Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction

Eisenberg, Mark J.; Afilalo, Jonathan; Lawler, Patrick R.; Abrahamowicz, Michał; Richard, Hugues; Pilote, Louise

doi:10.1503/cmaj.100463

Cited by 159 publications

(99 citation statements)

References 46 publications

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“…In a retrospective analysis of >19 000 patients surviving an index PCI, Spoon et al found a 33% decline in cardiac death at 5 years after PCI, but a 57% increase in noncardiac death, primary attributable to cancer, which accounted for 26.2% of deaths (4.3% from hematologic malignancies) during 5 years of follow‐up after PCI 24. For men and women aged at least 60 years at the time of the first PCI, excess risk of potentially fatal cancers attributable to radiation ranged from 0.4% to 4% 26, 27. The number of PCIs is a risk factor for subsequent development of lung cancer28 and leukemia,23 and contributes to the majority of the significant radiological exposure of the adult cardiology patient 29.…”

Section: Discussionmentioning

confidence: 99%

Stress Echocardiography Positivity Predicts Cancer Death

Carpeggiani

Landi

Michelassi

et al. 2017

JAHA

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BackgroundStress echocardiography (SE) predicts cardiac death, but an increasing share of cardiac patients eventually die of cancer. The aim of the study was to assess whether SE positivity predicts cancer death.Methods and ResultsIn a retrospective analysis of prospectively acquired single‐center, observational data, we evaluated 4673 consecutive patients who underwent SE from 1983 to 2009. All patients were cancer‐free at index SE and were followed up for a median of 131 months (interquartile range 134). We separately analyzed predetermined end points: cardiovascular, cancer, and noncardiovascular, noncancer death, with and without competing risk. SE was positive in 1757 and negative in 2916 patients; 869 cardiovascular, 418 cancer, and 625 noncardiovascular, noncancer deaths were registered. The 25‐year mortality was higher in SE‐positive than in SE‐negative patients, considering cardiovascular (40% versus 31%; P<0.001) and cancer mortality (26% versus 17%; P<0.01). SE positivity was a strong predictor of cancer (cause‐specific hazard ratio 1.19; 95% confidence interval, 1.16–1.73; P=0.05) and cardiovascular mortality (1.18; 95% confidence interval, 1.03–1.35; P=0.02). Fine–Gray analysis to account for competing risk gave similar results. Cancer risk diverged after 15 years, whereas differences were already significant at 5 years for cardiovascular risk.Conclusions SE results predict cardiovascular and cancer mortality. SE may act as a proxy of the shared risk factor milieu for cancer or cardiovascular death.

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Section: Discussionmentioning

confidence: 99%

Stress Echocardiography Positivity Predicts Cancer Death

Carpeggiani

Landi

Michelassi

et al. 2017

JAHA

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“…A recent review of low dose ionizing radiation from procedures done after myocardial infarction suggests that there is an increased risk of cancer as result of these procedures. 54 CT of the chest typically gives a lower dose than myocardial perfusion imaging (7 vs 15.6 milli-Sieverts), but is similar to that of a cardiac catheterization or CT of the abdomen. 55 If a patient needs a chest CT for diagnostic purposes, calculation of lung volume may be a useful adjunct.…”

Section: Does It Make Any Difference How You Measure Lung Volumes?mentioning

confidence: 99%

What Is the Clinical Value of Lung Volumes?

Ruppel

2012

Respir Care

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Lung volumes are considered part of a complete pulmonary function test, but their value for enhancing clinical decision making is unknown. Unlike spirometry and diffusing capacity of the lung for carbon monoxide (D LCO ), which do contribute to confirming or excluding a diagnosis, there are few clear indications when lung volumes are discriminatory. Confirming "restriction" when vital capacity (VC) or FVC is reduced is perhaps the most important. A restrictive pattern can have many etiologies, and clinicians often use VC or FVC as a primary index of lung volume. This makes "physiologic" sense because, in healthy subjects, and in patients with true restriction, VC comprises most of the total lung capacity (TLC). Mixed obstruction-restriction and the nonspecific pattern (ie, reduced FVC and FEV 1 , normal FEV 1 /FVC and TLC) require measuring TLC to confirm the underlying physiology. In obesity, VC and TLC may remain within normal limits, but functional residual capacity (FRC) can exponentially decrease. Increased lung volumes, particularly residual volume (RV), are commonly observed in airway obstruction. TLC may be normal, but is frequently increased in the late stages of COPD. Hyperinflation and air-trapping are terms commonly used to reflect these changes, but are not well standardized. The variability of lung volumes related to degree of obstruction suggests that measuring gas-trapping may be needed to monitor therapy. Changes in inspiratory capacity, RV, or FRC may be important gauges of response to bronchodilators or other hyperinflation-reducing therapies. How lung volumes are measured may be important, especially in patients who have moderate or severe airway obstruction. Body plethysmography is often considered more accurate than gas dilution methods in the presence of obstruction. However, the differences between techniques are not completely understood. Newer approaches such as computed tomography, although not suitable for routine testing, may help to delineate the true underlying physiology.

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“…The results of this study has concerned as the number of the fetographies have increased up to 2.2 fold during past two years. Although the individual risk of developing radiation-induced cancer following fetography was relatively low, but due to increasing the number of patients undergoing X-ray examinations, as well as reports of a substantial fraction of patients undergoing multiple and repeated X-ray examinations (12,13), the cumulative dose and following radiation risk could be significant. Therefore it was essential that followed a safety guideline for imaging of the pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Current Status of the Fetography: Preventing of the Future Radiation Induced Cancer

Zabihzadeh

Karami

2016

Iran J Cancer Prev

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Background: Fetography has named the radiography of the fetus in utero. Due to the potential risk of radiation-induced cancers and other malignant effects, this procedure has avoided and has completely replaced by ultrasonography. However it has observed that this invasive procedure has still followed in some clinical departments. Objectives: The aim of this study was to assess the current status of the fetography and its prevalence as an un-recommended diagnostic procedure in teaching hospitals of Ahvaz, Iran. Methods: The radiology and ultrasonography reception systems of two teaching hospitals of Ahvaz have investigated to identify pregnant patients who has undergone fetal presentation imaging (cephalic or breech) between 21 March 2013 and 21 March 2015. Results: In general 3741 pregnant women who have undergone fetal-presentation imaging during two past years have identified. There was significant statistically differences between X-ray and ultrasonography examinations (2528 vs. 1213; P value < 0.05), as those have accounted for 67.5% and 32.5% of the performed examinations, respectively. Women younger than 30 years, who were more sensitive to radiation, accounted for 51.2% of the X-ray examinations. The number of fetographies has increased as much as 2.2 fold during 2013 to 2015. Discussion: Women of the investigated hospital have received avoidable fetal irradiation due to fetography then it was a reason for concern. Ultrasonography should be the first-line imaging modality for pregnant women, especially in the case of fetalpresentation.

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Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction

Abstract: See related commentary by Mercuri and colleagues, page 413

Cited by 159 publications

References 46 publications

Stress Echocardiography Positivity Predicts Cancer Death

Stress Echocardiography Positivity Predicts Cancer Death

What Is the Clinical Value of Lung Volumes?

Current Status of the Fetography: Preventing of the Future Radiation Induced Cancer

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