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Current cardiology guidelines assign a class of recommendation 1 for the diagnosis of chest pain to five imaging techniques based on either anatomic (coronary computed tomography angiography) or functional approaches, such as stress single-photon emission tomography, stress positron emission tomography, stress cardiovascular magnetic resonance, and stress echocardiography. The choice is left to the prescribing physician, based on local availability and expertise. However, the five techniques differ substantially in their cost, applicability based on patient characteristics, long-term risk, and environmental impact. The average European immediate cost ranges from 50 to 1000 euros. The radiation exposure ranges from 0 to 500 chest x-rays. The environmental footprint ranges from 3 to 300 kg of carbon dioxide emissions equivalent. The ethical code of the World Medical Association 2021 recommends the responsible use of healthcare money by doctors, with the minimization of potential damage to patients and the environment. The Euratom law 2013/directive 59 reinforces the justification principle and the optimization principle for medical radiation exposures, with the legal responsibility of both the referrer and the practitioner. A small cost, a minimal long-term risk, and a modest carbon emission per examination multiplied by billions of tests per year become an unaffordable economic burden in the short-term, significant population damage to public health over the years, and impacts on climate change in decades. The cardiology community may wish to adopt a more sustainable practice with affordable, radiation-optimized, and carbon-neutral practices for the benefit of patients, physicians, payers, and the planet., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The aim was to track the exposure to radiation workers in six nuclear medicine examinations. A number of 180 patients were recruited and external exposure was measured. Patients had undergone cardiac stress and rest, bone scan, I-131 therapy, Gallium-67 and FDG PET/CT imaging. The average dose received due to cardiac stress and rest were 20.4 ± 5.0 and 16.0 ± 3.8 μSv per patient, respectively, whereas for bone scan, Ga-67, FDG and I-131 therapy, the average dose was 6.1 ± 2.5, 6.0 ± 1.4, 11.1 ± 2.2 and 4.1 ± 2.6 μSv per patient. The patient-to-staff dose coefficients were on average 0.051 ± 0.009, 0.042 ± 0.010, 0.034 ± 0.016, 0.039 ± 0.021, 0.052 ± 0.012, 0.094 ± 0.021 μSv m2/MBq h for stress, rest, bone, I-131, Ga-67 and FDG reported post-administration, respectively. Patient injection and setup for imaging represent a high percentage of the total dose received by staff. The information revealed is able to revise local measures, safety standards, and could help further in dose optimization and minimal exposure to occupationally exposed worker in nuclear medicine laboratories., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Medical exposure, the main source of artificial exposure, shows an increasing trend in the last years, manifested both by increasing the number of examinations with ionising radiation and by increasing the patient dose level. Annual results obtained for medical exposure to ionising radiation based on the data collected from Romanian hospitals are useful for the update of the national database and optimisation of diagnostic procedures in radiology and nuclear medicine. Medical exposure level is expressed in terms of annual collective dose and is evaluated from annual frequencies and the average effective dose per procedure for different types of radiological and nuclear medicine procedures. The Romanian hospitals reported during 2012 a number of 5,505,792 radiological examinations and 17,088 diagnostic procedures of nuclear medicine. Based on the data reported, the average effective doses and their contributions to the collective dose were evaluated. The main contributions to the collective dose of the radiological procedures are registered for CT abdomen and pelvis region, followed by thorax CT and head CT examinations. The next positions are fluoroscopic examination of the thorax and gastrointestinal disease and radiographic examination of the lumbar spine and thorax, which in spite of their low effective dose have an important contribution to the collective dose due to the large number of examinations. For nuclear medicine procedures, major contributions to collective dose are given by bone scintigraphy, followed by PET-CT and thyroid scintigraphy., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

New imaging technologies utilising X-rays and radiopharmaceuticals have developed rapidly. Clinical application of computed tomography (CT) has revolutionised medical imaging and plays an enormous role in medical care. Due to technical improvements, spatial, contrast and temporal resolutions have continuously improved. In spite of significant reduction of CT doses during recent years, CT is still a dominating source of radiation exposure to the population. Combinations with single photon emission computed tomography (SPECT) and positron emission tomography (PET) and especially the use of SPECT/CT and PET/CT, provide important additional information about physiology as well as cellular and molecular events. However, significant dose contributions from SPECT and PET occur, making PET/CT and SPECT/CT truly high dose procedures. More research should be done to find optimal activities of radiopharmaceuticals for various patient groups and investigations. The implementation of simple protocol adjustments, including individually based administration, encouraged hydration, forced diuresis and use of optimised voiding intervals, laxatives, etc., can reduce the radiation exposure to the patients. New data about staff doses to fingers, hands and eye lenses indicate that finger doses could be a problem, but not doses to the eye lenses and to the whole body., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The purpose of this study is to evaluate the effectiveness of personal radiation shields currently worn in hospital and other diagnostic environments. This study was performed with four different radioisotopes; (18)F, (99m)Tc, (124)I and (131)I. (18)F results showed a decrease in dose with 0.5-mm Pb shielding but the reduction provided does not warrant its use clinically. (124)I testing demonstrated that dose enhancement can occur in greater shield thicknesses. PET isotope (124)I can be adequately shielded using 0.25-mm Pb equivalent aprons but any higher thickness increase the wearer's dose. As a result more shielding does not always equal more protection. The (131)I test showed that no dose reduction occurred, even when tested with up to 1.25-mm Pb equivalent shielding. Novel radioisotopes being used in the laboratory and clinic should be individually tested as each requires specific shielding testing., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The purpose of this work is to evaluate the radiation exposure to nuclear medicine (NM) staff in the two positron emission tomography-computed tomography centres in Serbia and to investigate the possibilities for dose reduction. Dose levels in terms of Hp(10) for whole body and Hp(0.07) for hands of NM staff were assessed using thermoluminescence and electronic personal dosemeters. The assessed doses per procedure in terms of Hp(10) were 4.2-7 and 5-6 μSv, in two centres, respectively, whereas the extremity doses in terms of Hp(0.07) in one of the centres was 34-126 μSv procedure(-1). The whole-body doses per unit activity were 17-19 and 21-26 μSv GBq(-1) in two centres, respectively, and the normalised finger dose in one centre was 170-680 μSv GBq(-1). The maximal estimated annual whole-body doses in two centres were 3.4 and 2.0 mSv, while the corresponding extremity dose in the later one was 45 mSv. Improvements as introduction of automatic dispensing system and injection and optimisation of working practice resulted in dose reduction ranging from 12 up to 67 %., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Ionising radiation is increasingly used for the treatment of cancer, being the source of a considerable fraction of the medical irradiation to patients. With the increasing success rate of cancer treatments and longer life expectancy of the treated patients, the issue of secondary cancer incidence is of growing concern, especially for paediatric patients who may live long after the treatment and be more susceptible to carcinogenesis. Also, additional imaging procedures like computed tomography, kilovoltage and megavoltage imaging and positron emission tomography, alone or in conjunction with radiation therapy, may add to the radiation burden associated with the risk of occurrence of secondary cancers. This work has been based on literature studies and is focussed on the assessment of secondary doses to healthy tissues that are delivered by the use of modern radiation therapy and diagnostic imaging modalities in the clinical environment., (© The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)