Purpose of Review <p>This review aims to systematically evaluate the environmental impacts of key cardiac imaging modalities, identify current operational practices that disproportionately contribute to the carbon footprint, and propose evidence-based strategies to optimize imaging protocols for climate sustainability while preserving diagnostic accuracy and patient outcomes.</p> Recent Findings <p>There has been a significant increase in the utilization of cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT), cardiac positron emission tomography (PET) and single-photon emission computed tomography (SPECT) which comes with an unacknowledged cost to our environment with respect to carbon footprint, energy consumption and barriers to safe disposal of contrast agents. However, we are yet to incorporate environmental sustainability metrics in our major diagnostic guidelines.</p> Summary <p>In CMR, protocol refinements such as limiting the number of localizing images, using specific faster mapping sequence and optimizing protocols such that cine SSFP can be moved into the contrast wait period can lower energy use and scan time. PET/SPECT/CT sustainability is enhanced by stress-first protocols, tailoring CT dose to clinical need, and promoting circular manufacturing of scanners and cyclotron components. In echocardiography, the major opportunity lies in redesigning ultrasound contrast agent packaging to enable multi-dose use, minimizing single-use plastic waste. Collectively, climate-conscious imaging is achievable by powering down devices, integrating the use of sustainability index, utilizing green data storage centers and optimizing protocols and machines both of the acquisition and vendor side. Future research should quantify the environmental savings of these strategies and support scalable implementation across diverse practice settings.</p> Graphical Abstract <p></p>