Expert Consensus on Ionizing Radiation in CV Imaging

Megan Brooks

May 04, 2018

Cardiovascular (CV) procedures that use ionizing radiation are being performed with increasing frequency, which has led the American College of Cardiology (ACC) in collaboration with several organizations to issue an expert consensus document to promote safe and effective use of ionizing radiation.

Collaborating with the ACC on the document are the American Society of Nuclear Cardiology, Heart Rhythm Society, Mended Hearts, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Computed Tomography, and Society of Nuclear Medicine and Molecular Imaging.

The document was published online May 2 in the Journal of the American College of Cardiology.

In a preamble to the 69-page document, James Januzzi Jr, MD, chair of the ACC Task Force on Expert Consensus Decision Pathways, says the increase in ionizing radiation–based CV procedures has led to greater radiation exposure to patients and potentially clinicians.

"Although the clinical benefit of these procedures is substantial, there is concern about the implications of medical radiation exposure both to patients and to medical personnel," writes Januzzi.

"The ACC leadership concluded that it is important to provide practitioners with an educational resource that assembles and interprets the current radiation knowledge base relevant to cardiovascular imaging procedures that employ ionizing radiation. By applying this knowledge base, cardiovascular practitioners will be able to select and perform procedures optimally, and, accordingly, minimize radiation exposure to patients and to personnel," Januzzi says.

The writing committee, chaired by John W Hirshfeld Jr, MD, from University of Pennsylvania in Philadelphia, says the document serves as an "accessible resource" that compiles what is currently known about radiation biology and safety as they relate to CV imaging. It covers both patient and medical personnel safety issues for the three CV procedure classes that use ionizing radiation: x-ray fluoroscopy, x-ray computed tomography, and radionuclide scintigraphy.

The document includes discussions about radiation dosimetry and its determinants, radiation harm, the basics of equipment operation, strategies to minimize dose, and issues of radiation monitoring and tracking.

"The document's goal is to enable cardiovascular practitioners to select the optimal imaging technique for a given clinical circumstance while balancing a technique's risk and benefits, and to apply that technique optimally to generate high-quality diagnostic images that deliver the greatest clinical value with minimal radiation exposure," the committee writes.

The document recommends that patients participate with their physician in the decision to have procedures that require ionizing radiation and notes that it's the physician's responsibility to explain the radiation component along with other aspects of a procedure.

It also emphasizes the need for quality assurance, which requires verifying equipment performance and calibration and monitoring metrics for patients and personnel exposure, as well as proper training to ensure that all clinical personnel have a good understanding of radiation physics, biology, and protection. 

Training should create a "culture of respect for radiation hazard and a commitment to minimize exposure and maximize protection," the committee says. 

This research had no commercial funding. A list of disclosures for the writing committee is included with the original article.

J Am Coll Cardiol. Published May 2, 2018. Abstract

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