It is imperative that the entire medical imaging sector acts collectively and decisively to reduce its own environmental impact and prepare for the current and future effects of the climate crisis. The Radiology R7 meeting convened in Venice, Italy, on October 10-13, 2024 to discuss environmental sustainability and other key issues facing radiology and the patients served by medical imaging. Radiology R7 delegates agree that collaborative action is urgently needed to transform radiology systems to be climate-resilient, equitable, low-carbon, and sustainable. This special report highlights priorities and outlines a framework for environmentally sustainable radiology, centered on eight collaborative action areas. A health-centered response reinforces the role of radiologists as physicians, emphasizes the opportunity for medical imaging to improve health, and will be essential to engage key partners in climate action. Effective leadership and governance are needed to ensure that radiology services are accessible, equitable, affordable, high quality and sustainable. Collaboration and partnership are essential to achieve meaningful change. Health equity should be prioritized to increase global access to high quality radiology services while minimizing the environmental impact. Multiple climate response pathways should be implemented in parallel including mitigation strategies to reduce the use of energy, finite resources and waste and adaptation strategies to build resilience to the effects of climate change. Innovation and research are necessary to develop, validate, and implement sustainable solutions. Finally, knowledge sharing, education, and training are needed to disseminate information on actions toward environmentally sustainable radiology practices. We all have a role to play and must work together to achieve these aims quickly by identifying the problem, setting goals, implementing a plan, measuring impact, sharing results, and celebrating successes.