Estimating Carbon Dioxide Emissions and Direct Power Consumption of Linear Accelerator–Based External Beam Radiation Therapy

Abstract

Climate change is one of the direst health threats that humanity faces. We aim to estimate the carbon dioxide (CO2) emissions associated with the energy usage from linear accelerator (LINAC)-based external beam radiation therapy (EBRT) for the most common cancer diagnoses. We identified patients with the 4 most common cancer types treated with curative-intent EBRT. Beam-on time for each fraction was extracted from the treatment planning system and averaged over each site and treatment modality. The power was multiplied by the beam-on time in hours to yield kilowatt hours (kWh). Using the US Environmental Protection Agency Greenhouse Gas Equivalencies calculator, we converted the kWh into estimates of CO2-equivalent emissions for the average US power grid. Idle time of the LINAC was estimated via Varian Medical Systems. A total of 10 patients were included for each of the following modalities: conventionally fractionated for prostate cancer (28 fractions [fx]), prostate stereotactic body radiation therapy (SBRT) (5 fx), 15- and 5-fx regimens for early-stage breast cancer, 3- and 5-fx SBRT regimens for early-stage lung cancer, conventional EBRT (30 fx) for locally advanced lung cancer, and short- (5 fx) and long-course (25-28 fx) for rectal cancer. The modality with the lowest and highest carbon emissions per course, on average, was prostate SBRT (2.18 kg CO2; interquartile range, 1.92-2.30) and conventional treatment for prostate cancer (17.34 kg CO2; interquartile range, 10.26-23.79), respectively. This corresponds to CO2-equivalent emissions of driving an average of 5.4 miles and 41.2 miles in a standard vehicle, respectively. "Standby" mode for a LINAC TrueBeam and Clinac IX uses 112 kWh and 64.8 kWh per day, respectively. We have estimated CO2 emissions arising from direct energy usage of a LINAC for 4 common cancers treated with EBRT. "Standby" mode of a LINAC uses the most energy per day. Comprehensive studies are warranted to minimize the environmental effects of health and cancer care.