JACC: Radiation exposure worth the risk?

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Previously, patient radiation exposure from CT scans were compared to similar doses of radiation received by Hiroshima atomic bomb survivors. Today, with a push for dose reduction technology to hamper these concerns, dose exposure has significantly decreased, but fears still remain.

Leslee J. Shaw, PhD, of the Emory University School of Medicine in Atlanta, and colleagues, in an editorial featured in the Journal of the American College of Cardiology: Cardiovascular Imaging, said that while radiation concerns are still present, often benefits of imaging scans for cardiac patients outweigh the risks.

“For a cardiac imaging procedure, a focus solely on the risk of induced cancer can lead to imbalanced decision-making and disregard for the incremental detection of cardiac risk from procedures such as CT, SPECT or PET,” the authors wrote.

According to Shaw et al, evidence of the effective use of cardiac imaging procedures is scant and more of a focus should lie in revamping the decision making process for recommending CT, SPECT or PET scans to patients.

The researchers recommended the following four steps:
  • Devise reliable measurement methods;
  • Develop a standard approach for extrapolating high- to low-dose exposure situations;
  • Develop methods for estimating radiation-induced risk in imaging cohorts who have an elevated cancer risk; and
  • Create meaningful effective dose categories that are risk-based and relevant to cardiac imaging.

The authors said that the American College of Radiology has put forth a radiation risk level (RRL) to help minimize dose exposure and eliminate redundant and preventable testing.

“Because most patients undergoing cardiac imaging are symptomatic, the risk of heart disease is high, so the radiation risk is far less than the benefits gained,” said Shaw. “If we can identify appropriate patients for testing, then we can provide more intensive treatment and the patient will likely have better outcomes.”

The authors recommended that better information be put forth to patients to educate them on the benefits and dangers of cardiac CT exams.

“Our vision for the future includes a multi-faceted approach to devise high-quality evidence that may be clearly assimilated by patients and physicians alike,” the authors wrote.

Part of this approach, the authors said, is creating education websites for patients that inform the public on decision making and the risks and benefits of cardiac imaging.

Additionally, the authors recommend that clinical tests compare the risks of dose from nonionizing versus ionizing radiation procedures.

“Given the sizable population at risk for cardiovascular disease, such evidence would greatly contribute to reducing cardiac morbidity and mortality without disrupting projected national statistics for cancer incidence,” the authors concluded.