{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T04:03:58Z","timestamp":1793419438590,"version":"4.5.0"},"reference-count":54,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"funder":[{"DOI":"10.13039\/100007270","name":"University of Michigan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007270","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001252","name":"Mount Zion Health Fund Inc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001252","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","thegreenjournal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Radiotherapy and Oncology"],"published-print":{"date-parts":[[2026,1]]},"DOI":"10.1016\/j.radonc.2025.111161","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T21:07:05Z","timestamp":1758575225000},"page":"111161","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":4,"special_numbering":"C","title":["The climate and health impact of U.S. radiation therapy: estimating greenhouse gas emissions, DALYs, and potential of hypofractionation"],"prefix":"10.1016","volume":"214","author":[{"given":"Katie E.","family":"Lichter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7054-3130","authenticated-orcid":false,"given":"Alyssa","family":"Asaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2056-3308","authenticated-orcid":false,"given":"Muhammad Mustafa","family":"Qureshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minh Tam","family":"Truong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Parekh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Witztum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirjiv","family":"Anand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve S.","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9879-1290","authenticated-orcid":false,"given":"Trevor J.","family":"Royce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas G.","family":"Zaorsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surbhi","family":"Grover","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May","family":"Abdel-Wahab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakaria El","family":"Kouzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherif M.","family":"Gadoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Thiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0595-3682","authenticated-orcid":false,"given":"Matthew J.","family":"Eckelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5067-7077","authenticated-orcid":false,"given":"Nicolas","family":"Prionas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue S.","family":"Yom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Mohamad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.radonc.2025.111161_b0005","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.ijrobp.2022.04.039","article-title":"Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care","volume":"113","author":"Lichter","year":"2022","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.radonc.2025.111161_b0010","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.brachy.2022.06.002","article-title":"Environmentally sustainable brachytherapy care","volume":"21","author":"Lichter","year":"2022","journal-title":"Brachytherapy"},{"key":"10.1016\/j.radonc.2025.111161_b0015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0157014","article-title":"Environmental Impacts of the U.S. Health Care System and Effects on Public Health","volume":"11","author":"Eckelman","year":"2016","journal-title":"PLoS One"},{"key":"10.1016\/j.radonc.2025.111161_b0020","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1377\/hlthaff.2020.01247","article-title":"Health Care Pollution and Public Health damage In the United States: an Update","volume":"39","author":"Eckelman","year":"2020","journal-title":"Health Aff (Millwood)"},{"key":"10.1016\/j.radonc.2025.111161_b0025","series-title":"Cancer Facts & Figures 2025","author":"American Cancer Society","year":"2025"},{"key":"10.1016\/j.radonc.2025.111161_b0030","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/S1470-2045(15)00222-3","article-title":"Expanding global access to radiotherapy","volume":"16","author":"Atun","year":"2015","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0035","doi-asserted-by":"crossref","first-page":"193","DOI":"10.7150\/ijms.3635","article-title":"Cancer and Radiation Therapy: current advances and Future Directions","volume":"9","author":"Baskar","year":"2012","journal-title":"Int J Med Sci"},{"key":"10.1016\/j.radonc.2025.111161_b0040","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1002\/cncr.21324","article-title":"The role of radiotherapy in cancer treatment","volume":"104","author":"Delaney","year":"2005","journal-title":"Cancer"},{"key":"10.1016\/j.radonc.2025.111161_b0045","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/S1470-2045(24)00148-7","article-title":"Quantification of the environmental impact of radiotherapy and associated secondary human health effects: a multi-institutional retrospective analysis and simulation","volume":"25","author":"Lichter","year":"2024","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0050","doi-asserted-by":"crossref","unstructured":"Lichter KE, Charbonneau K, Sabbagh A, et al. Evaluating the Environmental Impact of Radiation Therapy Using Life Cycle Assessments: A Critical Review. Int J Radiat Oncol. Published online May 11, 2023. doi:10.1016\/j.ijrobp.2023.04.036.","DOI":"10.1016\/j.ijrobp.2023.04.036"},{"key":"10.1016\/j.radonc.2025.111161_b0055","unstructured":"Climate Change Statement- American Society for Radiation Oncology (ASTRO). ASTRO. Accessed November 7, 2024. https:\/\/www.astro.org\/patient-care-and-research\/climate-change-statement."},{"key":"10.1016\/j.radonc.2025.111161_b0060","doi-asserted-by":"crossref","unstructured":"Using hypofractionation to decarbonise radiation oncology | The BMJ. Accessed July 25, 2025. https:\/\/www.bmj.com\/content\/386\/bmj-2023-079072.short.","DOI":"10.1136\/bmj-2023-079072"},{"key":"10.1016\/j.radonc.2025.111161_b0065","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1016\/S0140-6736(20)30932-6","article-title":"Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial","volume":"395","author":"Brunt","year":"2020","journal-title":"Lancet"},{"key":"10.1016\/j.radonc.2025.111161_b0070","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1016\/S1470-2045(13)70386-3","article-title":"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","volume":"14","author":"Haviland","year":"2013","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0075","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/S1470-2045(06)70699-4","article-title":"Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial","volume":"7","author":"Owen","year":"2006","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0080","unstructured":"Patient transit and radiotherapy: Cost-effectiveness approach to environmental health savings. | Journal of Clinical Oncology. Accessed July 25, 2025. https:\/\/ascopubs.org\/doi\/abs\/10.1200\/JCO.2025.43.16_suppl.e23146."},{"key":"10.1016\/j.radonc.2025.111161_b0085","first-page":"17","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J Clin"},{"key":"10.1016\/j.radonc.2025.111161_b0090","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/S0140-6736(08)60348-7","article-title":"The UK Standardisation of Breast Radiotherapy (START) trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial","volume":"371","author":"START Trialists\u2019 Group","year":"2008","journal-title":"Lancet Lond Engl"},{"key":"10.1016\/j.radonc.2025.111161_b0095","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1245\/s10434-007-9747-3","article-title":"The National Cancer Data Base: a Powerful Initiative to Improve Cancer Care in the United States","volume":"15","author":"Bilimoria","year":"2008","journal-title":"Ann Surg Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0100","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1021\/es504719g","article-title":"Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States","volume":"49","author":"Thiel","year":"2015","journal-title":"Environ Sci Technol"},{"key":"10.1016\/j.radonc.2025.111161_b0105","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/j.jcrs.2017.08.017","article-title":"Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility","volume":"43","author":"Thiel","year":"2017","journal-title":"J Cataract Refract Surg"},{"key":"10.1016\/j.radonc.2025.111161_b0110","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.scitotenv.2012.03.006","article-title":"Life cycle assessment perspectives on delivering an infant in the US","volume":"425","author":"Campion","year":"2012","journal-title":"Sci Total Environ"},{"key":"10.1016\/j.radonc.2025.111161_b0115","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/ajcp\/aqab021","article-title":"Life Cycle Greenhouse Gas Emissions of Gastrointestinal Biopsies in a Surgical Pathology Laboratory","volume":"156","author":"Gordon","year":"2021","journal-title":"Am J Clin Pathol"},{"key":"10.1016\/j.radonc.2025.111161_b0120","unstructured":"Database. ecoinvent. Accessed September 3, 20https:\/\/ecoinvent.org\/database\/."},{"key":"10.1016\/j.radonc.2025.111161_b0125","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.scitotenv.2014.11.048","article-title":"Disability adjusted life year (DALY): a useful tool for quantitative assessment of environmental pollution","volume":"511","author":"Gao","year":"2015","journal-title":"Sci Total Environ"},{"key":"10.1016\/j.radonc.2025.111161_b0130","doi-asserted-by":"crossref","unstructured":"Vicini FA, Winter K, Freedman GM, et al. NRG RTOG 1005: A Phase III Trial of Hypo Fractionated Whole Breast Irradiation with Concurrent Boost vs. Conventional Whole Breast Irradiation Plus Sequential Boost Following Lumpectomy for High Risk Early-Stage Breast Cancer. Int J Radiat Oncol. 2022;114(3, Supplement):S1. doi:10.1016\/j.ijrobp.2022.07.2320.","DOI":"10.1016\/j.ijrobp.2022.07.2320"},{"key":"10.1016\/j.radonc.2025.111161_b0135","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1016\/S0140-6736(23)00619-0","article-title":"Dose-escalated simultaneous integrated boost radiotherapy in early breast cancer (IMPORT HIGH): a multicentre, phase 3, non-inferiority, open-label, randomised controlled trial","volume":"401","author":"Coles","year":"2023","journal-title":"Lancet"},{"key":"10.1016\/j.radonc.2025.111161_b0140","unstructured":"Protocol. Accessed February 18, 2025. https:\/\/www.nrgoncology.org\/Clinical-Trials\/Protocol\/nsabp-b-51-rtog-1304?filter=nsabp-b-51-rtog-1304."},{"key":"10.1016\/j.radonc.2025.111161_b0145","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.adro.2020.03.013","article-title":"Breast Radiation Therapy under COVID-19 Pandemic Resource Constraints-Approaches to Defer or Shorten Treatment from a Comprehensive Cancer Center in the United States","volume":"5","author":"Braunstein","year":"2020","journal-title":"Adv Radiat Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0150","doi-asserted-by":"crossref","first-page":"S309","DOI":"10.1016\/j.annonc.2024.08.174","article-title":"231O Locoregional hypo vs normofractionated RT in early breast cancer: 5 years results of the HypoG-01 phase III UNICANCER trial","volume":"35","author":"Rivera","year":"2024","journal-title":"Ann Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0155","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.1016\/j.ijrobp.2023.08.029","article-title":"Patient-Reported and Toxicity results from the FABREC Study: a Multicenter Randomized Trial of Hypofractionated vs. Conventionally-Fractionated Postmastectomy Radiation Therapy after Implant-based Reconstruction","volume":"117","author":"Wong","year":"2023","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.radonc.2025.111161_b0160","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1016\/j.ijrobp.2024.07.002","article-title":"A Randomized Trial of Hypofractionated Post-Mastectomy Radiation Therapy (PMRT) in Women with Breast Reconstruction (RT CHARM, Alliance A221505)","volume":"120","author":"Poppe","year":"2024","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.radonc.2025.111161_b0165","article-title":"Increase in Hypofractionated Radiation Therapy among patients with Invasive Breast Cancer or Ductal Carcinoma In Situ: who is Left behind? Pract","author":"Booth","year":"2024","journal-title":"Radiat Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0170","doi-asserted-by":"crossref","first-page":"e545","DOI":"10.1016\/S1470-2045(24)00407-8","article-title":"Radiotherapy and theranostics: a Lancet Oncology Commission","volume":"25","author":"Abdel-Wahab","year":"2024","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0175","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1016\/j.ijrobp.2014.05.135","article-title":"Long-term results of RTOG 0236: a phase II Trial of Stereotactic Body Radiation Therapy (SBRT) in the Treatment of patients with Medically Inoperable Stage I Non-Small Cell Lung Cancer","volume":"90","author":"Timmerman","year":"2014","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.radonc.2025.111161_b0180","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/S1470-2045(16)30102-4","article-title":"Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial","volume":"17","author":"Dearnaley","year":"2016","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0185","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S0140-6736(19)31131-6","article-title":"Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer: 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial","volume":"394","author":"Widmark","year":"2019","journal-title":"Lancet"},{"key":"10.1016\/j.radonc.2025.111161_b0190","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1056\/NEJMoa0906260","article-title":"Long-Term results of Hypofractionated Radiation Therapy for Breast Cancer","volume":"362","author":"Whelan","year":"2010","journal-title":"N Engl J Med"},{"key":"10.1016\/j.radonc.2025.111161_b0195","doi-asserted-by":"crossref","first-page":"S153","DOI":"10.1016\/j.ijrobp.2024.07.2170","article-title":"Hypofractionated Radiotherapy for Prostate Cancer: Preliminary results from the HypoAfrica Study","volume":"120","author":"Joseph","year":"2024","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.radonc.2025.111161_b0200","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.3332\/ecancer.2023.1508","article-title":"Challenges and opportunities for implementing hypofractionated radiotherapy in Africa: lessons from the HypoAfrica clinical trial","volume":"17","author":"Olatunji","year":"2023","journal-title":"Ecancermedicalscience"},{"key":"10.1016\/j.radonc.2025.111161_b0205","article-title":"Benefits of adopting Hypofractionated Radiotherapy as a Standard of Care in Low-and Middle-Income Countries","volume":"8","author":"Kraus","year":"2022","journal-title":"JCO Glob Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0210","article-title":"Hypofractionation in Breast Cancer Radiotherapy across World Bank Income groups: results of an International Survey","volume":"9","author":"Mushonga","year":"2023","journal-title":"JCO Glob Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0215","doi-asserted-by":"crossref","unstructured":"Patel TA, Jain B, Vapiwala N, et al. Trends in Utilization and Medicare Spending on Short-Course Radiation Therapy for Breast and Prostate Cancer: An Episode-Based Analysis From 2015 to 2019. Int J Radiat Oncol. Published online December 8, 2023. doi:10.1016\/j.ijrobp.2023.11.043.","DOI":"10.1016\/j.ijrobp.2023.11.043"},{"key":"10.1016\/j.radonc.2025.111161_b0220","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.ijrobp.2016.11.009","article-title":"The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer","volume":"97","author":"Boero","year":"2017","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.radonc.2025.111161_b0225","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.semradonc.2024.07.004","article-title":"Green Horizons in Oncology: a Blueprint for Environmentally Sustainable Radiation Therapy Facilities","volume":"34","author":"Baniel","year":"2024","journal-title":"Semin Radiat Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0230","first-page":"00174","article-title":"Tracking and reducing SF6 Usage in Radiation Oncology: a step Toward Net-Zero Health Care Emissions","volume":"S1879\u20138500","author":"Lichter","year":"2023","journal-title":"Pract Radiat Oncol Published online July 4"},{"key":"10.1016\/j.radonc.2025.111161_b0235","article-title":"The relationship between travel distance for treatment and outcomes in patients undergoing radiation therapy: a systematic review","volume":"9","author":"Silverwood","year":"2024","journal-title":"Adv Radiat Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0240","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1097\/COC.0000000000000332","article-title":"Evaluating Candidacy for Hypofractionated Radiation Therapy, Accelerated Partial Breast Irradiation, and Endocrine Therapy after Breast Conserving Surgery: a Surveillance Epidemiology and end results (SEER) analysis","volume":"41","author":"Manyam","year":"2018","journal-title":"Am J Clin Oncol"},{"key":"10.1016\/j.radonc.2025.111161_b0245","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ijrobp.2022.04.054","article-title":"Evaluating the Short-term Environmental and Clinical Effects of a Radiation Oncology Department\u2019s Response to the COVID-19 Pandemic","volume":"115","author":"Cheung","year":"2023","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.radonc.2025.111161_b0250","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.2105\/AJPH.2017.303846","article-title":"Estimated Global Disease Burden from US Health Care Sector Greenhouse Gas Emissions","volume":"108","author":"Eckelman","year":"2018","journal-title":"Am J Public Health"},{"key":"10.1016\/j.radonc.2025.111161_b0255","unstructured":"Health care\u2019s response to climate change: a carbon footprint assessment of the NHS in England - The Lancet Planetary Health. Accessed December 12, 2023. https:\/\/www.thelancet.com\/journals\/lanplh\/article\/PIIS2542-5196(20)30271-0\/fulltext?ref=tageins.at."},{"key":"10.1016\/j.radonc.2025.111161_b0260","unstructured":"Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation | Cancer Causes & Control. Accessed July 25, 2025. https:\/\/link.springer.com\/article\/10.1007\/s10552-024-01949-2."},{"key":"10.1016\/j.radonc.2025.111161_b0265","unstructured":"OpenAI. (2024).ChatGPT(v. 4) [AI language model]. Available fromhttps:\/\/chatgpt.com."},{"key":"10.1016\/j.radonc.2025.111161_b0270","unstructured":"SankeyMATIC. (n.d.).SankeyMATIC[Sankey diagram generator]. Retrieved [October 28th, 2024] fromhttps:\/\/sankeymatic.com\/."}],"container-title":["Radiotherapy and Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0167814025051655?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0167814025051655?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:30:19Z","timestamp":1786537819000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0167814025051655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":54,"alternative-id":["S0167814025051655"],"URL":"https:\/\/doi.org\/10.1016\/j.radonc.2025.111161","relation":{},"ISSN":["0167-8140"],"issn-type":[{"value":"0167-8140","type":"print"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The climate and health impact of U.S. radiation therapy: estimating greenhouse gas emissions, DALYs, and potential of hypofractionation","name":"articletitle","label":"Article Title"},{"value":"Radiotherapy and Oncology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.radonc.2025.111161","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"111161"}}