ESC to cardiologists: Bone up on radiation’s risks

Radiation in cardiovascular imaging is not the enemy; uninformed and unwise use is. So proposed authors of a European Society of Cardiology (ESC) position paper published Jan. 9 in the European Heart Journal.

“Cardiologists are responsible for about 40% of the entire cumulative ED [effective dose] to the U.S. population from all medical sources excluding radiotherapy,” wrote Eugenio Picano, MD, of the Institute of Clinical Physiology in Pisa, Italy, and colleagues. “In addition, the occupational radiation exposure of interventional cardiologists and cardiac electrophysiologists can be two to three times higher than that of diagnostic radiologists, and their exposure has increased steadily in the past few decades.”

The position paper reflects the findings of the ESC’s cardiovascular imaging, PCI and electrophysiology associations. The authors researched and wrote the report to raise awareness about medical radiation and provide recommendations for responsible and safe use of imaging and interventional techniques.

Many physicians underestimate radiation doses for the exams they order, the authors contended, and in cardiology as much as a third of tests may be partially or wholly inappropriate. This unnecessarily exposes patients to potentially high accumulative amounts of radiation with downstream risks such as cancer.

“We need the entire cardiology community to be proactive in minimizing the radiological friendly fire in our imaging labs,” Picano said in a release.

The position paper reviewed dose and risk in nuclear medicine, CT, interventional cardiology and electrophysiology. It lists patient and professional exposure levels and offers guidance on minimizing exposure. It also highlights imaging protocols for vulnerable patient populations such as children and pregnant women.

The authors took aim at jargon-filled informed consent forms that fail to clearly convey doses and risks to patients and physicians. They recommend presenting specific reference dose in tabular form and in a figure if possible; storing the actual dose in patient and laboratory records; and informing the patient of the actual dose after the test if he or she requests it.

“Effective dose has the advantage that it is not modality-specific and can be cumulated between different imaging modalities over time,” they wrote. “This simple consent process will gently force the doctor to learn what he/she already should know, enabling him/her to make more responsible choices.”   

The authors emphasized that cardiovascular imaging is a useful technology and that the benefit outweighs the risk of exposure when the test is appropriate and performed with adequate safeguards. “A smart cardiologist cannot be afraid of the essential and often life-saving use of medical radiation, but must be very afraid of radiation unawareness,” they concluded.