Caution is the eldest child of wisdom.

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Justine Cadet,
News Editor
Nineteenth century novelist and dramatist Victor Hugo is most well known for humanizing the plight of the French Revolutionists, and despite empathizing with the rebellious, he advised caution above all other virtues. A present-day struggle is currently roiling cardiac imaging over the utilization of coronary CT angiography (CCTA): both sides claim the mantle of patient advocate; however, those who discourage its preventive use are urging caution.

On Monday, an advisory panel, convened by the American Heart Association (AHA), published CCTA recommendations in Circulation, suggesting that the risk of potentially harmful effects from ionizing radiation is low at the dose levels used in cardiac imaging exams; however, because the exact level of risk is unknown, people without symptoms of heart disease should think carefully about undergoing the exams.

On the heels of these cautionary recommendations, Tuesday's edition of JAMA included a study that sought to evaluate the magnitude of CCTA's radiation dose in daily practice, along with factors contributing to radiation dose and the use of currently available strategies to reduce radiation dose in nearly 2,000 patients. The researchers found that the use of CCTA has the potential to expose patients to high doses of radiation, and methods available to reduce it are not frequently used.

To counteract the potential risks, the authors suggested that physicians and technologists who perform CCTA obtain further education on dose-saving strategies; and advised caution in over-recommending the exams.

Despite these trepidations, a market research report this week found that the adoption of 64-slice CT scanners by U.S. cardiology practices has more than doubled over the past two years.

Also of note this week, after more than a year of being cautious, an FDA advisory panel unanimously recommended prasugrel as an alternative treatment for patients with acute coronary syndrome.

On these topics, or any others, feel free to contact me.

Justine Cadet, News Editor