Environmental life cycle assessment of [18F]FDG PET/CT imaging in a hospital-based nuclear medicine department

Introduction The environmental impact of medical imaging is increasingly recognised, yet comprehensive assessments of nuclear medicine, specifically [ 18 F]FDG PET/CT imaging, remain limited. This study aims to perform a detailed Life Cycle Assessment (LCA) of standard [ 18 F]FDG PET/CT vertex-to-mid-thigh examinations to identify significant ecological impacts and suggest mitigation strategies. Methods A cradle-to-grave LCA, compliant with ISO 14040 standards, was conducted in an Italian hospital-based nuclear medicine department. A representative [ 18 F]FDG PET/CT protocol was analysed. Energy consumption of imaging equipment was directly measured, while HVAC energy use for each functional space was estimated using official data relating to the trigeneration plant at the hospital. Material-related impacts, including radiopharmaceutical production and single-use supplies, were modelled using SimaPro. Sensitivity analyses assessed the effect of national electricity grid decarbonisation. Results The Global Warming Potential (GWP) of a single [ 18 F]FDG PET/CT vertex-to-mid-thigh scan was approximately 7.6 kg CO 2 eq. HVAC systems were the main contributor (47% of GWP), including climate control of the scan room, control room, injection room, and cyclotron facility. Considering the patient care pathway, radiopharmaceutical production accounted for 36% of GWP. Direct scanner electricity use represented only 5.4%, while single-use disposables contributed mainly to toxicity-related impacts and waste generation. Sensitivity analyses indicated that electricity grid decarbonisation could reduce scan-related GWP by up to 50%. Conclusions The environmental footprint of [ 18 F]FDG PET/CT is primarily driven by climate control across functional spaces and radiopharmaceutical production. Improving HVAC efficiency, expanding renewable energy use and adopting reusable or lower-impact consumables could substantially reduce the environmental impact of nuclear medicine practices.