Editorial point of viewIssues regarding radiation dosage of cardiac nuclear and radiography procedures
Section snippets
Radiation dosage from cardiac diagnostic tests
The issue of radiation dosage is confusing to many clinicians. Part of this confusion is related to the terminology, especially given that radiation-related quantities and effects can be expressed in many different ways and competing terms have been used inconsistently in the past. Radiation dose or absorbed radiation dose refers to the amount of energy deposited by ionizing radiation per unit mass in a patient’s body as a result of exposure. The units of absorbed dose are rads or millirads in
What are the harmful effects of low-dose radiation?
The recent BEIR VII report concluded that the current scientific evidence is most consistent with the hypothesis that there is a linear, no-threshold dose-response relationship between the exposure to ionizing radiation and the development of cancer in human beings.1 Thus, according to this model, even relatively low doses of radiation increase the statistical risk of a malignancy developing in a patient. The BEIR committee estimate of lifetime risks of cancers was principally deduced from the
Risk-benefit of diagnostic studies
The risk-benefit relationship of radiographic imaging studies is normally very favorable, even for the procedures associated with higher doses. For example, heart disease is much more common in older adults, and therefore cardiac tests and procedures are performed much more frequently in mature adults than they are in young persons. At the Mid America Heart Institute, Kansas City, Mo, the majority of patients undergoing cardiac catheterization procedures and nuclear stress tests are over 65
Modulating radiation dosage
Although the estimated effects of low doses of ionizing radiation are controversial, it is intuitive and a basic principal of radiation safety that the dosage should be kept as low as reasonably achievable. To accomplish this goal, physicians should be thoroughly familiar with the dosimetry and the technical aspects of these diagnostic tests. There are several logical ways in which the radiation dosage of cardiac diagnostic tests can be lessened. For example, for myocardial perfusion imaging
What should the cardiac imaging community do?
The BEIR VII report calls for future research in the fields of radiation effects, including epidemiologic studies in high-risk populations who receive radiation for diagnostic tests. For example, the BEIR VII report acknowledges a “need to organize worldwide consortia that would use similar methods in data collection and follow-up. These consortia should record delivered doses and technical data from all x-ray or isotope-based imaging approaches including CT.” Currently in the United States,
Acknowledgment
We express our gratitude to Dr Michael Stabin for critical review of the manuscript.
The authors have indicated they have no financial conflicts of interest.
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