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Sustainability should be integrated as a core component of quality in CT practice, achieving the perfect balance between diagnostic excellence and environmental responsibility. Several key intervention areas can be identified. CT scanners consume substantial amounts of energy, with 44\u201372% used during nonproductive idle periods. Potential mitigation strategies include protocol optimization, automated power-down systems, and infrastructure improvements. The current \u201cstore-everything\u201d approach to CT datasets generates a considerable carbon footprint; adopting \u201cdigital temperance\u201d by retaining only clinically relevant images can reduce storage-related emissions. Although workstations consume less energy than scanners, their cumulative impact can be reduced through automated policies and optimized hardware lifecycle management. Iodinated contrast media persist in aquatic ecosystems and may generate toxic by-products. Sustainable strategies include personalized weight-based dosing, multi-energy CT to reduce contrast volume, and recovery or recycling programs. Single-use consumables and the environmental costs of artificial intelligence were also addressed. A 17-item action list was developed to translate the evidence-informed recommendations into practical actions for sustainable CT practice. The transition toward environmentally responsible CT practice is an ethical and professional necessity that can no longer be delayed. This position paper identifies the key challenges and proposes practical, evidence-informed strategies to transform resource-consuming CT practices into actionable and sustainable workflows, while maintaining clinical effectiveness.<\/jats:p>","DOI":"10.1007\/s11547-026-02294-x","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:32:55Z","timestamp":1791466375000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Greening computed tomography: a position paper on environmentally responsible imaging practice from the computed tomography subspecialty section of the Italian society of radiology"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7401-1971","authenticated-orcid":false,"given":"Michaela Iva","family":"Cellina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7133-8509","authenticated-orcid":false,"given":"Laura Maria","family":"Cacioppa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5797-1129","authenticated-orcid":false,"given":"Giulio","family":"Bagnacci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5059-3305","authenticated-orcid":false,"given":"Giulia","family":"Zamboni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariateresa","family":"Del Canto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1426-2402","authenticated-orcid":false,"given":"Giovanni","family":"Foti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"La Gioia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Bruno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2696-7047","authenticated-orcid":false,"given":"Davide","family":"Ippolito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3033-9713","authenticated-orcid":false,"given":"Salvatore","family":"Silipigni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0111-1346","authenticated-orcid":false,"given":"Nicola","family":"Maggialetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6778-6894","authenticated-orcid":false,"given":"Maria Antonietta","family":"Mazzei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-9471","authenticated-orcid":false,"given":"Chiara","family":"Floridi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"2294_CR1","doi-asserted-by":"publisher","first-page":"208","DOI":"10.3390\/healthcare14020208","volume":"14","author":"GM Trovato","year":"2026","unstructured":"Trovato GM, Huser CA, Wilson L et al (2026) Preparing health professionals for environmental health and climate change: a challenge for Europe. 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Radiol Med 130:1594\u20131601","journal-title":"Radiol Med"}],"container-title":["La radiologia medica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-026-02294-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11547-026-02294-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-026-02294-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:02:11Z","timestamp":1791471731000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11547-026-02294-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":115,"alternative-id":["2294"],"URL":"https:\/\/doi.org\/10.1007\/s11547-026-02294-x","relation":{},"ISSN":["1826-6983"],"issn-type":[{"value":"1826-6983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"31 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no relevant financial interests to disclose. Michaela Cellina and Chiara Floridi are Deputy Editors of La Radiologia Medica; Laura Maria Cacioppa is a Junior Deputy Editor of La Radiologia Medica. These authors were not involved in the peer review process or in the editorial decision regarding this manuscript.","order":1,"name":"Ethics","label":"Competing of Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This manuscript is a position paper based on published evidence and expert consensus and does not involve original research on human participants or animals.Generative artificial intelligence (ChatGPT, OpenAI) was used as an assistive tool during the design and graphical refinement of the summary figures included in this manuscript. All scientific content, figure concepts, data, annotations, and final editorial decisions were conceived, verified, and approved by the authors. No artificial intelligence tools were used for data analysis, interpretation of results, or generation of the scientific conclusions.","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}