Sustainability in German radiotherapy: professionals' perspectives on energy savings-results of a DEGRO working group survey.

Abstract

Purpose: The healthcare sector is a major source of carbon dioxide (CO₂) emissions, with radiotherapy (RT) being a particularly significant contributor due to its high energy consumption and patient-related travelling. Our survey aimed to gather opinions on energy savings and CO₂ reduction in various RT areas. We asked radiation oncologists and medical physicians about the importance of these issues in their day-to-day work as well as about their personal views on them.

Methods: An online survey was conducted via the German Society for Radiooncology (DEGRO) mailing list. The questionnaire covered demographics, attitudes toward energy-saving measures, and current clinical use of (ultra-)hypofractionation (UHF). Quantitative data were analyzed descriptively; free-text responses were thematically summarized.

Results: A total of 69 questionnaires were completed. Attitudes toward sustainability in RT were largely positive: almost 80% believed that topics such as climate protection and energy transition could influence future departmental decisions, and 77% considered sustainable manufacturing and maintenance by linear accelerator providers important. Over 95% reported using UHF regimens. Moderate hypofractionation was the standard for breast (77%) and prostate cancer (55%), while longer schedules remained common for bone metastases (62%). Moreover, 58% indicated willingness to expand UHF use, provided no medical disadvantages occurred.

Conclusion: There are broad awareness and support for sustainability in RT among German professionals. However, practical implementation of environmentally beneficial measures, such as UHF, remains constrained. Addressing systemic barriers and improving access to environmental impact data may facilitate more sustainable clinical workflows.