RADIATION PROTECTION CHALLENGES IN HYBRID IMAGING FACILITIES IN RESOURCE-LIMITED SETTINGS

Hybrid imaging has become an essential component of contemporary oncologic, neurologic, and infection-related imaging, yet it's safe implementation remains uneven in resource-limited settings. The challenge is no longer only the acquisition of PET/CT, SPECT/CT or PET/MR systems, but the capacity to sustain shielding design, workload estimation, dosimetry, quality assurance, regulatory oversight, waste control and specialist staffing over the operational life of the service. International standards already provide a coherent radiation protection framework through optimization, diagnostic reference levels, workplace monitoring, quality assurance, and regulatory control. However, implementation in lower-resource environments is frequently constrained by retrofitted facilities, limited access to clinically qualified medical physicists, weak internal dosimetry infrastructure, incomplete extremity and eye-lens monitoring, delayed calibration and maintenance support, and uneven inspection capacity. These constraints interact rather than operate independently. Infrastructure limitations increase dependence on administrative controls; workforce shortages weaken optimization and incident review; regulatory gaps reduce external verification; and procurement constraints delay shielding upgrades, automation, servicing and calibration. The result is a narrower margin for sustained optimization and demonstrable compliance. This review examines these challenges from a systems perspective, with emphasis on infrastructure and shielding, workforce capacity, radiopharmaceutical handling, CT optimization, monitoring and dosimetry systems, regulatory oversight, waste management, safety culture, economic constraints and equity-related implications. It argues that radiation protection performance in hybrid imaging is determined less by scanner availability alone than by the coherence of the surrounding protection system. Priority needs include stronger workforce development, more explicit integration of hybrid imaging into national radiation protection programmes, improved monitoring and QA infrastructure, and life cycle planning for shielding, servicing, calibration and waste control.