Cardiologists advised to reduce radiation exposure

Cardiologists urged to reduce inappropriate radiation exposure, Medical Press 8 Jan 14 Cardiologists are being urged to reduce patient radiation exposure in a European Society of Cardiology (ESC) position paper which outlines doses and risks of common cardiology examinations for the first time. The paper is published today in the European Heart Journal.

Lead author, Dr Eugenio Picano, FESC, said: “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.”

He added: “Unfortunately, radiation risks are not widely known to all 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 minimising the radiological friendly fire in our imaging labs.”

The paper lists doses and risks of the most common cardiology examinations for the first time. Computed tomography (CT), percutaneous coronary intervention (PCI), cardiac electrophysiology and nuclear cardiology deliver a dose equivalent to 750 chest X-rays (with wide variation from 100 to 2,000 chest X-rays) per procedure. These procedures are performed daily in all cardiology in- and out-patient departments, usually more than one procedure per admission. They are used for all forms of cardiac disease, from congenital to heart failure, but more intensively and frequently for ischemic heart disease.

PCI for dilation of coronary artery stenosis totals almost 1 million procedures per year in Europe. The additional lifetime risk of fatal and non-fatal cancer for one PCI ranges from 1 in 1000, to 1 in 100 for a healthy 50 year old man. Risks are 1.38 times higher in women and 4 times higher in children. Children’s higher risk is because their cells divide more quickly and they have more years in which to develop cancer.

Dr Picano said: “Even in the best centres, and even when the income of doctors is not related to number of examinations performed, 30 to 50% of examinations are totally or partially inappropriate according to specialty recommendations. When examinations are appropriate, the dose is often not systematically audited and therefore not optimised, with values which are 2 to 10 times higher than the reference, expected dose.”

The paper aims to reduce the unacceptably high rate of inappropriate examinations and reduce excessive doses in appropriate examinations. Dr Picano said: “In these hard economic times, 50% of the costly and risky advanced imaging examinations we do are for inappropriate indications. Politicians’ top priority should be to audit and cut down on useless and dangerous examinations.”…….http://medicalxpress.com/news/2014-01-cardiologists-urged-inappropriate-exposure.html

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