Diagnostic Imaging Services
 
The services of diagnostic imaging encompass a wide spectrum of clinical applications, which includes from the diagnosis and monitoring of common diseases in population with high incidence such as respiratory diseases, injuries, digestive conditions, control of the gestation, or mammary pathologies among others, to more complex diseases such as cancer, AIDS, disorders of the central nervous system or cardiovascular diseases

The effectiveness of these services depends enormously on the quality of the health care providers. The existence of well trained professionals, as well as the implementation of quality assurance programs, is essential in order to achieve the main objective of a well-oriented clinical diagnosis with optimal levels of radiation for the patients.
 
Radiation Therapy Services
 
Cancer is the second cause of death in the Region, and its incidence is expected to increase considerably in the developing countries.   It has been noted internationally that Radiation therapy will continue to be key in cancer treatment in the next decades. Its curative function is particularly important in several pathologies such as cervical and uterine cancers, head and neck, and breast or prostate, without forgetting its palliative function and cost effectiveness in all the pathologies.

The effectiveness and safety of the treatments depend on many factors including the correct diagnosis and stage, the adequate therapeutic decision, the precise localization of the tumor, or planning and delivery of the treatment. This motivates the need for implementing comprehensive quality assurance programs in order to improve the effectiveness of the treatments and radiation safety for the patients.

Technologies in Radiomedicine

The high costs associated with Diagnostic Imaging and Radiotherapy services, both in the initial investment and in its projections of operation, oblige to careful planning and management of its development.   Aspects such as cost of purchase and maintenance of the technology, geographical distribution, human resources, and frequency of use should be carefully considered.

The decision to incorporate radiomedicine technology should always be preceded by a thorough study of feasibility or preinvestment study that justifies it, in particular for the high technologies such as the computerized tomography, the magnetic resonance imaging, positron emission tomography, linear accelerators, or brachytherapy of high dose rate.
 
Radiation Protection and Safety

The advantages and the risks involved in the use of radiation, either medical, industrial or research applications, are well known. The high potential health risk implied in its use makes it necessary to adopt special measures for the radiation protection of patients, workers, public, and environment.

Six intergovernmental organizations with mandates in the matter, among them PAHO, reached a consensus in The International Basic Safety Standards for the Protection against Ionizing Radiation and for the Safety of the Sources of Radiation (the BSS), endorsed by the XXIV Pan American Sanitary Conference (resolution CSP24.R9), that establish, among other technical requirements, the need for having national regulatory authorities.   We are now in a stage of revision of the BSS whose new edition will compliment the established standards.

From among all the exposures of the population to artificial radiation, the medical exposure is by far the major contributor, and continues its rising trend worldwide.  The future impact of such increase of radiation dose to the population is very difficult to predict. As a consequence, it is necessary to adopt special measures for patient radiation protection to evaluate and control the doses of radiation that the medical sources provide. 

Several radiation accidents and over-exposures of patients have occurred in the Region, some of them with causalities.   This eventuality in addition to the current international situation of possible terrorist acts using radioactive material requires improving the preparation and response to radiological emergencies in the Region.

WHO has under way an international project on the health risk of the electromagnetic fields. In the Region, there is a growing concern while the regulations and knowledge in this sphere are still very heterogeneous from country to country.