Tracking and Reducing SF6 Usage in Radiation Oncology: A Step Toward Net-Zero Health Care Emissions

Sulfur hexafluoride (SF6) is a widely used insulating gas in medical linear accelerators (LINACs) due to its high dielectric strength, heat transfer capabilities, and chemical stability. However, its long lifespan and high Global Warming Potential (GWP) make it a significant contributor to the environmental impact of radiation oncology. SF6 has an atmospheric lifespan of 3,200 years and a GWP 23,000 times that of carbon dioxide (CO2). The amount of SF6 that can be emitted through leakage from machines is also concerning. It is estimated that the approximate 15,042 LINACs globally may leak up to 64,884,185.9 CO2-eq/year, which is the equivalent greenhouse gas emissions of 13,981 gasoline-powered passenger vehicles driven for one year. Despite being regulated as a greenhouse gas under the United Nations Framework Convention on Climate Change, SF6 use within healthcare is often exempt from regulation, and only a few states in the United States have specific SF6 management regulations. This article highlights the need for radiation oncology centers and LINAC manufacturers to take responsibility for minimizing SF6 emissions. Programs that track usage and disposal, conduct life-cycle assessments, and implement leakage detection can help identify SF6sources and promote recovery and recycling. Manufacturers are investing in research and development to identify alternative gases, improve leak detection, and minimize SF6 gas leakage during operation and maintenance. Alternative gases with lower GWP, such as nitrogen, compressed air, and perfluoropropane, may be considered as replacements for SF6. However, more research is needed to evaluate their feasibility and performance in radiation oncology. The article emphasizes the need for all sectors, including healthcare, to reduce their emissions to meet the goals of the Paris Agreement, and ensure the sustainability of healthcare and our patients. While SF6 is practical in radiation oncology, its environmental impact and contribution to the climate crisis cannot be ignored. Radiation oncology centers and manufacturers must take responsibility for reducing SF6 emissions by implementing best practices and promoting research and development around alternatives. To meet global emissions reduction goals and protect both planetary and patient health, the reduction of SF6 emissions will be essential.