{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:13:25Z","timestamp":1786979605666,"version":"build-2736575974"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Justus-Liebig-Universit\u00e4t Gie\u00dfen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The healthcare sector is a\u00a0large greenhouse gas producer. Especially in radiotherapy (RT), a\u00a0lot of electricity is consumed by the medical linear accelerator (linac) and associated patient travel. Our aim was to ascertain by how much electrical energy consumption and patient travel can be reduced by replacing normofractionated (NF) with emerging moderately hypofractionated (UF) or ultra-hypofractionated (UHF) concepts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We connected an energy meter to our linac (VersaHD, Elekta\u00a9, Stockholm, Sweden) and evaluated different fractionation concepts (NF, HF, UHF) for 30\u00a0patients with target volumes of the prostate, breast, and spine. In addition to the energy measurements, we also conducted an analysis of the carbon dioxide (CO\n                      <jats:sub>2<\/jats:sub>\n                      ) emissions associated with the variations in patient travel.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study measured the energy consumption of a\u00a0linac (in kWh) and its impact on CO\n                      <jats:sub>2<\/jats:sub>\n                      emissions for various radiotherapy fractionation concepts. Ultra-hypofractionated regimens consistently showed the lowest energy consumption and variability across prostate, breast, and bone metastasis treatment courses, while NF regimens had significantly higher energy consumption and variability. Transitioning from NF to UHF regimens reduced CO\n                      <jats:sub>2<\/jats:sub>\n                      emissions by up to 75%, driven by fewer patient visits and lower electricity consumption. These findings highlight the environmental and logistical benefits of HF and UHF treatment protocols.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The adoption of HF and UHF treatment concepts can significantly reduce energy consumption and CO\n                      <jats:sub>2<\/jats:sub>\n                      emissions, achieving an up to 75% reduction per treatment course. This is primarily due to decreased patient travel and electricity consumption at the linac. Extrapolated globally, these changes offer further potential to mitigate climate change.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-025-02419-7","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T01:44:31Z","timestamp":1750124671000},"page":"115-122","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Optimizing energy consumption in radiotherapy: standard vs. hypo-\/ultra-hypofractionation and becoming SMART (specific, measurable, achievable in radiotherapy)"],"prefix":"10.1007","volume":"202","author":[{"given":"Ann-Katrin","family":"Exeli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Lurtz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Agolli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7316-6422","authenticated-orcid":false,"given":"Daniel","family":"Habermehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"issue":"19","key":"2419_CR1","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1056\/NEJMra2210769","volume":"390","author":"ML Bell","year":"2024","unstructured":"Bell\u00a0ML, Gasparrini\u00a0A, Benjamin\u00a0GC (2024) Climate Change, Extreme Heat, and Health. N\u00a0Engl J Med 390(19):1793\u20131801","journal-title":"N Engl J Med"},{"issue":"12","key":"2419_CR2","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1377\/hlthaff.2020.01247","volume":"39","author":"MJ Eckelman","year":"2020","unstructured":"Eckelman\u00a0MJ et\u00a0al (2020) Health Care Pollution And Public Health Damage In The United States: An Update. Health Aff (millwood) 39(12):2071\u20132079","journal-title":"Health Aff (millwood)"},{"issue":"7","key":"2419_CR3","doi-asserted-by":"publisher","first-page":"e271","DOI":"10.1016\/S2542-5196(20)30121-2","volume":"4","author":"M Lenzen","year":"2020","unstructured":"Lenzen\u00a0M et\u00a0al (2020) The environmental footprint of health care: a\u00a0global assessment. Lancet Planet Health 4(7):e271\u2013e279","journal-title":"Lancet Planet Health"},{"key":"2419_CR4","unstructured":"Climate change. https:\/\/www.who.int\/europe\/news-room\/fact-sheets\/item\/climate-change"},{"key":"2419_CR5","unstructured":"Sustainability Commitment & Responsibility | Company | Elekta. https:\/\/www.elekta.com\/company\/sustainability\/"},{"key":"2419_CR6","doi-asserted-by":"publisher","first-page":"102652","DOI":"10.1016\/j.ejmp.2023.102652","volume":"112","author":"R Chuter","year":"2023","unstructured":"Chuter\u00a0R et\u00a0al (2023) Towards estimating the carbon footprint of external beam radiotherapy. Phys Med 112:102652","journal-title":"Phys Med"},{"issue":"6","key":"2419_CR7","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/S1470-2045(24)00148-7","volume":"25","author":"KE Lichter","year":"2024","unstructured":"Lichter\u00a0KE et\u00a0al (2024) Quantification of the environmental impact of radiotherapy and associated secondary human health effects: a\u00a0multi-institutional retrospective analysis and simulation. Lancet Oncol 25(6):790\u2013801","journal-title":"Lancet Oncol"},{"issue":"10237","key":"2419_CR8","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1016\/S0140-6736(20)30932-6","volume":"395","author":"A Murray Brunt","year":"2020","unstructured":"Murray Brunt\u00a0A et\u00a0al (2020) Hypofractionated breast radiotherapy for 1\u00a0week versus 3\u00a0weeks (FAST-Forward): 5\u2011year efficacy and late normal tissue effects results from a\u00a0multicentre, non-inferiority, randomised, phase\u00a03\u00a0trial. Lancet 395(10237):1613\u20131626","journal-title":"Lancet"},{"key":"2419_CR9","doi-asserted-by":"crossref","unstructured":"van As N et\u00a0al (2024) Radical Prostatectomy Versus Stereotactic Radiotherapy for Clinically Localised Prostate Cancer: Results of the PACE\u2011A Randomised Trial. Eur Urol","DOI":"10.1016\/j.eururo.2024.08.030"},{"issue":"5","key":"2419_CR10","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.prro.2024.04.018","volume":"14","author":"S Alcorn","year":"2024","unstructured":"Alcorn\u00a0S et\u00a0al (2024) External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 14(5):377\u2013397","journal-title":"Pract Radiat Oncol"},{"issue":"5","key":"2419_CR11","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/j.ijrobp.2022.04.039","volume":"113","author":"KE Lichter","year":"2022","unstructured":"Lichter\u00a0KE et\u00a0al (2022) Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care. Int J Radiat Oncol Biol Phys 113(5):915\u2013924","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"3","key":"2419_CR12","doi-asserted-by":"publisher","first-page":"101170","DOI":"10.1016\/j.adro.2022.101170","volume":"8","author":"RF Shenker","year":"2023","unstructured":"Shenker\u00a0RF et\u00a0al (2023) Estimating Carbon Dioxide Emissions and Direct Power Consumption of Linear Accelerator-Based External Beam Radiation Therapy. Adv Radiat Oncol 8(3):101170","journal-title":"Adv Radiat Oncol"},{"key":"2419_CR13","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/1748-717X-9-194","volume":"9","author":"R Foerster","year":"2014","unstructured":"Foerster\u00a0R et\u00a0al (2014) Spinal bone metastases in gynecologic malignancies: a\u00a0retrospective analysis of stability, prognostic factors and survival. Radiat Oncol 9:194","journal-title":"Radiat Oncol"},{"issue":"5","key":"2419_CR14","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1177\/030089161109700512","volume":"97","author":"D Habermehl","year":"2011","unstructured":"Habermehl\u00a0D et\u00a0al (2011) Defining the role of palliative radiotherapy in bone metastasis from primary liver cancer: an analysis of survival and treatment efficacy. Tumori 97(5):609\u2013613","journal-title":"Tumori"},{"issue":"9","key":"2419_CR15","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1007\/s00066-014-0651-z","volume":"190","author":"I Schlampp","year":"2014","unstructured":"Schlampp\u00a0I et\u00a0al (2014) Stability of spinal bone metastases in breast cancer after radiotherapy: a\u00a0retrospective analysis of 157 cases. Strahlenther Onkol 190(9):792\u2013797","journal-title":"Strahlenther Onkol"},{"issue":"5","key":"2419_CR16","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1016\/j.rpor.2020.07.003","volume":"25","author":"M Mayinger","year":"2020","unstructured":"Mayinger\u00a0M et\u00a0al (2020) Hypo- vs. normofractionated radiation therapy in breast cancer: A\u00a0patterns of care analysis in German speaking countries. Rep Pract Oncol Radiother 25(5):775\u2013779","journal-title":"Rep Pract Oncol Radiother"},{"key":"2419_CR17","unstructured":"CO-Bilanz M Strom | CO2-Rechner des Umweltbundesamtes. https:\/\/uba.co2-rechner.de\/de_DE\/living-pt"},{"key":"2419_CR18","unstructured":"Shelly 3EM. https:\/\/www.shelly.com\/de\/products\/shelly-3em"},{"issue":"10196","key":"2419_CR19","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/S0140-6736(19)31131-6","volume":"394","author":"A Widmark","year":"2019","unstructured":"Widmark\u00a0A et\u00a0al (2019) Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5\u2011year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase\u00a03\u00a0trial. Lancet 394(10196):385\u2013395","journal-title":"Lancet"},{"issue":"17","key":"2419_CR20","doi-asserted-by":"publisher","first-page":"1884","DOI":"10.1200\/JCO.2016.71.7397","volume":"35","author":"CN Catton","year":"2017","unstructured":"Catton\u00a0CN et\u00a0al (2017) Randomized Trial of a\u00a0Hypofractionated Radiation Regimen for the Treatment of Localized Prostate Cancer. J\u00a0Clin Oncol 35(17):1884\u20131890","journal-title":"J Clin Oncol"},{"issue":"28","key":"2419_CR21","doi-asserted-by":"publisher","first-page":"3261","DOI":"10.1200\/JCO.19.02750","volume":"38","author":"AM Brunt","year":"2020","unstructured":"Brunt\u00a0AM et\u00a0al (2020) Ten-year results of FAST: a\u00a0randomized controlled trial of 5\u2011fraction whole-breast radiotherapy for early breast cancer. J\u00a0Clin Oncol 38(28):3261\u20133272","journal-title":"J Clin Oncol"},{"issue":"11","key":"2419_CR22","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1016\/S1470-2045(13)70386-3","volume":"14","author":"JS Haviland","year":"2013","unstructured":"Haviland\u00a0JS et\u00a0al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14(11):1086\u20131094","journal-title":"Lancet Oncol"},{"key":"2419_CR23","first-page":"045OL","volume":"032","author":"German Guideline Program in Oncology (German Cancer Society, German Cancer Aid","year":"2021","unstructured":"German Guideline Program in Oncology (German Cancer Society, German Cancer Aid (2021) Interdisciplinary Evidenced-based Practice Guideline for the Early Detection, Diagnosis, Treatment and Follow-up of Breast Cancer Long. AWMF 032:45OL","journal-title":"AWMF"},{"key":"2419_CR24","unstructured":"https:\/\/de.statista.com\/statistik\/daten\/studie\/38897\/umfrage\/co2-emissionsfaktor-fuer-den-strommix-in-deutschland-seit-1990\/"},{"key":"2419_CR25","doi-asserted-by":"crossref","unstructured":"Bedir A et\u00a0al (2024) Sustainability in radiation oncology: opportunities for enhancing patient care and reducing CO(2) emissions in breast cancer radiotherapy at selected German centers. Strahlenther Onkol","DOI":"10.1007\/s00066-024-02303-w"}],"container-title":["Strahlentherapie und Onkologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-025-02419-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00066-025-02419-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00066-025-02419-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T09:06:34Z","timestamp":1770195994000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00066-025-02419-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["2419"],"URL":"https:\/\/doi.org\/10.1007\/s00066-025-02419-7","relation":{},"ISSN":["0179-7158","1439-099X"],"issn-type":[{"value":"0179-7158","type":"print"},{"value":"1439-099X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]},"assertion":[{"value":"17 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A.-K.\u00a0Exeli, A.\u00a0Lurtz, L.\u00a0Agolli, and D.\u00a0Habermehl declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}