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ESC cautions against inappropriate radiation exposure
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A new position paper from the European Society of Cardiology advises cardiologists to avoid performing tests involving ionizing radiation if the needed information can be obtained with a non-ionizing test of comparable accuracy.
If a test utilizing ionizing radiation must be performed, lowest dose possible is recommended, and cardiologists should be aware of the factors that modulate dose, Eugenio Picano, MD, PhD, and colleagues wrote on behalf of the ESC’s Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology.
“Cardiologists today are the true contemporary radiologists. Cardiology accounts for 40% of patient radiology exposure and equals more than 50 chest X-rays per person per year,” Picano stated in a press release. “Unfortunately, radiation risks are not widely known to all cardiologists and patients and this creates a potential for unwanted damage that will appear as cancers, decades down the line. We need the entire cardiology community to be proactive in minimizing the radiological friendly fire in our imaging labs.”
Importance of terminology
Many of the paper’s recommendations concern terminology. Communication of doses and risks is based on a highly technical language, so “as a result, both patients and doctors often are unaware of what they are doing, in terms of doses and radiation risks,” the authors wrote.
Instead, the paper recommends translating all dose information into millisievert, equivalent number of chest radiographs and equivalent periods of natural background radiation. For example, PCI has a mean effective dose of 15 mSv, which translates to an equivalent of 750 chest X-rays and 6.3 years of natural background radiation. It also recommends that after the examination, the actual dose be filed in the patient’s and laboratory’s records and the information be given to the patient upon request.
Specific thresholds of acceptable and unacceptable exposure for certain procedures are not recommended “because of the numerous sources of variability.”
The authors advise that cardiology departments make radioprotection a strong priority, as it is “the most effective shielding to enhance the safety of patients, doctors and staff.”
New technology, protocols minimize doses
According to the paper, strategies to minimize dose in nuclear cardiology include:
- Use of 99mTc (technetium) sestamibi or tetrofosmin agents as preferred radiopharmaceuticals in SPECT.
- Use of a protocol in which stress imaging is performed first and rest imaging is not performed in patients with normal stress images, which can decrease radiation exposure by 75%.
- Elimination of dual radioisotope testing, which has an “unacceptably high” effective dose of approximately 30 mSv.
- Use of SPECT detectors with cadmium zinc telluride technology.
In CT scanning, manufacturers have taken steps to reduce radiation doses, so cardiac CT angiography with a gated acquisition of a single frame in end-diastole can now be performed with an effective dose of <2 mSv, Picano and colleagues wrote.
In interventional cardiology and radiophysiology, the introduction of non–radiology-based methods of cardiac mapping and the use of co-registration of CT or cardiac MR images have the potential to reduce radiation doses, according to the paper.
Cardiologists should also keep in mind that for any given radiation exposure, the cancer risk is higher in women than in men by approximately 38%, and higher in children than in adults by threefold or fourfold, the authors wrote.
Disclosure: See the full position paper for the authors’ relevant financial disclosures.
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