The healthcare sector contributes approximately 5% of global greenhouse gas emissions, with operating rooms (ORs) representing one of the most energy-intensive hospital environments. Their carbon footprint is enhanced by high energy consumption, disposable reliance, and variable anesthetic gases. Meanwhile, damage to infrastructure, disruption of supply networks, and higher health hazards, such as postoperative infections, are due to climate change that compromises surgical care. Notwithstanding this reciprocal interaction, surgical training rarely covers sustainability. While anesthetics, such as desflurane, have particularly high warming potential relative to other safer alternatives, ORs use more energy per square meter than any other hospital space. Still, there are few lifecycle analyses and formal instruction on waste reduction, anesthetic choices, or environmentally friendly products. Combining sustainability into surgical education mirrors the ethical responsibility of “do no harm” and provides practical advantages, including institutional credibility, patient trust development, and cost reduction. Training prospective surgeons in waste separation, low-impact anesthetic use, and leadership roles, such as “sustainability champions,” will help drive long-term change. Preparing environmentally aware surgeons in the age of the climate crisis is both a moral imperative and a practical necessity for the healthcare sector. Entrenching sustainability within surgical training represents a population-level public health intervention that can reduce healthcare-related emissions while strengthening climate-resilient health systems.

Cardiovascular toxicity has emerged as a major determinant of long-term outcomes in cancer survivors as advances in oncologic therapies continue to improve survival. Conventional cardiac surveillance strategies predominantly rely on functional and structural changes, often identifying myocardial injury after clinically significant damage has occurred. The aim of this narrative review is to critically evaluate the role of nuclear imaging in advancing precision cardio-oncology by enabling earlier, mechanism-based detection and characterization of cancer therapy-related cardiotoxicity. We summarize current clinical applications of PET- and SPECT-based imaging, examine molecular and tracer-level innovations, and discuss emerging hybrid imaging and analytic approaches relevant to individualized cardiovascular risk stratification. Current literature indicates that nuclear imaging provides unique insights into myocardial perfusion, metabolism, inflammation, and microvascular dysfunction, facilitating detection of subclinical injury across diverse anticancer therapies, including anthracyclines, targeted agents, and immune checkpoint inhibitors. By integrating molecular imaging with conventional modalities, nuclear techniques support more personalized surveillance and management strategies. This narrative review highlights nuclear imaging as an emerging complementary modality within precision cardio-oncology supporting earlier detection and risk stratification, and outlines future directions required to optimize its clinical integration and impact on cardiovascular outcomes across the cancer care continuum.