Cumulative patient effective dose in cardiology

Abstract

Medical radiation from X-rays and nuclear medicine is the largest non-natural (man-made) source of radiation exposure in Western countries. The aim of this study was to assess the individual cumulative effective dose in patients admitted to our cardiology ward. We collected a cumulative radiological history from a structured questionnaire and access to hospital records in 50 consecutive adult patients (36 males; age, 66.7+/-10.8 years) admitted to the Institute of Clinical Physiology in Pisa. The cumulative effective dose was assessed as an indicator of stochastic risk of cancer. We derived the effective dose for each individual examination from the Medical Imaging Guidelines of the European Commission (2001). On average, each patient underwent a median of 36 examinations (interquartile range, 23-46). The median cumulative effective dose was 60.6 mSv. Three types of procedures were responsible for approximately 86% of the total collective effective dose: (i) arteriography and interventional cardiology (12% of examinations, 48% of average dose per patient); (ii) nuclear medicine (5% of examinations, 21% of average dose per patient); and (iii) CT (4% of examinations, 17% of average dose per patient). The median estimated extra risk of cancer was approximately 1 in 200 exposed subjects. In conclusion, the average contemporary cardiological patient is exposed to a significant cumulative effective dose from diagnostic and therapeutic interventions. It is important to log cumulative dose for each patient at the time of each examination. Every effort should be made to justify the indications and to optimize the doses.

Stress Echocardiography Positivity Predicts Cancer Death

“…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. In a previous study in a much larger population of 16 311 in‐hospital cardiac patients admitted to our institution over the past 40 years, we showed that the cumulative estimated effective radiation dose from cardiologic testing was a significant predictor of cancer death and for (fatal and nonfatal) cancer onset 28…”

Evaluation of coronary angiographic projections to balance the clinical yield with the radiation risk

“…This objective is particularly important in cardiac imaging as, although the absolute radiation dose from an individual coronary angiography procedure might be relatively low, patients with cardiac disease often undergo multiple imaging procedures which can lead to substantial cumulative exposures [2].…”

Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure

“…(14)(15)(16) We can indirectly estimate the effective radiation doses for the present study by converting the DAP values in the present study using the recommended conversion factor for cardiac ablation procedures. (17) When this conversion was done, we obtained an estimated effective radiation dose of 3.1 millisieverts (mSv) for patients with AVNRT who underwent ablation using CF.…”

“…Although these estimates are difficult to objectively quantify and interpret, any effective method to minimise radiation exposure is likely beneficial for both patients and medical staff. (13,14) Such considerations are important, especially when the advantages of NFS are weighed against its apparent excessive cost. The present study was not without limitations.…”