Pioneering Sustainability In Nuclear Medicine: A Comprehensive Exploration Of Environmental, Economic, And Social Dimensions In Global Healthcare Practice

The integration of sustainable development principles into nuclear medicine marks a significant shift toward healthcare that is environmentally responsible, economically practical, and socially fair. This scoping review takes a detailed look at global strategies for sustainability in nuclear medicine, following the Joanna Briggs Institute (JBI) methodology to evaluate evidence from 36 peer-reviewed studies published between 1978 and 2024. Findings show that nuclear medicine departments around the world are actively adopting sustainable practices across three main areas: environmental sustainability (highlighted in 83.3% of studies, focusing on reducing waste, improving energy efficiency, and optimizing radiopharmaceutical use), economic sustainability (covered in 33.3% of studies, emphasizing cost-effectiveness and resource management), and social sustainability (featured in 25% of studies, exploring healthcare equity and workforce development). Geographically, Spain leads research efforts in this area, followed by notable contributions from Saudi Arabia and Brazil. When it comes to medical procedures, studies show equal focus on therapeutic applications (33.3%) and combined diagnostic-therapeutic approaches (33.3%), with strong attention to SPECT imaging (18.1%) and growing interest in PET/CT sustainability (9.7%). Hospital-based programs (63.9%) dominate compared to non-hospital settings (22.2%), highlighting the greater ability of hospitals to implement wide-ranging sustainability initiatives. "Critical quality assessment reveals that 88.9% of included studies represent Level 4-5 evidence according to the Oxford Centre for Evidence-Based Medicine framework, with only one randomized controlled trial identified. This concentration of lower-level evidence limits the strength of causal inferences, particularly regarding quantitative claims of environmental impact reduction." Environmental actions have achieved measurable impact, such as a 64% reduction in CO2 emissions per procedure through waste reduction and a 30% decrease in energy use by optimizing protocols. However, significant gaps remain in understanding the broader economic impacts and the social implications of these initiatives. Overall, this review shows that nuclear medicine is actively advancing sustainable development goals, while also pointing out the need for more research and stronger implementation in key areas.