Reducing Radiation Exposure from Cardiovascular Imaging Through Implementation of Appropriate Use Criteria

Abstract

Cardiac imaging is a key instrument in the evaluation of patients with known or suspected coronary artery disease. Although clear benefits accompany the use of nuclear cardiology and cardiac CT techniques, is well-documented in the medical literature, there is growing concern about the risk related to exposure to ionizing radiation. Although the true impact of low-level ionizing radiation is often poorly characterized, clinicians and medical organizations encourage minimization of exposure, with a focus on a balance between benefits and risks of cardiac imaging procedures. The appropriate use criteria (AUC), developed by the American College of Cardiology Foundation, American Heart Association, and multiple other societies, provide guidance regarding test utilization and assist in optimizing an approach involving the right test for the right patient at the right time. By reducing inappropriate use of cardiac CT and radionuclide imaging, exposure to unnecessary ionizing radiation may be minimized. Evaluation of appropriateness allows for practitioners to monitor their performance and serves to provide focus for educational efforts related to inappropriate test indications. Several key areas, including test layering and the use of serial imaging in asymptomatic patients likely contribute to inappropriate use and increased radiation exposure. Therefore, the use of AUC, in conjunction with other radiation dose reduction efforts, promotes significant improvement in patient safety.