Cardiologists Urged to Reduce Patient Radiation Exposure

Cardiologists should actively reduce the amount of radiation exposure among their patients who undergo cardiac imaging techniques, according to a position paper issued by the European Society of Cardiology (ESC) and published in the European Heart Journal.

There are many benefits of cardiac imaging, but cardiologists are not always aware of the radiation dose of the examinations prescribed or practiced, the authors wrote. The paper provides a European perspective on the best way for cardiologists to play an active role in implementing into clinical practice the key principle of radiation protection, ensuring that patients get the “right imaging exam, at the right time, with the right radiation dose.”

"Cardiologists today are the true contemporary radiologists,” lead author Dr Eugenio Picano, FESC, said in a release. “Cardiology accounts for 40 percent of patient radiology exposure and equals more than 50 chest X-rays per person per year."

The authors listed the doses and risks of the most common cardiology exams that included computed tomography (CT), percutaneous coronary intervention (PCI), cardiac electrophysiology, and nuclear cardiology, which deliver a dose equivalent to 750 chest X-rays (with wide variation from 100 to 2,000 chest X-rays) per procedure.

Currently, there are almost one million PCIs for dilatation of coronary artery stenosis performed in Europe annually. According to the researchers, the additional lifetime risk of fatal and non-fatal cancer for one PCI ranges from one in 1000, to one in 100 for a healthy 50-year-old man. Risks are 1.38 times higher in women and four times higher in children. Their higher risk is due to quicker cell division and children have more years in which to develop cancer.

"Even in the best centers, and even when the income of doctors is not related to number of examinations performed, 30 to 50 percent of examinations are totally or partially inappropriate according to specialty recommendations,” said Picano. Doses are also often higher than they need be, two to 10 times higher than the reference, expected dose. Lower doses are possible and can be done by working with companies that can develop more efficient ways of delivering the radiation doses, he noted.

The authors suggested that patients be provided with the procedures’ estimated dose before the exam and the actual dose received after, if requested. This could become a legal requirement through the European Directive Euratom law 97/43, but application of the law is being delayed by technical and practical difficulties.

Patients can also play a role in decreasing radiation exposure by not requesting advertised screening tests and asking their physicians about radiation dose when tests are recommended.  

"The smart patient and the smart cardiologist cannot be afraid of radiation since it is essential and often life saving,” Picano added. “But they must be very afraid of radiation negligence or unawareness. This paper will help to make cardiology wards and laboratories a safer place for patients and doctors through an increase of radiation awareness and knowledge."