call to actions, um, that I,

34:54

uh, I would like to emphasize as practical steps.

35:00

So the first call to action is to, is to link

35:04

what we do at home and at work.

35:07

And let me say this a little bit differently.

35:12

Most of us at home, uh,

35:16

have some measure of

35:20

reducing our waste.

35:22

We may recycle, we may compost,

35:27

we may ride our bikes.

35:29

We may have an ev, we may, uh,

35:34

grow our own food.

35:35

We may choose to have a more plant forward diet.

35:41

Um, most of us, me included, um,

35:47

had done that without thinking about

35:50

doing the same thing at work.

35:52

I would like to give everyone listening here permission

35:55

to break down that false barrier between what we do at home

36:00

and what we do at work.

36:01

There's no reason

36:02

that we can't bring our sustainable mindset,

36:07

uh, to, uh, reduce, reuse, recycle,

36:12

and bring that into our work environment.

36:16

And when we do, we, we will see so many opportunities.

36:21

I'm showing a picture, this is actually my hand.

36:23

And, uh, some of us are aware of the term carbon footprint,

36:28

um, footprints, uh, that, that notion of the carbon

36:33

footprint was actually, uh, uh,

36:37

really promulgated by British Petroleum.

36:41

They hired a PDR firm,

36:44

and the goal was to, to take the concept of

36:50

emissions and the emissions that were being caused

36:53

by British Petroleum.

36:55

And instead of thinking about what an

36:59

oil company might do to think about renewable energy sources

37:04

was essentially to shove that on to individuals

37:07

and make it our personal responsibility.

37:10

And it has worked fabulously well.

37:14

Uh, so much so that a lot of climate activists without

37:19

actually recognizing it, have taken to shaming people who,

37:25

uh, who maybe fly

37:26

or who drive gas, uh, uh, powered vehicles.

37:31

And I, I wanna, I wanna say, no, that is wrong.

37:35

We, we should all consider our individual actions,

37:40

of course, but let's not ever shame others.

37:46

Let's not ever judge others.

37:49

And let's think about what we can actually do

37:54

as opposed to what we've done in the past.

37:57

And don't consider our, uh, you know,

38:02

flying as, as being like, oh, the, the, the, the,

38:05

the single worst thing we can do.

38:07

There. There are simple actions we can take,

38:10

like perhaps eating less beef

38:13

that can have a actually remarkable impact.

38:17

Um, the second key ask, and,

38:20

and perhaps this might be the single most important message

38:24

I'd like to, uh, uh, to emphasize today,

38:29

is when we talk about the health of the planet,

38:32

when we talk about climate change, when we talk about trying

38:36

to make, uh, uh, sustainable, uh,

38:40

practices happen at work, we need

38:44

to first start with empathy.

38:47

We need to first start by listening.

38:51

Um, empathy, uh,

38:55

doesn't work by taking colored corn starch

39:00

and spraying stone hge.

39:03

Empathy doesn't start by taking mashed potatoes

39:08

and hurling them at a Monet in a museum that really,

39:13

like, if, if we think that, uh, somehow

39:18

individuals aren't thinking about climate change

39:22

or thinking about the planet,

39:23

and when they see some of these like ridiculous acts

39:27

that they're, that's what they needed to be,

39:29

to be switched on, it's just wrong.

39:32

We need to think about, uh, when we consider

39:38

our c-suite, when we consider our coworkers,

39:42

when we consider our neighbors,

39:44

when we consider our patients, what are their needs,

39:50

and start by listening.

39:53

And when we understand their needs, almost always

39:58

there is a, um, an opportunity

40:02

to meet those needs through a sustainable practice.

40:08

Let me explain. A, uh, right now in the United States,

40:12

40% of hospitals are losing money.

40:16

40%. They are struggling to stay alive.

40:21

So in trying to help those hospitals,

40:26

if we try and schedule a meeting with the CEO

40:32

and or anyone in the c-suite

40:34

or any of the, the real administrators

40:37

and say, Hey, we need to fight for the planet, we need to,

40:41

to reduce our emissions, the immediate response is, we're,

40:46

we're in danger of closing down

40:50

because we're losing money, we're hemorrhaging money,

40:54

and if we close down, there will be no care for

40:58

patients in this community.

41:01

So we just rephrase it.

41:03

And if that's the need, we say, Hey,

41:07

we've got a solution to some of our money problems.

41:11

We've got a way to save money. And let me tell you how.

41:14

And that goes to, uh, almost always reducing

41:20

emissions and waste saves money, almost always.

41:25

Or if we're thinking about quality, almost always

41:30

sustainable solutions, improve quality.

41:34

Uh, think about who wants to send all that plastic waste,

41:39

who wants to send all that medical waste

41:42

and have it be incinerated, uh, in the, in the communities

41:46

outside of our medical centers where physicians don't live,

41:51

because that's where the incineration happens.

41:54

It doesn't happen in the wealthier neighbors neighborhoods.

41:57

It happens in the neighborhoods

41:58

where people can least tolerate it.

42:00

And it's often children who then come in with asthma,

42:04

just like my daughter, and have to be treated.

42:07

So we can think about then, uh, qua a quality.

42:12

You know, reducing our missions is a quality metric.

42:14

It's also a, a, a as we'll describe, uh,

42:18

next in equity approach.

42:20

It's also a tactic for innovation.

42:23

So when we understand the needs of our

42:27

health system, of our department, of our communities,

42:32

we then can consider sustainability as

42:37

part of the toolkit.

42:39

And so my last ask is then to link people

42:43

and the plan, I,

42:48

uh, I'm confident that a number

42:51

of folks listening today

42:53

or in the recorded, uh, uh, session

42:57

are interested in health equity.

42:59

And as you, we all should be,

43:03

we should really be looking at how we reduce some

43:06

of the disparities in health outcomes.

43:10

Um, if you are involved in equity, if you care about equity

43:15

and you do not consider climate change,

43:20

you are missing a major opportunity to improve equity.

43:26

The same time, if you care about climate change,

43:31

recognize that the interventions

43:35

that we do have an important opportunity

43:39

to reduce disparities.

43:42

And so, let's think about this, uh, with an example.

43:47

It's really easy if you live in the United States to say,

43:50

you know, coal, coal is the dirtiest fuel, which it is.

43:55

We should get rid of all the coal plants,

43:59

which I would, uh, agree with.

44:02

But we'd have to then think, what happens

44:04

to all those coal workers?

44:06

What happens to all those poor families,

44:09

often in West Virginia who don't have anybody advocating

44:12

for them, who've been coal workers for generations?

44:17

We then have to, we can take the opportunity

44:19

as we remove coal plants to help elevate those

44:25

communities that have been based on coal, by educating them,

44:29

by providing new skills where they can take on jobs

44:34

and be elevated to higher paying jobs in a

44:39

clean energy economy.

44:41

So that's an example where we can link people in the planet.

44:44

I'm gonna give another one. This is from

44:46

Boston Medical Center.

44:47

And I really wanna highlight the, the amazing work

44:51

of Bob Biggio, who over the, the past decade,

44:56

has built remarkable, remarkable, uh,

45:01

uh, sustainability programs across, uh,

45:04

Boston Medical Center,

45:06

which remembers a safety net hospital.

45:09

And this is an, this is a clear example

45:12

of linking sustainability to local communities.

45:17

And so what Boston Medical Center did, remember,

45:20

this is a safety net hospital.

45:24

They applied for dollars

45:27

from the US Inflation Reduction Act.

45:30

And, uh, for those of you who are not aware,

45:33

this is legislation that was passed.

45:35

It was bipartisan. It was passed in 2022 and

45:40

provided $380 billion to,

45:46

uh, clean and green the infrastructure

45:50

in the United States.

45:52

So there were dollars available

45:54

to help health systems do this.

45:56

And so what Boston Medical Center did is they were building

46:01

a new hospital in an underserved community

46:05

in the Boston area,

46:07

and they used these dollars

46:09

to put solar panels on the roof.

46:14

They then constructed a, um, an agreement

46:19

with, uh, I think it was New England Power, what,

46:23

whatever the local utility in there.

46:26

And they took the green energy that came out,

46:31

you know, from the solar panels,

46:34

and they, uh, they used that energy.

46:39

And this is what's really amazing.

46:40

They, they took 80 patients

46:43

that would come into the emergency room frequently,

46:47

who often were, were coming to the emergency room,

46:50

fundamentally because of health effects

46:53

of not having either air conditioning or heat.

46:58

And they, you could have, as a,

47:01

a physician could write a prescription for clean energy.

47:06

And what that would mean is

47:07

that those individuals would get $50 a month credit

47:12

from the power company to use the clean energy

47:16

that was generated from top of the hospital.

47:20

This is mind blowingly innovative.

47:23

I so, uh, want to applaud Boston Medical Center

47:29

for thinking in an entirely different way about how we can

47:35

use our hospitals to benefit the communities in a way

47:39

that's often the, the biggest need, which is like, you know,

47:42

how do I live my life in a way

47:46

that I can meet the needs of, uh, my family?

47:51

In this case, it was clean energy.

47:53

Um, university, uh, case, uh,

47:57

university hospitals in, uh,

48:00

Cleveland is doing the same thing with food pantries,

48:04

putting them out in the community, offering clean, uh,

48:08

healthy food items, uh, to patients in need.

48:12

So there are different ways we can do this.

48:16

Uh, I'd like to then end by saying,

48:19

we have the opportunity today in radiology

48:22

to make a tremendous impact on the health

48:27

of our patients, on our communities, and our planet.

48:31

Uh, we can do it,

48:33

but to do it, we have to really do this together

48:37

and, uh, start making changes at scale,

48:40

because that's how we'll generate the impact.

48:43

And I'd like to think about this as compound interest.

48:47

The work we do today

48:50

will actually have impact not just for today,

48:53

but it for every subsequent year.

48:56

So the quicker, the sooner, the bolder we can act.

49:00

Now, the longer

49:04

and the bigger the impact over time.

49:08

And I'd like to say, don't just believe me,

49:15

I'm one person,

49:16

but I, I think sometimes we can even appeal

49:19

to a higher authority.

49:21

The Vatican has actually now gone green.

49:26

All their vehicles are, uh, ev.

49:29

So if it's good enough for the Pope, I recommend that it's,

49:33

uh, something we all consider.

49:36

So thank you. Thank you for listening today.

49:38

Thank you for joining me.

49:41

And I'd invite you to connect with me on, uh,

49:45

on LinkedIn, or if you'd like

49:47

to learn more about sustainable, uh, medicine, I have a, uh,

49:52

blog@readerie.com.

49:54

Thank you to modality for, uh, this opportunity.

49:59

All right. Thank you so much for sharing your LEC

50:01

lecture with us today, Dr.

50:03

Oie. Um, at this time, we will open the floor

50:06

for any questions from our audience.

50:08

You may submit your questions through the q

50:10

and a feature, Dr.

50:12

Oie, I don't know if you see at the bottom of the screen.

50:17

Okay. Uh, Murray Solomon. Thank you.

50:20

Thank you, thank you, Murray.

50:22

It is difficult to be optimistic.

50:24

Are you really convinced that this is a war we can win?

50:29

Um, Murray, thank you for for asking this question,

50:32

and I will answer it very directly.

50:37

Uh, we don't, uh, we don't have an option.

50:42

We have to win this one, and we can do it,

50:45

and we can do it fundamentally by recognizing,

50:50

uh, this is a multi-generational,

50:56

uh, challenge.

51:00

Uh, we're not going to solve it this decade.

51:02

We're not gonna solve this next decade.

51:04

But what we need to learn is that, uh, our,

51:09

our timelines, our horizons are gonna be way longer

51:14

than the horizons of our politicians, the United States, uh,

51:19

you know, congress, two year term senate,

51:22

six years president, four years.

51:25

So those timelines are not the same timelines that,

51:29

uh, we need to think about something as, uh, as

51:34

large and difficult to tackle as climate change.

51:40

For me, a great example

51:42

that I use is JFK

51:45

and the 1960s, the space Race.

51:49

Um, and thinking about the space race, uh, that

51:55

it, it wasn't clear to JFK that he would ever see

52:01

the, um, us landing on the moon by the end

52:05

of his presidency.

52:07

Unfortunately, uh, uh, he was assassinated.

52:12

He never got to experience us landing on the moon.

52:15

But I, I would look at this from a, uh,

52:19

a multi-generational perspective.

52:21

Really take the long

52:22

and recognize that when we look in the mirror right now,

52:26

we wanna be able to tell our kids, our grandkids,

52:28

our friends, kids and grandkids, uh, that we tried

52:32

and we did everything in our capacity, uh, as opposed

52:36

to just said, this is such a big problem.

52:39

I don't know where to begin.

52:41

And getting your point, if you don't know where to begin,

52:45

vote, vote.

52:47

That's a really, that's an action we all can take.

52:52

Uh, okay. Uh, Martha Kears, can you explain again

52:56

how the cost savings

52:57

and energy were applied as a dollar credit

53:00

for patients at Boston Medical?

53:02

Okay, so the, the way this was a, uh, this worked

53:08

was that, uh, clinicians at Boston Medical

53:12

were given the opportunity to write prescriptions.

53:16

And they were, for the first 80 patients, the, the,

53:20

the goal was to look at patients

53:23

who were coming in frequently to the emergency room,

53:27

and, uh, and actually what a lot, uh, uh, in,

53:32

at Boston Medical Center.

53:33

What they found is that a number

53:35

of clinicians were writing letters

53:37

to tell the local utility company, please don't turn off,

53:42

uh, the power for our patients.

53:47

That's what they would in, in, yes, there's pre-auth forms,

53:50

but if you're a safety net hospital,

53:52

you may not be worrying about pre-auth.

53:55

In this case, they were writing letters to say,

53:58

please keep the power supply on for patient X,

54:03

because if you remove the power, they're,

54:05

they're gonna cycle down.

54:07

So this was an example

54:09

to then essentially elevate those patients

54:12

because then the utility company would get that $50

54:19

functionally from the medical center

54:20

and then be able to supply the energy.

54:23

So thank you, Dr. Kerns.

54:29

Are there any other questions?

54:35

Well, I want to thank everyone for joining today, uh,

54:38

especially thank the, the modality, uh,

54:40

folks for setting this up.

54:42

Jackie Ashley, Alexandra, Ben

54:46

and, uh, initially, uh, Daniel Arnold for,

54:49

uh, for inviting me.

54:50

Uh, this was, uh, this was great. I'm always here to help.

54:54

If any of you have questions.

54:55

We in radiology have a long tradition of innovation.

54:59

We cannot be caught flatfooted here.

55:03

We have an opportunity, just like with AI

55:06

to make an immense difference across, uh,

55:09

how healthcare is delivered, uh,

55:12

by embedding sustainability.

55:14

So please consider that. Thank you.

55:17

Thank you all. Take care. Thank you.

55:19

Thank you so much Dr.

55:20

Oie, and thank you for such a very enlightening lecture

55:24

and very inspiring as well for all of us

55:26

to take action today.

55:28

And thank you to everyone

55:29

for participating in our noon conference.

55:32

You can access the recording of today's conference

55:34

and all our previous noon conferences

55:36

by creating a free MRI online account.

55:39

We'll also email out a link to the replay later today.

55:43

Be sure to join us next week on Thursday,

55:46

August 29th at 12:00 PM Eastern, where Dr.

55:49

Joshua Nickerson will deliver a lecture entitled SWI Imaging

55:53

Practical Applications.

55:55

You can register for@mionline.com

55:58

and follow us on social media

55:59

for updates on future noon conferences.

56:01

Thanks again, and have a great day.