Cardiologists urged to reduce inappropriate radiation exposure

A recently published position paper from the European Society of Cardiology urges cardiologists to reduce patient radiation exposure.(Picano E et al. Eur Heart J. 2014 The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology).

 The paper outlines for the first time the radiation doses and risks of common cardiology examinations The lead author, Dr Eugenio Picano, said: “Cardiologists today, are the true contemporary radiologists. Cardiology accounts for 40% of patient radiology exposure and corresponds to more than 50 chest X-rays per person
per year.”

The ESC paper calls particularly for a reduction in the unacceptably high rate of inappropriate examinations and excessive doses. Picano added: “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.”

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

There are a total of almost 1 million PCI procedures carried out per year in Europe for dilation of coronary artery stenosis. The additional lifetime risk of fatal and non-fatal cancer for one PCI procedure 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 because their cells divide more quickly and they have more life-time during which to develop cancer.

Dr Picano said: “Even in the best centers, 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. What’s worse is that even when the need for a CT examination is appropriate, the dose level is often not systematically audited and therefore not optimized. Frequently real doses 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, it is difficult to accept that 50% of the costly and risky advanced imaging examinations cardiologists carry out are for inappropriate indications. The top priority should be to audit and cut down on useless and dangerous examinations.”

He added: “Decreased doses can best be accomplished by working with industry. Many companies are now successfully fighting a ‘dose war’. Companies who develop better ways of reducing doses will ultimately win in the future global competition. Radiological sustainability is becoming a competitive marketing advantage.”