PTCOG ECR Webinar Series · Part 3
April 28, 2025
Environmental Sustainability
& Climate Resilience
in Proton Therapy
Emerging directions in proton therapy research · Securing research funding
Presented by
Dr. Katie Lichter, MD, MPH
Principal Investigator, Lichter Lab
Dartmouth Cancer Center · Geisel School of Medicine
katie.e.lichter@dartmouth.edu
geiselmed.dartmouth.edu/lichter-lab
Why This Matters
The intersection of cancer care and climate change
🌍
#1
Public Health Threat
The WHO has declared climate change the single greatest public health challenge of the 21st century.
🏥
4–5%
of Global Emissions
The healthcare sector is responsible for ~4–5% of global greenhouse gas emissions — more than aviation.
⚡
High
Energy Intensity
Oncology is among the most energy-intensive specialties, with radiation therapy, imaging, and surgery all contributing significantly.
Cancer care is uniquely vulnerable to — and a contributor to — our changing climate. Extreme weather, wildfires, and system-level disruptions increasingly threaten patient access, safety, and outcomes.
PTCOG ECR Webinar Series — Part 3
The Lichter Lab
Dartmouth Cancer Center · Geisel School of Medicine
We study the interplay between healthcare delivery and climate change — quantifying the environmental footprint of cancer care and building more resilient, equitable, patient-centered systems.
Climate Resiliency
How climate change disrupts cancer care through wildfires, air pollution, and infrastructure strain — and how to build more resilient delivery systems.
Decarbonizing Cancer Care
Using life cycle assessment (LCA) to quantify the environmental footprint of cancer care — from imaging and radiation therapy to waste and energy use.
Patient-Centered Sustainability
Ensuring efforts to reduce environmental impact align with trust, transparency, and high-quality care — centering patient voices throughout.
Healthier Patients. Healthier Planet.
geiselmed.dartmouth.edu/lichter-lab
Carbon Footprint of PBT · PTCOG ECR Webinar Series
Our Research Portfolio
Selected projects from the Lichter Lab
Climate & Outcomes
Wildfires & Radiotherapy Compliance
Multi-site analysis of patient access and treatment adherence during U.S. wildfire events. Published in Cancer Causes & Control, 2025.
Carbon Footprint
LCA of Radiotherapy
Quantified environmental impact of radiotherapy across multiple institutions. Published in The Lancet Oncology, 2024.
Decarbonization
Hypofractionation & Emissions
Can shorter treatment courses reduce radiotherapy's carbon load? Published in BMJ, 2024 with policy implications.
Tools for Action
SUSTAIN — Breast Imaging
Integrating environmental metrics into breast imaging decisions, with future applications in screening policy and reimbursement.
Waste Reduction
Brachytherapy Waste Audit
Simple, validated toolkit for clinician-led waste reduction in brachytherapy OR settings. Published in Brachytherapy, 2025.
Climate Resilience
Winter Hazard & Telehealth
Dartmouth Living Lab: reducing extreme weather impacts on DHMC cancer patients via alerts and telehealth conversion.
Carbon Footprint of PBT · PTCOG ECR Webinar Series
PTCOG ECR Webinar Series · Part 3
Carbon Footprint of
High- and Low-Energy
Proton Beam Therapy
Chuter R, Newton-Sullivan V, Hardy M, Stolarzcyk L, Lichter K, Tanderup K
The Christie NHS · UCL Hospitals · Clatterbridge Cancer Centre · Dartmouth Cancer Center · Danish Centre for Particle Therapy
Presenting: Dr. Katie Lichter, MD MPH
🔹 Environmental Sustainability 🔹 Carbon Footprint 🔹 Proton Beam Therapy
April 28, 2025
Background & Aims
WHO: Climate change is the major public health challenge of the 21st century. Healthcare is resource-intensive with a substantial carbon footprint — yet carbon data for proton beam therapy (PBT) remains unavailable.
This study aimed to:
AIM 01
Establish the carbon footprint of four PBT services
AIM 02
Identify the largest contributing factors to guide effective carbon reduction
AIM 03
Identify similarities and differences between centres to uncover reduction opportunities
Carbon footprint of EBRT has been reported; no data existed for PBT prior to this study.
Carbon Footprint of PBT · PTCOG ECR Webinar Series
Methods
Study Design
Approach: Process-based bottom-up carbon accounting
Centres studied:
• 2 High-energy (UK)
• 1 Low-energy (UK)
• 1 High-energy (Denmark)
Building lifetime assumed: 100 years
Emissions expressed as CO₂e
Factors Measured
Note: Building energy consumption (electricity, heating, cooling) was not included in scope.
Carbon Footprint of PBT · PTCOG ECR Webinar Series
Results
1,628–4,067
kgCO₂e
High-Energy Centres (UK & Denmark)
1,138
kgCO₂e
Low-Energy Centre (UK)
Denmark: Equipment Energy Split
RF Amplifier 55%
Magnets 21%
Servers 18%
Gantries 7%
Carbon Footprint of PBT · PTCOG ECR Webinar Series
Conclusions
⚡
Energy is the dominant factor
Electricity to deliver treatment forms the largest share of measured activities across all centres.
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Key modifiers identified
Renewable energy proportion, overnight RF power shutdown, and annual patient throughput significantly affect carbon footprint.
🚶
Transport varies by site
Patient and staff travel differs significantly between centres — likely driven by public transport access and active travel options.
📊
PBT vs linac radiotherapy
Proton therapy is estimated to be significantly more carbon-intensive than linac-based EBRT on a per-patient basis.
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Pathway to carbon reduction
Low-energy centres show lower footprint; bottom-up methodology can guide targeted reduction strategies across institutions.
PTCOG ECR Webinar Series — Part 3 · Carbon Footprint of Proton Beam Therapy
Building a Diversified Funding Portfolio
Starting with pilot grants and building toward national & federal funding
Federal & Large Grants
NIH, NSF, PCORI, DOE, FEMA · Multi-year, $500K–$3M+
National Foundations & Societies
Conquer Cancer / ASCO Foundation · RSNA · Radiation Oncology Institute
Regional Foundations & Philanthropy
Couch Family Foundation · Mount Zion Health Fund · Bay Area PSR · UC Carbon Neutrality Initiative
Institutional Pilot & Early Career
Dartmouth Cancer Center · Irving Institute · UCSF EaRTH Center · UCSF DEIA
▲ Scale & Ambition
Why a Portfolio Approach?
🌱
Start with institutional pilots — they fund proof-of-concept and generate preliminary data
📄
Use publications and pilot data to compete for foundation and society grants
🤝
Build national collaborations that strengthen federal applications
🏆
Early career mechanisms (K awards, ASCO YIA, ROI) bridge pilot to federal funding
🔁
Each grant funds the next — diversification reduces risk and sustains momentum
💡
Novel topics need a champion: frame climate + cancer as a gap, not a niche
Carbon Footprint of PBT · PTCOG ECR Webinar Series
Thank You
Questions & Contact
Get in Touch
Dr. Katie Lichter, MD, MPH
katie.e.lichter@dartmouth.edu
geiselmed.dartmouth.edu/lichter-lab
Dartmouth Cancer Center
Geisel School of Medicine
With Gratitude to PTCOG & ECR
Thank you to the PTCOG Early Career Researchers community for creating this platform to connect, share science, and advance sustainable and equitable care in particle therapy. Special thanks to Dr. Chiara Paganelli and the organizing team for the invitation.
Study Collaborators — Carbon Footprint of PBT
Robert Chuter · Victoria Newton-Sullivan · Mark Hardy · Liliana Stolarzcyk · Kari Tanderup
The Christie NHS · UCL Hospitals · Clatterbridge Cancer Centre · Dartmouth Cancer Center · Danish Centre for Particle Therapy · Aarhus University
Lichter Lab — Thank you to all current members, collaborators, and alumni
Weijie Pan · Alex Conway · Alyssa Asaro · Caroline Walsh · Genevieve Silva · Sierra Silverwood · Taylor Drew · Libby Oren · Kiley Charbonneau · Rachel Sabol · Cassandra Thiel · Rob Chuter · Kari Tanderup · and many more
PTCOG ECR Webinar Series — Part 3 · April 28, 2025