IJCS | Volume 32, Nº6, November / December 2019

DOI: 10.5935/2359-4802.20190051 Introduction Cardiovascular diseases are the leading cause of global death, accounting for 31% of deaths in 2015 according to the World Health Organization (WHO). Three-quarters of these deaths occurred in low- and middle-income countries. 1 In Brazil, in 2011, there were approximately 350,000 deaths of cardiovascular origin, becoming the most important cause of death since the epidemiological transition of the 60’s. 2 The diagnosis in the early stages and the management of more severe cases are among the most important methods in the fight against cardiovascular diseases. Imaging procedures with ionizing radiation has a major role in this area. According todata frompublic outpatient health services of the BrazilianUnifiedHealth System (SUS, Sistema Único de Saúde ) (Figure 1), 3 in the last 10 years, the number of procedures performed for evaluation of cardiovascular diseases using ionizing radiation has increased (73% in nuclear medicine, 18% in interventional radiology and 12% in cardiac catheterization), except for conventional radiology, in which a decreased has been seen (-58%). These numbers, however, underestimate the number of tests performed with the general population, since diagnostic methods such as coronary angiotomography have not been incorporated into the SUS yet, and the time for inclusion of new techniques to public health care is much higher than to supplementary health care. Although the benefits are undeniable, the increased use of procedures with ionizing radiation results in a greater potential risk for patients, who may undergo 8 to 10 procedures in a single year, and for workers, who may be exposed to radiation for more than 40 hours of work a week. Studies in the United States have shown that the estimated effective dose of radiation due to medical imaging procedure for an individual increased five times from 0.6 mSv/year in 1987 to 3.2 mSv/year in 2006, surpassing the natural sources of radiation (Figure 2). 4 For instance, the exposure for medical purposes in 2006 would be comparable to 160 chest x-ray examinations per person per year. 5 The technological progress is a constant in this market, valued at billions of dollars. New methods and applications have quickly emerged, requiring that health professionals from all areas be involved in continuing education processes for the rational use of radiation. However, studies have already shown that those responsible for requesting examinations and performing procedures involving ionizing radiation have very low knowledge of the principles of radiation protection. 6,7 It is common to observe the unfamiliarity with the principles of radioprotection by health professionals and even situations of unjustifiable fear when mentioning the use of radioactive elements. Requirements of radiation protection Cardiologists and health professionals should generally be aware of the basic requirements for radiation protection (Justification, Optimization and Limitation of Individual Dose), as defined by the 639 VIEWPOINT International Journal of Cardiovascular Sciences. 2019;32(6):639-644 Mailing Address: Fernando de Amorim Fernandes Hospital Universitario Antonio Pedro - Medicina Nuclear - Av. Marquês do Paraná, 303. Postal Code: 24033-900, Niterói, Rio de Janeiro, RJ – Brazil. E-mail: fernando.fernandes2@gmail.com Challenges and Opportunities in the use of Ionizing Radiation for Cardiovascular Diseases Fernando de Amorim Fernandes, 1 A lair Augusto Sarmet Moreira Damas dos Santos, 1 A nderson de Oliveira, 2 Cláudio Tinoco Mesquita 1 Hospital Universitário Antônio Pedro, 1 Niterói, RJ – Brazil Comissão Nacional de Energia Nuclear, 2 Rio de Janeiro, RJ – Brazil Manuscript received January 07, 2018, revised manuscript November 23, 2018, accepted February 19, 2019. Cardiovascular Diseases/mortality; NuclearMedicine; Diagnostic, Imaging;/methods; Nuclear Energy; Air Ionization/radiation effects; Radiation/protection. Keywords