COMMENTARY

Rita Redberg on Excess Use of Radiation Imaging Tests

Rita F. Redberg, MD

Disclosures

February 20, 2014

In This Article

Action Points

The takeaways for us as a profession are really similar for primary care doctors, cardiologists, and radiologists, as well as emergency department physicians, in that we need to evaluate every test -- and in particular imaging tests that use ionizing radiation -- such that the benefits of this test will outweigh the risks, and we've considered alternatives, done a really careful history and physical examination, and think the tests will not just give us information. Because of course, all tests will give us information, but it will give us information that we couldn't have gotten from a nonionizing test or a history, and it will give us information that actually leads to a treatment that will lead to better outcomes, and a treatment that we couldn't have arrived at without the use of an imaging test.

It's estimated currently that 1 in 4 Americans gets a CT scan every year (including repeat scans).[5] I think in ways we don't even realize, the use of CT scans in particular (and certainly we're doing a lot of nuclear cardiology tests, too) has increased.

Specific to nuclear cardiology, one suggestion that we had was triggered by a survey done for the American Society of Nuclear Cardiology by Andrew Einstein and Leslee Shaw and colleagues, looking at ways to easily reduce radiation exposure from commonly used myocardial perfusion imaging tests.[6] One way is to do stress-first tests. The survey they did suggested that only 7% of all of the tests currently done were stress-first tests, but certainly there's potential to do more and that change alone can reduce radiation exposure from myocardial perfusion imaging by 50%.

The other changes we suggest are to use as low a radiation dose as possible or to choose techniques that use the lowest radiation dose for necessary scans, and then of course really thinking about which scans are necessary. The appropriateness criteria that have been developed by both the American College of Cardiology[7] and the American College of Radiology[8] have been really helpful in this regard as well.

In conclusion, I wrote this editorial because I think there are things that we can all do, starting immediately, that would significantly reduce cancer risk from radiation exposure in the United States and worldwide. Those things are first, be more aware of the radiation risk associated with the tests that we order in our offices or in the hospital. Second, when ordering tests, consider the risks and benefits of this test, and be convinced that we need this test with radiation in order to get the information necessary for that patient. Finally, when ordering necessary tests, do it in a way that reduces the radiation exposure for that patient.

With those fairly simple steps, we can make a huge difference in reducing cancer risk from radiation exposure in the United States. Thank you.

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