Climate change has widespread impacts on patient health, affecting most body organs. At the same time, healthcare systems are a large contributor to global greenhouse emissions and other environmental harms, yet very few such organizations have taken concrete steps to encourage sustainable practices. Radiology should drive sustainable change because we are one of the most energy intensive and one of the fastest growing specialties within healthcare. While most current efforts focus on decreasing carbon emissions and other impacts of individual modalities, radiologists ought to broaden their perspectives. Incentives and education for trainees and clinicians to reduce unnecessary imaging is paramount to decrease radiology's environmental impact. A three-pronged approach guides change: increasing sustainability of essential studies, leveraging education to decrease low-value imaging, and expanding equitable access to preventative (high-value) imaging services. If radiology takes the lead, other specialties may follow.