The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology

Abstract

The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging techniques. Cardiologists are responsible for a large part of the radiation exposures every person gets per year from all medical sources. Therefore, they have a particular responsibility to avoid unjustified and non-optimized use of radiation, but sometimes are imperfectly aware of the radiological dose of the examination they prescribe or practice. This position paper aims to summarize the current knowledge on radiation effective doses (and risks) related to cardiac imaging procedures. We have reviewed the literature on radiation doses, which can range from the equivalent of 1-60 milliSievert (mSv) around a reference dose average of 15 mSv (corresponding to 750 chest X-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. We provide a European perspective on the best way to play an active role in implementing into clinical practice the key principle of radiation protection that: 'each patient should get the right imaging exam, at the right time, with the right radiation dose'.

Radiation doses and estimated risk from angiographic projections during coronary angiography performed using novel flat detector

“…These steep projections involve increased radiation dose to both staff and patients. There is an increased number of interventions performed annually, (15) and contribution of radiation doses from individual projections is not widely reported in clinical setup to the extent of providing awareness among interventionalists as the study protocols may vary. However, there are studies in literature on radiation doses from various projections on anthropomorphic phantoms (16) .…”

Ką Turėtume Žinoti Apie Medicininę Apšvitą?

“…Atsitiktinių reiškinių rizika didžiausia vaikams, moterims didesnė nei vyrams, apie du kartus sumažėja vyresnio amžiaus žmonėms (3 pav.) [5,16]. Dažniausiai atliekamų rentgenografinių ir KT tyrimų metu gaunamos efektinės dozės pateiktos 2 lentelėje [7].…”

“…Nulemtųjų ir atsitiktinių JS sukeltų reiškinių palyginimas. Pritaikyta pagal BEIR VII originalius duomenis [5] 4 pav. JS nulemtasis reiškinys -odos pažeidimas, išsivystęs po pakartotinių angiografijos ir angioplastikos procedūrų, kurių metu gauta sugertoji dozė didesnė nei 20 Gy Didžiausios apšvitos dozės gaunamos KT procedūrų metu.…”

Safety and efficacy of cryoablation without the use of fluoroscopy

“…In selected arrhythmias fluoroless ablation is possible with the use of EAM system [1,2]. Because there is no safe ionizing radiation dose in 2005 Hirsfeld introduced a strategy of As Low As Reasonably Achievable (ALARA), involving the use of various techniques to reduce fluoroscopy [3].…”

“…X-rays could affect the structure of DNA whereas fluoroscopy impairs the repair processes of DNA structure. Therefore, catheter ablation with the use of EAM (without fluoroscopy) could be safer than conventional ablation [2,[9][10][11].…”