Cardiologists feel responsible for reducing inappropriate imaging

A European Society of Cardiology position paper, published last week in the European Heart Journal, urges cardiologists to take efforts to reduce inappropriate radiation exposure.

"Cardiologists today, are the true contemporary radiologists. Cardiology accounts for 40 percent of patient radiology exposure and equals more than 50 chest X-rays per person per year," lead author Eugenio Picano of the Institute of Clinical Physiology in Pisa, Italy, said in an announcement. "Unfortunately, radiation risks are not widely known to all cardiologists and patients ... this creates a potential for unwanted damage that will appear as cancers, decades down the line. We need the entire cardiology community to be proactive in minimizing the radiological friendly fire in our imaging labs."

The article outlined the radiation doses and risks of the most common cardiology examinations. For example, the authors wrote, computed tomography (CT), percutaneous coronary intervention (PCI), cardiac electrophysiology and nuclear cardiology can deliver an average dose equivalent to 750 chest X-rays per procedure; all are procedures performed frequently in all cardiology in- and out-patient departments.

To that end, Picano said, many are performed inappropriately, and with excessive doses of radiation.

"Even in the best centers, and even when the income of doctors is not related to number of examinations performed, 30 to 50 percent of examinations are totally or partially inappropriate according to specialty recommendations," he said. "When examinations are appropriate, the dose is often not systematically audited and therefore not optimized, with values which are two to 10 times higher than the reference, expected dose."

The authors also pointed out that X-rays used in radiology and nuclear medicine are "proven class 1 carcinogens," and that cardiologists must ensure that every effort is made to perform "the right imaging exam, with the right dose, to the right patient."

Picano added that policymakers should work to audit and reduce "useless and dangerous" examinations, and that healthcare providers should be working with device makers to come up with improved methods of reducing dose.

"Companies who develop better ways of reducing doses will win in the future global competition," he said. "Radiological sustainability is becoming a competitive marketing advantage."

"The smart patient, and the smart cardiologist, cannot be afraid of radiation since it is essential and often life saving," he added. "But they must be very afraid of radiation negligence or unawareness. This paper will help to make cardiology wards and laboratories a safer place for patients and doctors through an increase of radiation awareness and knowledge."

To learn more:
- read the position paper in the European Heart Journal
- see the announcement

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