IJCS | Volume 32, Nº6, November / December 2019

643 Practice) methodology was developed to guide quality audits of nuclear medicine practices and audit groups were trained in a number of countries. A research with the experience and the impact in a BrazilianHospital was published recently. 12 Coordinated researches such as the INCAPS study are also part of global initiatives to improve practices. It investigated the application of eight good practices in 308 Nuclear Medicine Services in 65 countries. Only 45%of them showed a satisfactory index. 13 Subsequently, a similar study performed in healthcare centers in Brazil reported an even lower number, 25% with satisfactory index, and a correlation between a higher level of qualification of the service and presence of an interdisciplinary team, resulting inmore appropriate and precise indications of tests involving ionizing radiation. 14 International alliances supported by WHO and the IAEA, such as the Image Gently, ImageWisely, EuroSafe, LatinSafe, Canada Safe Imaging, ArabSafe, AfroSafe and others, have made relevant contributions in the standardization of procedures, information production and dissemination of radiation protection. Knowledge as one of the pillars of radiological safety The global impact and the growth of cardiovascular diseases, the greater number of medical applications, and consequently, of the radiation doses to patients and workers, the constant technological advances and the complexity regarding the use of ionizing radiations for health care make it clear that the understanding of the concepts and responsibilities is critical for the continued growth of the benefits and mitigation of risks and potential effects. The Bonn Call for Action 10 actions are a step towards this direction and the consensus of the American College of Cardiology and four other societies is even more direct suggesting that specialists have the responsibility to understand the basics of radiation protection first to make appropriate choices and after to conduct optimized procedures. The publication also suggests that this topic should be part of the training and certification of physicians. 5 In Brazil, there are similar initiatives to international ones in radiology, but not in nuclear medicine. In many cases, concerns about radiation protection are still restricted to the legal obligations established by the CNEN and the Brazilian Health Regulatory Agency. The safe future of the field is linked to the recognition of the value of multidisciplinary teams and of the quality of professional training. However, there are no specific certifications for radiology technicians and technologists, pharmacists and nurses in Brazil. On the other hand, medical physicists are considered specialists in nuclear medicine or in radiology when approved for this title by the Brazilian Association of Medical Physics. However, these professionals usually do not get support from the community for the certification. In addition, despite legal difficulties, the maintenance of expertise certificates should be tied to the continuing education of specialists. Finally, patients’ care is the main objective and the involvement of patients in medical and therapeutic decisions, considering accepted risks and benefits has increased, and needs to be fostered with knowledge. Author contributions Conception and design of the research: Fernandes AF, Mesquita CT. Acquisition of data: Fernandes AF. Analysis and interpretation of the data: Fernandes AF, Mesquita CT. Writing of the manuscript: Fernandes AF. Critical revision of themanuscript for intellectual content: Fernandes AF, Mesquita CT, Oliveira A, Santos AASMD. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. Fernandes et al. Ionizing radiation for cardiovascular diseases Int J Cardiovasc Sci. 2019;32(6):639-644 Viewpoint