Radiation Exposure in Cardiovascular Medicine

Abstract

How important is the issue of radiation exposure in cardiovascular medicine? What constitutes best medical practice with respect to patient medical exposure and personnel occupational exposure? Article see p 226 During the past 2 decades, we have enjoyed a remarkable development and refinement of diagnostic and therapeutic cardiovascular procedures. Concomitantly, there has been substantial growth in the number of procedures performed. Of these widely used modalities, x-ray fluoroscopically guided invasive cardiovascular procedures, x-ray CT, and nuclear medicine studies all involve exposure to ionizing radiation. In addition to exposing patients, invasive cardiovascular procedures expose physician-operators and laboratory personnel. The initial infatuation with the capabilities of these diagnostic and therapeutic modalities has been tempered by a growing awareness of their potential, inapparent hazards both to patients and to medical personnel. It is important that we devote attention to assessing the hazard more accurately and to minimizing everyone's exposure. Patients and medical personnel present different radiation exposure issues. For both groups, the principal hazard is the stochastic risk of radiation-induced neoplasm. Patients generally undergo a modest number of comparatively large exposures, whereas medical personnel incur a long-term, continual low-level occupational exposure. Practitioner occupational exposure for invasive cardiovascular procedures is becoming a more prominent concern because these procedures increasingly are concentrated in a group of highly active practitioners whose careers span ≥30 years.1,2 Thus, these physicians may receive a substantial lifetime occupational exposure. The large prevalence of spontaneously occurring neoplastic disease confounds attempts to draw a cause-and-effect connection between a particular neoplasm and the associated occupational or medical radiation exposures. Thus, exposure-neoplasm relationships can be detected only through population-based studies. There are many challenges to estimating the attributable risk of a radiation exposure. Existing models are likely more accurate when applied to intermittent large medical exposures than to long-term low-level occupational …