A Systematic Review of Integrated Risk Indicators for PET Radiopharmaceutical Production: Methodologies and Applications

This systematic review examines the methodologies and applications of integrated risk indicators in positron emission tomography (PET) radiopharmaceutical production, focusing on occupational, technological, and environmental risks. Conducted in accordance with PRISMA 2020 guidelines and utilizing the Ryyan software 2023 for article screening, the review synthesizes findings from 70 studies published between 2020 and 2025 in English and Spanish, including articles, conference papers, and reviews. The review was registered on PROSPERO (CRD420251078221). Key disciplines contributing to risk assessment frameworks include environmental science, occupational health and safety, civil engineering, mining engineering, maritime safety, financial/economic risk, and systems engineering. Predominant risk assessment methods identified are probabilistic modeling (e.g., Monte Carlo simulations), machine learning (e.g., neural networks), multi-criteria decision-making (e.g., AHP and TOPSIS), and failure mode and effects analysis (FMEA), each offering strengths, such as uncertainty quantification and systematic hazard identification, alongside limitations like data dependency and subjectivity. The review explores how frameworks from other industries can be adapted to address PET-specific risks, such as radiation exposure to workers, equipment failure, and waste management, and how studies integrate these factors into unified risk indicators using weighted scoring, probabilistic methods, and fuzzy logic. Gaps in the literature include limited stakeholder engagement, lack of standardized frameworks, insufficient real-time monitoring, and under-represented environmental risks. Future research directions propose developing PET-specific tools, integrating AI and IoT for real-time data, establishing standardized frameworks, and expanding environmental assessments to enhance risk management in PET radiopharmaceutical production. This review highlights the interdisciplinary nature of risk assessment and the critical need for comprehensive, tailored approaches to ensure safety and sustainability in this field.