Cardiac imaging: Why patients must be partners in the decision-making process

Earlier this year, a European Society of Cardiology position paper--published in the European Heart Journal--urged cardiologists to be more proactive in reducing inappropriate radiation exposure to their patients during cardiology procedures.

According to the paper's lead author, Eugenio Picano, cardiologists now are "true contemporary radiologists," particularly when one considers the fact that cardiology represents 40 percent of patient radiology exposure.

The problem, he maintains, is that not all cardiologists--as well as their patients--are thoroughly aware of the radiation risks associated with these procedures.

Now, an article published in the Journal of the American College of Cardiology recommends measures physicians can take to enhance the safety and effectiveness of such procedures and to make their patients partners in the decision to undergo these exams

According to a group of physicians led by Andrew Einstein of Columbia University, an imaging team should:

  • Avoid administering tests that involve radiation exposure to patients with inappropriate indications
  • Adhere to quality standards
  • Maintain a database of radiation dosimetric safety metrics for all patients undergoing imaging procedures involving exposure to radiation; and
  • Follow clinical practice guidelines in performing the tests

What's more, in keeping with the idea that imaging should be more "patient-centric," procedures that involve higher levels of radiation exposure should be subject to shared-decision making between patients and their providers, Einstein and his colleagues say. For example, imaging procedures with effective radiation doses that exceed 20 mSv should occasion the ordering physician to either have a detailed discussion with their patient about the projected cancer risks associated with radiation exposure, or obtain written informed consent from the patient.

And, according to the recommendations, any communication between the provider and patient should use "simple and clear language to communicate" such risks.

When a provider orders a cardiac imaging test for the right reason, the benefits from the test are bound to outweigh the risks associated with radiation. Yet, it's clear that patients are going to have concerns about radiation-related risks, particularly with the amount of media attention being paid to the issue. And, as lay persons, the chances are that patients aren't going to completely understand why a certain test is being appropriately suggested.

These recommendations from Einstein and his colleagues are welcome. As Lewis Wexler of the Department of Radiology at Stanford University said in an accompanying editorial to Einstein's recommendations, patients "deserve" a conversation that addresses concerns about imaging and radiation, and provides them with evidence in an easily understandable way that can help them participate in decisions to undergo these tests. - Mike (@FierceHealthIT)

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