Cardiac CT back on the firing line

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The debate over utilization of coronary CT angiography (CCTA) continues to storm, with the highly respected Journal of the American Medical Association weighing in. Of concern to the authors of a study published this month is that some CCTA practitioners do not appear to be following the as-low-as-reasonably-achievable (ALARA) principle in the utilization of ionizing radiation.

The authors found that there was wide variability in radiation dose in 21 university hospitals and 29 community hospitals that were surveyed as part of their research. As such, they observed that many clinicians may still be unfamiliar with the magnitude of radiation exposure that is received during CCTA and with the factors that contribute to radiation dose.

In an accompanying editorial, Andrew J. Einstein, MD, PhD, of the Columbia University College of Physicians and Surgeons in New York City, noted that the findings suggest dose-reduction methods can be used in the majority of patients, which should serve as “a wake-up call to cardiac CT laboratories that do not routinely use the methods.”

As a way of helping cardiologists understand ALARA and explain the risk and benefits of imaging procedures that use ionizing radiation, the American Heart Association recently convened an expert panel to explain how radiation dose to patients is determined.

The advisory, published this month in Circulation, also issued a call to clinicians to order cardiac CT exams appropriately, as the benefit of performing these scans in patients without symptoms is still unclear.

“The bottom line is that patients need thoughtful advice from their doctors as to what heart imaging test is right for them,” said panel member Thomas Gerber, MD, PhD, a cardiologist at Mayo Clinic campus in Jacksonville, Fla. “Their doctors need to understand and be able to carefully weigh the risks and benefits of these tests in each patient's special situation.”

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Jonathan Batchelor, Web Editor